This piece was copublished with The 19th, a nonprofit newsroom reporting on gender, politics policy and power.
The word “Black” has been almost completely removed from a package of bills that have long been viewed as Congress’ main legislative vehicle to address the Black maternal health crisis, frustrating some advocates who feel Black women are being erased from the policy.
The key change this year is the title. The Momnibus Act — filed in mid-March — was called the Black Maternal Health Momnibus Act in 2023; before that it was the Black Maternal Health Momnibus Act of 2021 and the Black Maternal Health Momnibus Act of 2020. None of the previous packages, which were championed by Democrats, have been enacted.
But references to “Black” in the package’s legislative text have also evolved. The 2020 version has more than a dozen, primarily referencing Black women. In the 2021 version, many of those were replaced with nearly a dozen references to “Black pregnant and postpartum individuals.” All those descriptions were removed in the 2023 bill, with the word Black appearing only once across the entire package, referencing a historically Black college or university or other minority-serving institution. Those 2023 changes carried over to the latest version.
The legislation — which does not appear to have a path forward in the Republican-controlled Congress — has long been touted as a way to address the United States’ abysmal maternal health mortality rates, as well as the stark disparities for Black women. Maternal mortality rates in the United States surpass all other developed nations. In 2023, there were 18.6 maternal deaths for every 100,000 live births in the nation. The rate is far worse for Black women at 50.3; they are nearly three times more likely to die than white women from a pregnancy-related cause, irrespective of income or education.
But removing “Black” from the title of the bill comes as the Trump administration attacks initiatives aimed at diversity, equity and inclusion. Advocates worry that the title change is both a signal that racial disparities shouldn’t be at the forefront of discussion — and a warning sign that they won’t be addressed.
Democratic Rep. Lauren Underwood of Illinois, a lead sponsor of the Momnibus package, said the title change reflected how people describe the legislation, which this year covers everything from the perinatal workforce to research investments.
“When people are like, ‘What’s going on with the Momnibus? Has the Momnibus passed? I’m looking for information on the Momnibus,’ or whatever — this reflects that,” said the congresswoman, who emphasized that the bill continues to help Black women. She also highlighted that the Black Maternal Health Caucus that she helps oversee has secured hundreds of millions of dollars for maternal health policies that center Black women.
For some, the changes and the explanation behind it are more complicated. The 19th spoke with leaders of more than a half dozen groups that work to improve Black maternal health, many who have not spoken publicly about this.
“There is a painful irony in a bill that originated as the Black Maternal Health Momnibus Act, that was named to address the Black maternal health crisis, no longer naming the population it was created to serve,” Angela D. Aina, cofounder and executive director of the Black Mamas Matter Alliance (BMMA), said in a statement. The group is not publicly supporting the Momnibus package this year but has in past years.
Several advocates also said they’re frustrated but still support Underwood, a Black woman who often speaks about Black maternal health through a personal lens. When the bill was reintroduced, Aza Nedhari, president and CEO of Mamatoto Village, which supports Black maternal health policies, frankly detailed her thoughts on the changes in a LinkedIn post. Yet she understands that there are lots of forces at play.
“I do think that Congresswoman Underwood genuinely cares about this issue,” Nedhari told The 19th. “She’s been working on this for so long. I think we need to put the focus on where it needs to be: Why does she even have to make this choice in the first place?”
A spokesperson for Underwood said removing the word Black from most of the legislation in 2023 was due to technical edits related to the Kira Johnson Act, a bill in the Momnibus package named after a Black woman who died in 2016 in the hours after childbirth. The legislation encourages investments in community-based organizations that support mothers.
Though it has not been enacted, aspects of the bill have been implemented through congressional funding directed to the Office of Minority Health under the Department of Health and Human Services. These appropriations, first approved under the Biden administration, total more than $30 million to date. Underwood’s spokesperson said removing the word Black in 2023 aligned the legislative text with language used by the Office of Minority Health to avoid future regulatory hiccups under existing regulations.
