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.
Similar content being viewed by others
REFERENCES
Clinton W. Radio address by the President to the nation. Washington, DC: Office of White House Press Secretary, May 12, 1996.
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.
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.
“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.
Letter from Richard Froh, Vice-President, Kaiser Foundation Health Plan to Senator Bill Bradley (September 4, 1996).
Curtin S, Kozak L. Decline in U.S. Cesarean delivery rate appears to stall. Birth, 1998;25:259–62.
Declercq E, Simmes D. The politics of “drive through deliveries”: Putting early postpartum discharge on the legislative agenda. Milbank Quarterly, 1997;75:175–202.
Braveman P, Kessel W, Egerter S, Richmond J. Early discharge and evidence-based practice. JAMA, 1997;278:334–336.
Raube K, Merrell K. Maternal minimum-stay legislation: cost and policy implications. American Journal of Public Health, 1999;89:922–23.
Britton J. Postpartum early hospital discharge and follow-up practices in Canada and the United States. Birth, 1998;25:161–168.
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.
Edmonson M, Stoddard J, Owens L. Hospital readmission with feeding-related problems after early postpartum discharge of normal newborns. JAMA, 1997;278:299–303.
Kun KE, Muir E. Drive-by deliveries: Influences on state legislators. Public Health Reports, 1997;112:276–283.
Chalmers I, Enkin M, Keirse M. Effective care in pregnancy and childbirth, Vol. I, II. New York: Oxford University Press, 1989.
Congressional Record—Daily Digest (November 12, 1998).
Ornstein N, Mann T, Malbin M. Vital statistics on Congress, 1997–1998 (pp. 160–167). Washington: CQ Press, 1998.
Dye T. (1998). Understanding public policy (9th ed.). Englewood Cliffs, NJ: Prentice Hall.
Shadish W, Cook T, Leviton L. Foundations of program evaluation: Theories of practice. Newbury Park, CA, Sage Publications, 1991.
Gazmararian J, Koplan J. Length-of-stay after delivery: Managed care versus fee for service. Health Affairs, 1996;15:74–80.
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.)
Kingdon J. Agendas, alternatives and public policies (2nd ed.). New York: Harper-Collins, 1995.
Rochefort D, Cobb R (Eds.). The politics of problem definition: Shaping the policy agenda. Lawrence: University of Kansas Press.
Interview with Senator Bradley Legislative Aide Margy Heldring, October 1996.
Weissert C, Weissert W. Governing health: The politics of health policy. Baltimore: Johns Hopkins University Press, 1996.
104th Congress, 1st Session. S.969. Newborns' and Mothers' Health Protection Act of 1996. Mr. Bradley, New Jersey, and co-sponsors. June 27, 1995.
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.
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.
Interview, Charlotte Fraas, legislative aide to Congressman George Miller, November 1996.
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.
American College of Obstetricians and Gynecologists. Press release, May 23, 1995.
Eidelman AI. Early discharge—early trouble. Journal of Perinatology, 1992;12:101–102.
Nightline (1995). Transcript, June 28. New York: ABC News.
Davidson RH, Oleszek WJ. Congress and its members. (4th ed.) (p. 227). Washington: CQ Press, 1994.
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.
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.
U.S. General Accounting Office. Maternity care: Appropriate follow-up services critical with short hospital stays. GAO/HEHS-96-207 (1996).
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.
Center for Patient Advocacy (1996) Press Release, July 23.
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).
Interview with Sarah Boyd, legislative aide to Congressman Gerald Solomon, December, 1996.
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.
“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.
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.
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.
Coalition for Improving Maternity Services. Ten Steps of the Mother-Friendly Childbirth Initative. Washington, DC: ASPO/Lamaze, 1996.
Declercq E. Changing childbirth in England: Lessons for U.S. Health Reform. Journal of Health Politics, Policy and Law, 1998;23(5):833–859.
Author information
Authors and Affiliations
Rights 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
Issue Date:
DOI: https://doi.org/10.1023/A:1021806028262