Establishes the New York dignity in pregnancy and childbirth act; requires hospitals and other facilities that provide perinatal care to implement an evidence-based implicit bias program for all health care providers involved in the perinatal care of patients within those facilities; requires the department of health to publish reports on maternal morbidity and pregnancy related deaths.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A4018A
SPONSOR: Forrest TITLE OF BILL:
An act to amend the public health law, in relation to requiring hospi-
tals and other facilities that provide perinatal care to implement an
evidence-based implicit bias program and requiring the department of
health to publish reports on maternal morbidity and pregnancy related
deaths
PURPOSE OR GENERAL IDEA OF BILL:
To require healthcare facilities that provide perinatal care to imple-
ment evidence-based implicit bias programs to reduce the instances of
maternal mortality for Black mothers and their babies and require the
department to track data on severe maternal morbidity.
SUMMARY OF SPECIFIC PROVISIONS:
Section 1 establishes that this act shall be known as and may be cited
as the "New York Dignity in Pregnancy and Childbirth Act".
Section 2 adds a new section 2803-nn to the public health law requiring
hospitals to require that all clinical staff providing perinatal care
must complete on an annual basis an evidence-based implicit bias train-
ing program approved by the department.
Section 3 adds new subdivisions 9, 10, 11 and 12 to section 2509 of the
public health law to require that the department track data on severe
maternal morbidity, and aggregate such by region, racial and ethnic
identity, as well as publish such data.
Section 4 sets the effective date.
JUSTIFICATION:
Every person is entitled to dignity and respect during and after preg-
nancy and childbirth. Patients should receive the best care possible
regardless of their race, gender, age, class, sexual orientation, gender
identity, disability, language proficiency, nationality, immigration
status, gender expression, or religion. For women of color, particularly
Black women, the maternal mortality rate remains three to four times
higher than the rate for Caucasian women. In New York, the mortality
rate for Black women per one hundred thousand births is 51.6, whereas
for Caucasian women it is 15.9. New York has a responsibility to
decrease the number of preventable pregnancy and childbirth - related
deaths. Studies have repeatedly highlighted the existence of these
disparities, with Black women and their babies, in particular, facing
significantly higher risks of complications and mortality. Despite
controlling for socioeconomic status, access to care, and overall
health, these disparities persist, indicating that systemic issues such
as implicit bias play a role in shaping these outcomes.
Implicit racial bias training is crucial for pregnancy and childbirth
workers due to its potential to significantly decrease racial and ethnic
disparities in maternal and infant health outcomes. Implicit biases are
unconscious attitudes or stereotypes that affect our understanding,
actions, and decisions. In the context of healthcare, these biases can
influence the quality of care that a provider delivers. For example, a
provider might unintentionally under-assess a patient's pain or dismiss
their concerns based on their racial or ethnic identity. This could lead
to delayed diagnoses, inappropriate treatment plans, and overall lower
quality of care. For pregnant women, these biases can translate into
higher rates of severe maternal morbidity and mortality.
By requiring hospitals and other facilities that provide perinatal care
to implement evidence-based implicit bias training programs, healthcare
providers can become aware of their unconscious biases and learn strate-
gies to mitigate their impact. This can foster more open communication
with patients, leading to improved patient satisfaction and trust. In
the long term, addressing these biases can contribute to health equity,
ensuring that every woman - regardless of her racial or ethnic back-
ground - receives high quality, respectful care during pregnancy and
childbirth. In turn, this can help reduce the stark disparities in
maternal and infant health outcomes currently seen.
PRIOR LEGISLATIVE HISTORY:
2023-2024: A.8833/S.8375 - referred to health
FISCAL IMPLICATIONS:
TBD
EFFECTIVE DATE:
Immediately
STATE OF NEW YORK
________________________________________________________________________
4018--A
2025-2026 Regular Sessions
IN ASSEMBLY
January 30, 2025
___________
Introduced by M. of A. FORREST, LEVENBERG, LUNSFORD, GIBBS, SHRESTHA,
GONZALEZ-ROJAS, BICHOTTE HERMELYN, GALLAGHER, MEEKS, SIMONE, RAGA,
TAPIA, CRUZ, OTIS -- read once and referred to the Committee on Health
-- recommitted to the Committee on Health in accordance with Assembly
Rule 3, sec. 2 -- committee discharged, bill amended, ordered
reprinted as amended and recommitted to said committee
AN ACT to amend the public health law, in relation to requiring hospi-
tals and other facilities that provide perinatal care to implement an
evidence-based implicit bias program and requiring the department of
health to publish reports on maternal morbidity and pregnancy related
deaths
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. This act shall be known and may be cited as the "New York