The definitions in the bill
Some of the references to Black people were replaced with “demographic groups with elevated rates of maternal mortality, severe maternal morbidity, maternal health disparities, or other adverse perinatal or childbirth outcomes.” The latest bill also links to a formal definition for “racial and ethnic minority groups” that includes Black people.
“The definitions in the bill are designed to make sure that the money can get to the communities that need it,” Underwood told The 19th, who emphasized the substance of the bill has not changed and has been expanded to encourage more research funding.
The bill retains language aimed at addressing data collection of Hispanic people and has provisions acknowledging Indigenous populations.
“BMMA supports those provisions and the communities they serve, and we recognize the importance of that specificity. The asymmetry is what gave us pause,” Aina said.
Several organizers told The 19th they raised their concerns about the bill’s title and text changes privately to Underwood.
At least some advocates were aware of the 2023 changes at the time but supported the legislation because of the political and social climate under President Joe Biden and Vice President Kamala Harris, both vocal supporters of Black maternal health policies.
But since then, President Donald Trump has targeted the Office of Minority Health for elimination amid efforts aimed at dismantling diversity, equity and inclusion.
When asked if the bill’s title change is related to the political climate, Underwood responded: “The Momnibus does talk about the Black maternal health crisis. So it is not accurate to say that the Momnibus has removed references to Black and it doesn’t aim to address the Black maternal health crisis.”
Underwood’s explanation — which doesn’t appear to acknowledge the text changes — is unsettling for Nourbese Flint, president of All* Above All, a national organization that supports reproductive justice by expanding abortion access. Flint’s organization is weighing whether to support the legislation this year.
“It suggests that there’s something wrong with it being about Black women,” she said. “I think that is the piece that I am really concerned about, is that there’s nothing wrong with having a bill that is trying to close the gap for Black women dying.”
Underwood reiterated that the Momnibus legislation is the signature bill from the Black Maternal Health Caucus, which she has co-chaired since its launch in 2019. The Momnibus package also still has the support of hundreds of groups, companies and affiliations.
“Our number one singular priority is advancing the Momnibus, period,” she said. “That has not changed. That has always been the case.”
The National Partnership for Women & Families, which advocates for policies that improve maternal health and tracks state-level Momnibus efforts, is among the groups no longer supporting the legislation.
“The National Partnership for Women & Families firmly believes that the need to address the Black maternal health crisis is urgent and that the commitment to addressing this crisis effectively begins with clearly naming the problem,” Jocelyn Frye, president of the group, said in a statement. “At a time when this administration too often refuses to confront the prevalence of racial disparities — and in some cases denying they exist altogether — it is more important than ever to center those most affected.”
Jamila K. Taylor is president and CEO at the Institute for Women’s Policy Research, a national think tank that examines gender and racial inequities from an economic lens. The group has endorsed the Momnibus in the past but has not this year — but it is supporting some of the individual bills that make up the package.
“We are in the midst of a fraught social and political moment as a nation. People of color, and Black women in particular, are facing diminished political power, disproportionate job loss, and poorer health outcomes — including higher maternal death rates than their White peers,” Taylor said in a statement to The 19th. “It is more important than ever to center the needs of Black women in the policy solutions to address racial biases and injustices.”
Frye and Taylor said separately that they hope to keep working with Underwood and other members of Congress to make progress on Black maternal health issues.
Underwood declined to comment on the views of advocates or private concerns in a follow-up inquiry to her office.
A domino effect of the DEI backlash
Trump’s attacks on DEI have had a ripple effect across corporations, research grants and college campuses. Recent federal cuts to Medicaid, which accounts for 40 percent of all live births and 65 percent of births to Black mothers, are expected to worsen health outcomes for pregnant and postpartum people.
It’s part of why changes to the bill may be so concerning for some advocates, said Deva Woodly, a professor at Brown University who studies the impact of public discourse on social and economic issues. She said the changes — even if some predate Trump’s return to office — could lessen the efficacy of the bills if they’re passed.
