FILED SENATE
May 2, 2024
GENERAL ASSEMBLY OF NORTH CAROLINA
S.B. 875
SESSION 2023 PRINCIPAL CLERK
S D
SENATE BILL DRS15440-MGa-153
Short Title: Total Maternal Care Act. (Public)
Sponsors: Senators Smith and Batch (Primary Sponsors).
Referred to:
1 A BILL TO BE ENTITLED
2 AN ACT ENACTING THE NORTH CAROLINA MOMNIBUS ACT OF 2024.
3 Whereas, every person should be entitled to dignity and respect during and after
4 pregnancy and childbirth, and patients should receive the best care possible regardless of age,
5 race, ethnicity, color, religion, ancestry, disability, medical condition, genetic information,
6 marital status, sex, gender identity, gender expression, sexual orientation, socioeconomic status,
7 citizenship, nationality, immigration status, primary language, or language proficiency; and
8 Whereas, the United States has the highest maternal mortality rate in the developed
9 world, where about 700 women die each year from childbirth and another 50,000 suffer from
10 severe complications; and
11 Whereas, according to the North Carolina Maternal Mortality Review and Prevention
12 Committee, sixty-three percent (63%) of all maternal deaths in 2014-2015 were determined to
13 be preventable; and black women are at increased risk to die from pregnancy complications
14 compared to white women; and
15 Whereas, the federal Centers for Disease Control and Prevention finds that the
16 majority of pregnancy-related deaths are preventable; and
17 Whereas, pregnancy-related deaths among black birthing people are also more likely
18 to be miscoded; and
19 Whereas, access to prenatal care, socioeconomic status, and general physical health
20 do not fully explain the disparity seen in maternal mortality and morbidity rates among black
21 individuals, and there is a growing body of evidence that black people are often treated unfairly
22 and unequally in the health care system; and
23 Whereas, implicit bias is a key driver of health disparities in communities of color;
24 and
25 Whereas, health care providers in North Carolina are not required to undergo any
26 implicit bias testing or training; and
27 Whereas, currently there does not exist any system to track the number of incidents
28 where implicit prejudice and implicit stereotypes led to negative birth and maternal health
29 outcomes; and
30 Whereas, it is in the interest of this State to reduce the effects of implicit bias in
31 pregnancy, childbirth, and postnatal care so that all people are treated with dignity and respect
32 by their health care providers; Now, therefore,
33 The General Assembly of North Carolina enacts:
34
35 PART I. SUPPORTING COMMUNITY-BASED ORGANIZATIONS
36
*DRS15440-MGa-153*
 General Assembly Of North Carolina Session 2023
1 ESTABLISHMENT OF MATERNAL MORTALITY PREVENTION GRANT
2 PROGRAM
3 SECTION 1.1.(a) Definitions. – The following definitions apply in this section:
4 (1) Culturally respectful congruent. – Sensitive to and respectful of the preferred
5 cultural values, beliefs, world view, and practices of the patient, and aware
6 that cultural differences between patients and health care providers or other
7 service providers must be proactively addressed to ensure that patients receive
8 equitable, high-quality services that meet their needs.
9 (2) Department. – The North Carolina Department of Health and Human
10 Services.
11 (3) Postpartum. – The one-year period beginning on the last day of a woman's
12 pregnancy.
13 SECTION 1.1.(b) Establishment of Grant Program. – The Department shall
14 establish and administer a Maternal Mortality Prevention Grant Program to award grants to
15 eligible entities to establish or expand programs for the prevention of maternal mortality and
16 severe maternal morbidity among black women. The Department shall establish eligibility
17 requirements for program participation which shall, at a minimum, require that applicants be
18 community-based organizations offering programs and resources aligned with evidence-based
19 practices for improving maternal health outcomes for black women.
20 SECTION 1.1.(c) Outreach and Application Assistance. – Beginning July 1, 2024,
21 the Department shall (i) conduct outreach to encourage eligible applicants to apply for grants
22 under this program and (ii) provide application assistance to eligible applicants on best practices
23 for applying for grants under this program. In conducting the outreach required by this section,
24 the Department shall give special consideration to eligible applicants that meet the following
25 criteria:
26 (1) Are based in, and provide support for, communities with high rates of adverse
27 maternal health outcomes and significant racial and ethnic disparities in
28 maternal health outcomes.
