H.R. 6238: NIH IMPROVE Act
Sponsor
Lauren Underwood
Democrat · IL-14
Congress should write NIH's maternal health program into law
Why it matters
$317 million over five years, at $63.4 million a year, would go to research on why mothers in the U.S. die or nearly die around childbirth — and what prevents it. H.R. 6238 takes an NIH maternal health program that exists today at the agency's discretion and makes it a requirement in federal law, with its own funding line through 2030.
The bill is one section long, and its first verb is "continue." It directs the NIH director to keep running a maternal health program called the IMPROVE Initiative, short for Implementing a Maternal health and PRegnancy Outcomes Vision for Everyone.
H.R. 6238 would turn an optional NIH program into one the agency is required by law to run, with $63.4 million a year authorized from 2026 through 2030.
The program has three jobs. First, research aimed at reducing preventable maternal deaths and severe maternal morbidity — the life-threatening complications, like hemorrhage or organ failure, that stop short of death. Second, figuring out which biological, behavioral, and other factors drive those outcomes in specific regions of the country, rather than treating the U.S. as one average.
Third, closing gaps between groups. NIH would test and evaluate community-based interventions for women in populations whose rates of maternal death and severe complications run above the national rate, and study the risk factors and biology behind the leading causes.
The research agenda covers the full arc: before pregnancy, during it, and after delivery. NIH could carry it out through grants, contracts, cooperative agreements, or other agreements with outside partners.
Authorizing $63.4 million is not the same as spending it — appropriators would still decide each year how much NIH actually gets for this work.
Bill Progress
Latest Action · Jul 21, 2026
Passed the House, received in Senate
H.R. 6238 Bill Summary
What H.R. 6238 actually does.
The program can't quietly disappear
The NIH director would be required to continue running the IMPROVE Initiative. Today it exists at the agency's discretion; under the bill it becomes a standing duty in federal law.
Preventable deaths and near-deaths are the target
Research would focus on cutting preventable maternal deaths and severe maternal morbidity — serious complications such as heavy bleeding, infection, or organ damage that can follow pregnancy.
Care after delivery counts
The initiative covers health before, during, and after pregnancy, so postpartum complications fall inside its scope.
Regional answers, not national averages
NIH would build evidence on what drives maternal outcomes in specific parts of the U.S., looking at biological, behavioral, and other factors.
Programs tested in the communities most affected
NIH would carry out and evaluate community-based interventions for women in populations with higher-than-national rates of maternal death and severe complications, and study the biology behind the leading causes.
$63.4 million a year through 2030
The bill authorizes $63.4 million for each fiscal year from 2026 through 2030, about $317 million total, delivered through grants, contracts, cooperative agreements, or other agreements.
Who benefits from H.R. 6238?
People who are pregnant or recently gave birth
The research is aimed at the complications that send new mothers back to the hospital or worse, including problems that show up weeks after delivery.
Women in places with higher maternal death rates
The bill singles out populations whose rates of maternal death and severe complications exceed the national rate, and directs NIH to test interventions with them, not just study them.
Maternal health researchers
University and hospital teams would have a program that Congress has put in law, which gives multi-year studies more certainty than one that depends on agency priorities.
Clinics and community organizations
Local groups working with mothers could partner with NIH on the community-based interventions the bill directs it to run and evaluate.
Who is affected by H.R. 6238?
National Institutes of Health
NIH would lose the option to wind the program down on its own and would have to pursue the specific research objectives the bill lists.
Other NIH research priorities
If appropriators fund the full amount out of a flat NIH budget, that money could come at the expense of other research areas.
Doctors, nurses, and hospitals
Evidence from the initiative could shape clinical guidance on preventing and treating severe pregnancy complications, including postpartum care.
Congressional appropriators
They would decide each year whether IMPROVE gets the full $63.4 million, less, or nothing. The authorization sets a ceiling, not a payment.
Cost & Funding
Authorization
$63.4 million per year for fiscal years 2026 through 2030, about $317 million total
- This is an authorization of appropriations. No money moves until Congress includes it in an annual spending bill.
- $63.4 million a year works out to roughly $174,000 a day.
- Spread across the roughly 3.6 million U.S. births the CDC records each year, the full amount comes to about $18 per birth.
- NIH could distribute funds through grants, contracts, cooperative agreements, or other agreements.