“There is no race-neutral way to address Black maternal mortality. It has to be addressed honestly and unabashedly, and trying to address it in a way that does not name the subject is going to be inefficacious,” she said. “Because if you leave the language cloudy, then it can be misapprehended and deliberately misused by whomever is in power and enforcing the law.”
Woodly offered a hypothetical scenario in which a women’s health bill makes its way through Congress over several years but references to women are gradually taken out.
“The health bill that doesn’t name women cannot address women’s health,” she said. “The Black maternal health bill that does not name Black women cannot address Black maternal health.”
Elizabeth Dawes, director of maternal and reproductive health at The Century Foundation, a progressive think tank, called the shift in language “demoralizing” and “disheartening” — a reinforcement for her that Congress is not working enough to address the concerns of Black women like herself. She worries it sets a bad precedent for grassroots advocacy.
“When we’re thinking about the future of how we advocate for change, and what that means and what that looks like, it would reshape that for us to be vague about our ask, for us to be general,” said Dawes, another cofounder of BMMA who is no longer affiliated with the group and now helps lead the Black Maternal Health Federal Policy Collective. “I think we’ve seen enough of how general conversations go. I think they go nowhere.”
That tension was on display during a congressional hearing on April 17 when Rep. Summer Lee, a Democrat from Pennsylvania, questioned Health and Human Services Secretary Robert F. Kennedy Jr. about reports that the department told organizations applying for federal dollars to remove nearly 200 words, including Black, from funding applications.
“How are we going to solve the Black maternal mortality crisis if we cannot say ‘Black’?” she asked Kennedy.
Lee told The 19th in an interview after that exchange that she had not noticed the title change on the Momnibus bill, which she supports as a co-sponsor.
“I’m not shocked,” she said. “We’ve seen a lot of people shifting not their priorities but how they word it preemptively in a lot of instances, because they’re afraid that if they are forward with their mission, that their organization, that their program is geared toward addressing a particular issue that they think falls within diversity, equity or inclusion, that they will no longer be able to receive the funding.”
Lee’s office later declined to further comment on Underwood’s explanation for the title change.
The office of Democratic Rep. Alma Adams of North Carolina, one of the lead sponsors of the bill, did not respond to multiple requests for comment. Suzy Vazquez, a spokesperson for Democratic Sen. Cory Booker of New Jersey, the bill’s main sponsor in the Senate, said: “When Senator Booker speaks about this issue and this legislation it is in the context of the maternal health care crisis facing the Black community. His purpose and priority is ending disparities in maternal health and advancing policies that improve outcomes for Black moms and their families by standing up in Congress to ensure no mother is left behind.”
Nedhari had a response to that statement: “This issue is not whether or not people genuinely care. It’s about the level of courage that you are willing to have in this moment — to name that this is for who it’s for.”
Underwood, who has a background in nursing, speaks often about the intersection of disparate maternal health outcomes and Black women. She participates in multiple events focused on Black maternal health, most recently during Black Maternal Health Week in mid-April. She told The 19th that she is continuing to consolidate support for the package and is having conversations “with colleagues on both sides of the aisle about the priorities.”
“There’s always opportunities to advance one or more bills through the committee process, and we’ve been pursuing those opportunities aggressively,” she said. She declined to specify which bills.
Amid the federal stalemate, Black women have taken action on the state level to address racial maternal health disparities — including state-level Momnibus bills, Medicaid postpartum coverage extensions, doula reimbursement and the establishment of maternal mortality review committees with community representation.
Dawes added that many of the efforts to address racial maternal health disparities are led by Black women and they’re not waiting around for Congress to act.
“We’re going to fight for Black moms no matter what. We’re going to get them the care they need no matter what. So if Congress isn’t going to do it, let’s see what can happen in the states. If the states aren’t going to do it, let’s see what happens at the city and county level,” she said. “But I believe Congress has the responsibility to do something, and that something needs to be wholehearted. It needs to be comprehensive, it needs to be thorough, and it needs to be bold enough to name Black women, to name the people who it’s trying to support.”