29 (2) Are led by black women.
30 (3) Offer programs and resources that are aligned with evidence-based practices
31 for improving maternal health outcomes for black women.
32 SECTION 1.1.(d) Grant Awards. – In awarding grants under this section, to the
33 extent possible, the grant recipients shall reflect different areas of the State. The Department shall
34 not award a single grant for less than ten thousand dollars ($10,000) or more than fifty thousand
35 dollars ($50,000) per grant recipient. In selecting grant recipients, the Department shall give
36 special consideration to eligible applicants that meet all of the following criteria:
37 (1) Meet all of the criteria specified in subdivisions (1) through (3) of subsection
38 (c) of this section.
39 (2) Offer programs and resources designed in consultation with and intended for
40 black women.
41 (3) Offer programs and resources in the communities in which they are located
42 that include any of the following activities:
43 a. Promoting maternal mental health and maternal substance use disorder
44 treatments that are aligned with evidence-based practices for
45 improving maternal mental health outcomes for black women.
46 b. Addressing social determinants of health for women in the prenatal
47 and postpartum periods, including, but not limited to, any of the
48 following:
49 1. Inadequate housing.
50 2. Transportation barriers.
51 3. Poor nutrition and a lack of access to healthy foods.
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 General Assembly Of North Carolina Session 2023
1 4. Need for lactation support.
2 5. Need for lead abatement and other efforts to improve air and
3 water quality.
4 6. Lack of access to child care.
5 7. Need for baby supplies such as diapers, formula, clothing, baby
6 and child equipment, and safe car seat installation.
7 8. Need for wellness and stress management programs.
8 9. Education about maternal health and well-being.
9 10. Need for coordination across safety net and social support
10 services and programs.
11 11. Barriers to employment.
12 c. Promoting evidence-based health literacy and pregnancy, childbirth,
13 and parenting education for women in the prenatal and postpartum
14 periods, including group-based programs and peer support groups.
15 d. Providing individually tailored support from doulas and other perinatal
16 health workers to women from pregnancy through the postpartum
17 period.
18 e. Providing culturally respectful congruent training to perinatal health
19 workers such as doulas, community health workers, peer supporters,
20 certified lactation consultants, nutritionists and dietitians, social
21 workers, home visitors, and navigators.
22 f. Conducting or supporting research on issues affecting black maternal
23 health.
24 g. Developing other programs and resources that address
25 community-specific needs for women in the prenatal and postpartum
26 periods and are aligned with evidence-based practices for improving
27 maternal health outcomes for black women.
28 SECTION 1.1.(e) Technical Assistance to Grant Recipients. – The Department shall
29 provide technical assistance to grant recipients regarding all of the following:
30 (1) Capacity building to establish or expand programs to prevent adverse maternal
31 health outcomes among black women.
32 (2) Best practices in data collection, measurement, evaluation, and reporting.
33 (3) Planning centered around sustaining programs implemented with grant funds
34 to prevent maternal mortality and severe maternal morbidity among black
35 women when the grant funds have been expended.
36 SECTION 1.1.(f) Reports. – By October 1, 2026, the Department shall submit a
37 report on the grant program authorized by this section to the Joint Legislative Oversight
38 Committee on Health and Human Services and the Fiscal Research Division. The report shall
39 include at least all of the following components:
40 (1) A detailed report on funds expended for the program for the 2024-2025 fiscal
41 year.
42 (2) An assessment of the effectiveness of outreach efforts by the Department
43 during the application process in diversifying the pool of grant recipients.
44 (3) Recommendations for future outreach efforts to diversify the pool of grant
45 recipients for this program and other related grant programs, as well as for
46 funding opportunities related to the social determinants of maternal health.
47 SECTION 1.1.(g) The Maternal Mortality Prevention Grant Program authorized by
48 this section expires on June 30, 2026.