2 Dignity in Pregnancy and Childbirth Act".
3 § 2. The public health law is amended by adding a new section 2803-nn
4 to read as follows:
5 § 2803-nn. Implicit bias training in regard to perinatal care. 1. For
6 the purpose of this section, the following definitions shall apply:
7 (a) "implicit bias" shall mean a bias in judgment or behavior that
8 results from subtle cognitive processes, including implicit prejudice
9 and implicit stereotypes that often operate at a level below conscious
10 awareness and without intentional control.
11 (b) "perinatal care" shall mean the provision of care during preg-
12 nancy, labor, delivery, and postpartum and neonatal periods.
13 2. Every hospital shall require clinical staff that provides perinatal
14 care to certify, on an annual basis, completion of an evidence-based
15 implicit bias training curriculum approved by the department, including
16 training on the following:
17 (a) identification of previous or current unconscious biases and
18 misinformation;
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD07167-02-6
A. 4018--A 2
1 (b) identification of personal, interpersonal, institutional, struc-
2 tural, and cultural barriers to inclusion;
3 (c) corrective measures to decrease implicit bias at interpersonal and
4 institutional levels, including ongoing policies and practices for that
5 purpose;
6 (d) information on the effects, including, but not limited to, ongoing
7 personal effects, of historical and contemporary exclusion and
8 oppression of minority communities;
9 (e) information about cultural identity across racial or ethnic
10 groups;
11 (f) information about communicating more effectively across identi-
12 ties, including racial, ethnic, religious, and gender identities;
13 (g) discussion on power dynamics and organizational decision making;
14 (h) discussion on health inequities within the perinatal care field,
15 including information on how implicit bias impacts maternal and infant
16 health outcomes;
17 (i) perspectives of diverse, local constituency groups and experts on
18 particular racial, identity, cultural, and provider-community relations
19 issues in the community; and
20 (j) information on reproductive justice.
21 § 3. Section 2509 of the public health law is amended by adding four
22 new subdivisions 9, 10, 11, and 12 to read as follows:
23 9. The department shall track data on severe maternal morbidity,
24 including, but not limited to, all of the following health conditions:
25 (a) obstetric hemorrhage;
26 (b) hypertension;
27 (c) preeclampsia and eclampsia;
28 (d) venous thromboembolism;
29 (e) sepsis;
30 (f) cerebrovascular accident; and
31 (g) amniotic fluid embolism.
32 10. The data on severe maternal morbidity collected pursuant to subdi-
33 vision nine of this section shall be published at least once every two
34 years after both of the following have occurred:
35 (a) the data has been aggregated by state regions, as defined by the
36 department, to ensure data reflects how regionalized care systems are or
37 should be collaborating to improve maternal health outcomes, or other
38 smaller regional sorting based on standard statistical methods for accu-
39 rate dissemination of public health data without risking a confidential-
40 ity or other disclosure breach; and
41 (b) the data has been disaggregated by racial and ethnic identity.
42 11. The department shall track data on pregnancy-related deaths,
43 including, but not limited to, all of the conditions listed in subdivi-
44 sion nine of this section, indirect obstetric deaths, and other maternal
45 disorders predominantly related to pregnancy and complications predomi-
46 nantly related to the puerperium.
47 12. The data on pregnancy-related deaths collected pursuant to subdi-
48 visions nine and eleven of this section shall be published at least once
49 every three years after both of the following have occurred:
50 (a) the data has been aggregated by state regions, as defined by the
51 department, to ensure data reflects how regionalized care systems are or
52 should be collaborating to improve maternal health outcomes, or other
53 smaller regional sorting based on standard statistical methods for accu-
54 rate dissemination of public health data without risking a confidential-
55 ity or other disclosure breach; and
56 (b) the data has been disaggregated by racial and ethnic identity.
A. 4018--A 3
1 § 4. This act shall take effect on the one hundred eightieth day after
2 it shall have become a law. Effective immediately, the addition, amend-
3 ment and/or repeal of any rule or regulation necessary for the implemen-
4 tation of this act on its effective date are authorized to be made and
5 completed on or before such effective date.
