Skip to main content
Log in

Making U.S. Maternal and Child Health Policy: From “Early Discharge” to “Drive Through Deliveries” to a National Law

  • Published:
Maternal and Child Health Journal Aims and scope Submit manuscript

Abstract

Objectives: To examine the national policymaking process in maternal and child health through a case study of the passage of a national law aimed at extending postpartum hospital stays. Methods: The study is based on a review of official and unofficial documents associated with the bill's legislative progress as well as an examination of scholarly research on early discharge and media coverage of the issue. Interviews were also conducted with legislative and interest group staff. Results: The passage of early discharge legislation occurred in an unusually short time frame and was aided by its minimal public costs, the willingness of its supporters to compromise on key elements, and its perceived appeal to female voters in an election year. Clinical and public health research had little influence on the process. Conclusions: Maternal and child health advocates, while facing a problem with a politically weak constituency base, can benefit from their important symbolic role in policymakers' minds. They must respect the importance of compromise to legislative institutions and be alert to opportunities to frame their issues in a politically popular way.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

REFERENCES

  1. Clinton W. Radio address by the President to the nation. Washington, DC: Office of White House Press Secretary, May 12, 1996.

    Google Scholar 

  2. Braveman P, Egerter S, Pearl M, Marchi K, Miller C. Early discharge of newborns and mothers: a critical review of the literature. Pediatrics, 1995;96:716–726.

    Google Scholar 

  3. United States Senate Committee on Labor and Human Resources, 104th Congress, First session. Hearings on S.969 to require that health plans provide for a minimum hospital stay for a mother and child following the birth of the child. Washington, DC: Government Printing Office, September 12, 1995.

  4. “Newborns' and Mothers' Health Protection Act of 1966,” (July 19, 1996). Senate of the United States, 104th Congress, 2nd session, amendment to H.R. 3666, p. 2.

  5. Letter from Richard Froh, Vice-President, Kaiser Foundation Health Plan to Senator Bill Bradley (September 4, 1996).

  6. Curtin S, Kozak L. Decline in U.S. Cesarean delivery rate appears to stall. Birth, 1998;25:259–62.

    Google Scholar 

  7. Declercq E, Simmes D. The politics of “drive through deliveries”: Putting early postpartum discharge on the legislative agenda. Milbank Quarterly, 1997;75:175–202.

    Google Scholar 

  8. Braveman P, Kessel W, Egerter S, Richmond J. Early discharge and evidence-based practice. JAMA, 1997;278:334–336.

    Google Scholar 

  9. Raube K, Merrell K. Maternal minimum-stay legislation: cost and policy implications. American Journal of Public Health, 1999;89:922–23.

    Google Scholar 

  10. Britton J. Postpartum early hospital discharge and follow-up practices in Canada and the United States. Birth, 1998;25:161–168.

    Google Scholar 

  11. Liu LL, Clemens CJ, Shay DK, Davis RL, Novack AH. The safety of newborn early discharge: the Washington state experience. JAMA, 1997;278:293–298.

    Google Scholar 

  12. Edmonson M, Stoddard J, Owens L. Hospital readmission with feeding-related problems after early postpartum discharge of normal newborns. JAMA, 1997;278:299–303.

    Google Scholar 

  13. Kun KE, Muir E. Drive-by deliveries: Influences on state legislators. Public Health Reports, 1997;112:276–283.

    Google Scholar 

  14. Chalmers I, Enkin M, Keirse M. Effective care in pregnancy and childbirth, Vol. I, II. New York: Oxford University Press, 1989.

    Google Scholar 

  15. Congressional Record—Daily Digest (November 12, 1998).

  16. Ornstein N, Mann T, Malbin M. Vital statistics on Congress, 1997–1998 (pp. 160–167). Washington: CQ Press, 1998.

    Google Scholar 

  17. Dye T. (1998). Understanding public policy (9th ed.). Englewood Cliffs, NJ: Prentice Hall.

    Google Scholar 

  18. Shadish W, Cook T, Leviton L. Foundations of program evaluation: Theories of practice. Newbury Park, CA, Sage Publications, 1991.

    Google Scholar 

  19. Gazmararian J, Koplan J. Length-of-stay after delivery: Managed care versus fee for service. Health Affairs, 1996;15:74–80.

    Google Scholar 

  20. U.S. Department of Health and Human Services (1996). Maternal and Child Health Bureau. Maternal and Infant Health: From Insurance to Assurance. Presented at the annual meeting of the Association of Maternal and Child Health Programs, Washington, DC, (March 11, 1996.)