49
50 APPROPRIATIONS TO IMPLEMENT PART I
DRS15440-MGa-153 Page 3
 General Assembly Of North Carolina Session 2023
1 SECTION 1.2.(a) The following sums are appropriated from the General Fund to
2 the Department of Health and Human Services, Division of Public Health, for the 2024-2025
3 fiscal year:
4 (1) Ninety-three thousand five hundred thirteen dollars ($93,513) in nonrecurring
5 funds to establish a time limited, full-time Public Health Program Coordinator
6 IV position within the Department of Health and Human Services dedicated
7 to performing the following duties:
8 a. Providing application assistance to Maternal Mortality Prevention
9 Grant Program applicants.
10 b. Providing technical assistance to Maternal Mortality Prevention Grant
11 Program recipients.
12 c. Preparing the reports due under Section 1.1(f) of this Part.
13 (2) Four hundred ninety-five thousand five hundred dollars ($495,500) in
14 nonrecurring funds to be allocated to the Maternal Mortality Prevention Grant
15 Program authorized by Section 1.1 of this Part. The Department of Health and
16 Human Services may use up to ten percent (10%) of these funds for
17 administrative purposes related to the grant program. The balance of these
18 funds shall be used to operate the grant program.
19 SECTION 1.2.(b) The Department of Health and Human Services is authorized to
20 hire one full-time, time-limited Public Health Program Coordinator IV position to perform the
21 duties described in subdivision (a)(1) of this section.
22 SECTION 1.2.(c) This section becomes effective July 1, 2024.
23
24 PART II. IMPLICIT BIAS IN HEALTH CARE
25 SECTION 2.1.(a) Part 5 of Article 1B of Chapter 130A of the General Statutes, as
26 amended by Section 1.1 of this act, is amended by adding new sections to read:
27 "§ 130A-33.62. Department to establish implicit bias training program for health care
28 professionals engaged in perinatal care.
29 (a) The following definitions apply in this section:
30 (1) Health care professional. – A licensed physician or other health care provider
31 licensed, registered, accredited, or certified to perform perinatal care and
32 regulated under the authority of a health care professional licensing authority.
33 (2) Health care professional licensing authority. – The Department of Health and
34 Human Services or an agency, board, council, or committee with the authority
35 to impose training or education requirements or licensure fees as a condition
36 of practicing in this State as a health care professional.
37 (3) Implicit bias. – A bias in judgment or behavior that results from subtle
38 cognitive processes, including implicit prejudice and implicit stereotypes, that
39 often operate at a level below conscious awareness and without intentional
40 control.
41 (4) Implicit prejudice. – Prejudicial negative feelings or beliefs about a group that
42 a person holds without being aware of them.
43 (5) Implicit stereotypes. – The unconscious attributions of particular qualities to
44 a member of a certain social group that are influenced by experience and based
45 on learned associations between various qualities and social categories,
46 including race and gender.
47 (6) Perinatal care. – The provision of care during pregnancy, labor, delivery, and
48 postpartum and neonatal periods.
49 (7) Perinatal facility. – A hospital, clinic, or birthing center that provides perinatal
50 care in this State.
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1 (b) The Department, in collaboration with (i) community-based organizations led by
2 black women that serve primarily black birthing people and (ii) a historically black college or
3 university or other institution that primarily serves minority populations, shall create or identify
4 an evidence-based implicit bias training program for health care professionals involved in
5 perinatal care. The implicit bias training program shall include, at a minimum, all of the following
6 components:
7 (1) Identification of previous or current unconscious biases and misinformation.
8 (2) Identification of personal, interpersonal, institutional, structural, and cultural
9 barriers to inclusion.
10 (3) Corrective measures to decrease implicit bias at the interpersonal and
11 institutional levels, including ongoing policies and practices for that purpose.
12 (4) Information about the effects of implicit bias, including, but not limited to,
13 ongoing personal effects of racism and the historical and contemporary
14 exclusion and oppression of minority communities.
15 (5) Information about cultural identity across racial or ethnic groups.
16 (6) Information about how to communicate more effectively across identities,
17 including racial, ethnic, religious, and gender identities.
18 (7) Information about power dynamics and organizational decision making.
19 (8) Trauma-informed care best practices and an emphasis on shared decision
20 making between providers and patients.
21 (9) Information