disparity. (26) Black women are twice as likely to experience postpartum depression, and disproportionately higher rates of preeclampsia compared to White women. (27) Racism is deeply ingrained in United States systems, including in health care delivery systems between patients and providers, often resulting in disparate treatment for pain, irreverence for cultural norms with respect to health, and dismissiveness. However, the provider pool is not primed with many people of color, nor are providers (whether maternity care clinicians or maternity care support personnel) consistently required to undergo implicit bias, cultural competency, respectful care practices, or empathy training on a consistent, on-going basis. (28) Women are not the only people who can become pregnant or give birth. Nonbinary, transgender, and gender-expansive people can also become pregnant. The terms birthing people or birthing persons are also used to describe pregnant or postpartum people in a way that is inclusive of individuals who experience gender beyond the binary. (29) Substance misuse among pregnant women, including the use of substances that are illegal or criminalized, misuse of prescribed medications, and binge drinking, has increased year after year for the past decade. Pregnant people with substance use disorder, particularly those with opioids, amphetamines, and cocaine use disorders, are at greater risk of severe maternal morbidity, including conditions such as eclampsia, heart attack or failure, and sepsis. 3. Improving Federal efforts with respect to prevention of maternal mortality (a) Funding for State-Based perinatal quality collaboratives development and sustainability (1) In general Not later than one year after the date of enactment of this Act, the Secretary of Health and Human Services (referred to in this subsection as the Secretary ), acting through the Division of Reproductive Health of the Centers for Disease Control and Prevention, shall establish a grant program to be known as the State-Based Perinatal