  21. Kingdon J. Agendas, alternatives and public policies (2nd ed.). New York: Harper-Collins, 1995.

    Google Scholar 

  22. Rochefort D, Cobb R (Eds.). The politics of problem definition: Shaping the policy agenda. Lawrence: University of Kansas Press.

  23. Interview with Senator Bradley Legislative Aide Margy Heldring, October 1996.

  24. Weissert C, Weissert W. Governing health: The politics of health policy. Baltimore: Johns Hopkins University Press, 1996.

    Google Scholar 

  25. 104th Congress, 1st Session. S.969. Newborns' and Mothers' Health Protection Act of 1996. Mr. Bradley, New Jersey, and co-sponsors. June 27, 1995.

  26. 104th Congress, 1st Session. H. R. 1936. To Provide for certain minimum requirements under the Federal Employees Health Benefits Program with respect to obstetrical benefits. Mr. Miller, California and co-sponsors. June 27, 1995.

  27. 104th Congress, 1st Session. H. R. 1955. To amend the Employee Retirement Income Security Act of 1974 to provide for certain minimum requirements for group health plans with respect to obstetrical benefits. Mr. DeFazio and Mr. Miller, California and co-sponsors. June 27, 1995.

  28. Interview, Charlotte Fraas, legislative aide to Congressman George Miller, November 1996.

  29. Peterson M. How health policy information is used in Congress. In Mann T, Ornstein N (Eds.), Intensive care: How Congress shapes health policy (pp. 79–125). Washington, DC: American Enterprise Institute, 1995.

    Google Scholar 

  30. American College of Obstetricians and Gynecologists. Press release, May 23, 1995.

  31. Eidelman AI. Early discharge—early trouble. Journal of Perinatology, 1992;12:101–102.

    Google Scholar 

  32. Nightline (1995). Transcript, June 28. New York: ABC News.

  33. Davidson RH, Oleszek WJ. Congress and its members. (4th ed.) (p. 227). Washington: CQ Press, 1994.

    Google Scholar 

  34. 104th Congress, 1st Session, S.969 in the Senate of the United States, “Newborns and Mothers' Health Protection Act of 1996.” June 27, 1995, p. 2 lines 13, 14.

  35. U.S. Senate Committee on Labor and Human Resources (1996). 104th Congress. Second Session. S969 [Report No. 104–326] July 19, 1996. Bill reported with amendment.

  36. U.S. General Accounting Office. Maternity care: Appropriate follow-up services critical with short hospital stays. GAO/HEHS-96-207 (1996).

  37. U.S. Senate. Debate on Department of Veteran Affairs and Housing and Urban Development, and Independent Agencies Appropriations Act, 1997 (p. S9910). September 5, 1996.

  38. Center for Patient Advocacy (1996) Press Release, July 23.

  39. Sinclair B. Party leaders and the new legislative process. In Dodd L, Oppenheimer B. (Eds.), Congress Reconsidered (6th ed.) (pp. 229–245). Washington: CQ Press (1997).

    Google Scholar 

  40. Interview with Sarah Boyd, legislative aide to Congressman Gerald Solomon, December, 1996.

  41. Smith S, Lawrence E. Party control of committees in the Republican Congress. In Dodd L, Oppenheimer B (Eds.), Congress reconsidered (6th ed.) (p. 163). Washington: CQ Press, 1997.

    Google Scholar 

  42. “Newborns' and Mothers' Health Protection Act of 1966,” Senate of the United States, 104th Congress, 2nd session, amendment to H.R. 3666. July 19, 1996, p. 4, lines 12, 13.

  43. 104th Congress, 2nd Session HR3666, Making Appropriations for the Departments of Veterans Affairs and Housing and Urban Development... for fiscal year ending September 30, 1997. Amendment, “Newborns and Mothers' Health Protection Act of 1996.” September 24, 1996 in the Senate of the US, p. 4, lines 14–16.

  44. Egerter S, Braveman P, Kunwar P. For the Secretary's Advisory Committee on Infant Mortality. 1998. Draft Preliminary Report to Congress Mandated by the Newborns' and Mothers' Health Protection Act of 1996. March 5, 1998.

  45. Coalition for Improving Maternity Services. Ten Steps of the Mother-Friendly Childbirth Initative. Washington, DC: ASPO/Lamaze, 1996.

    Google Scholar 

  46. Declercq E. Changing childbirth in England: Lessons for U.S. Health Reform. Journal of Health Politics, Policy and Law, 1998;23(5):833–859.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Declercq, E. Making U.S. Maternal and Child Health Policy: From “Early Discharge” to “Drive Through Deliveries” to a National Law. Matern Child Health J 3, 5–17 (1999). https://doi.org/10.1023/A:1021806028262

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1021806028262

Navigation