What Congress Is Saying
H.R. 6238 has come up 7 times in the Congressional Record so far.
H.R. 6238 also appeared in 1 more House floor reference and 4 routine cosponsor filings.
HR6238 Legislative Journey
Committee Action
Jul 21, 2026
Received in the Senate and Read twice and referred to the Committee on Health, Education, Labor, and Pensions.
House: Vote Held
Jul 20, 2026
On motion to suspend the rules and pass the bill, as amended Agreed to by voice vote. (text: CR H4651)
House: Committee Action
Jul 9, 2026
Reported (Amended) by the Committee on Energy and Commerce. H. Rept. 119-734.
House: Vote: 46-0
May 21, 2026
Ordered to be Reported (Amended) by the Yeas and Nays: 46 - 0.
House: Committee Action
Nov 20, 2025
Referred to the House Committee on Energy and Commerce.
About the Sponsor
Lauren Underwood
Democrat, Illinois's 14th congressional district · 7 years in Congress
Committees: Appropriations
View full profile →
Cosponsors (4)
This bill has 4 cosponsors: 3 Democrats, 1 Republican, reflecting bipartisan support. Cosponsors represent 4 states: District of Columbia, Maryland, Pennsylvania, and 1 more.
Committee Sponsors
Health, Education, Labor, and Pensions Committee
0 of 23 committee members cosponsored
No committee members have cosponsored this bill
Energy and Commerce Committee
0 of 54 committee members cosponsored
No committee members have cosponsored this bill
34 Democrats across these committees haven't cosponsored yet. Mobilize their constituents
H.R. 6238 Quick Facts
- Committee
- Health, Education, Labor, and Pensions
- Chamber
- House
- Policy
- Health
- Introduced
- Nov 20, 2025
Passed the House, received in Senate
Jul 21, 2026
Official Sources
Official status page for H.R. 6238, with the bill text, House passage, and Senate referral.
NIH program page for the IMPROVE Initiative, the existing maternal health research program this bill would write into law.
CDC surveillance system that tracks pregnancy-related deaths nationwide, the outcome the IMPROVE Initiative aims to reduce.
CDC explainer on severe maternal morbidity, the life-threatening complications the bill names as a core research target.
Part B of title IV of the Public Health Service Act, where the bill adds the IMPROVE Initiative as new section 409K.
NIH grants portal; the bill lets NIH carry out the initiative through grants, contracts, and cooperative agreements.
The Senate committee that received H.R. 6238 after House passage and would need to act on it next.
H.R. 6238 Common Questions
What is the NIH IMPROVE Initiative?
It is an existing NIH maternal health research program. IMPROVE stands for Implementing a Maternal health and PRegnancy Outcomes Vision for Everyone. It studies why mothers die or suffer severe complications around pregnancy, and tests ways to prevent it.
If IMPROVE already exists, what does H.R. 6238 change?
Right now NIH runs it by choice. H.R. 6238 requires the NIH director to keep running it and sets out its research goals in law, so it can't be dropped without Congress changing the statute.
How much money does H.R. 6238 provide?
It authorizes $63.4 million a year for fiscal years 2026 through 2030, about $317 million total. That is a ceiling: appropriators still decide each year how much NIH actually gets.
What is severe maternal morbidity?
It means life-threatening complications of pregnancy or childbirth that stop short of death, such as heavy bleeding, sepsis, or organ failure. H.R. 6238 makes reducing these, along with maternal deaths, a core goal.
Does H.R. 6238 cover problems after giving birth?
Yes. The bill directs research on health before, during, and after pregnancy, so postpartum complications are part of the program.
Does H.R. 6238 fund programs in communities, or only lab research?
Both. NIH would run and evaluate community-based interventions for women in populations with higher-than-national rates of maternal death and severe complications, alongside research on risk factors and biology.
Who sponsored H.R. 6238?
Rep. Lauren Underwood (D-IL) introduced it in November 2025 with Rep. Brian Fitzpatrick (R-PA) as an original cosponsor.
Where is H.R. 6238 now?
The House passed it by voice vote on July 20, 2026. It is now with the Senate Health, Education, Labor, and Pensions Committee.
Based on H.R. 6238 bill text
H.R. 6238 Bill Text
“To establish the IMPROVE Initiative within the National Institutes of Health.”
Source: U.S. Government Publishing Office
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