By Allie Morris
AUSTIN – Most pregnancy-related deaths in 2019 were preventable and disproportionately affected Black Texans, according to a long-awaited state report released on Thursday.
The deaths were primarily driven by hemorrhage, mental health conditions and blood clots during pregnancy and in the year after. Mental health conditions, discrimination and violence all played a role.
Advocates said the report by the Texas Maternal and Morbidity Review Committee underscores how the state must do more to aid pregnant Texans and address disparities.
“Every mother who didn’t make it, every child and family who lost her too soon is reflected in the report,” said committee member Nakeenya Wilson, a maternal health advocate in Austin. “And now we must all take it at face value and do the work to change the narrative.”
The Department of State Health Services released the report after a months-long delay, which frustrated members of the committee, Democratic lawmakers and maternal health advocates.
The final review of all 147 deaths won’t be finalized until next year, but the major findings are expected to remain the same.
The analysis comes as the Legislature is preparing to meet starting Jan. 10.
As in past years, the committee’s top recommendation is to extend Medicaid coverage to a full year post-pregnancy. The GOP-controlled Legislature last session approved a six month postpartum policy, but the report stressed 12 months is needed to “help identify and properly manage health conditions before they become life-threatening.”
Fourteen women died during pregnancy, the analysis found, while 45 died in the days and months after giving birth.
The committee also noted an important theme that runs through the report: “the persistence of maternal health disparities.”
Between 2016 and 2020, the rate of serious pregnancy complications rose for all women, the report found, but most steeply for Black Texans. In 2020, Black women were twice as likely to experience critical health issues in childbirth, including sepsis and preeclampsia.
Even as white and Hispanic Texans saw their rates of severe hemorrhage decline over recent years, the rate for Black women rose.
“The report makes clear that state leaders must do more to prevent maternal deaths and support healthy pregnancies among Texas women of all backgrounds but particularly among Black women,” said Diana Forester, Director of Health Policy for the advocacy group Texans Care for Children.
The report recommended engaging Black communities in the development of programming, diversifying the maternal health workforce and requiring bias training.
It also examined the role of medical providers. The analysis found delays in treatment, quality of care issues and inadequate assessment of risk all factored into the maternal deaths.
“There tends to be a lot of blaming and shaming on the moms,” said state Rep. Shawn Thierry, D-Houston. “The report does show that there is discrimination that exists, that there is a lack of quality care being provided at times at the clinical level.”
It remains to be seen how the report will affect the upcoming legislative session. House Speaker Dade Phelan, R-Beaumont, has named a full-year of postpartum Medicaid coverage a priority. The issue did not make Lt. Gov. Dan Patrick’s list.
Committee members have said they are also hoping for legislative tweaks to speed up their work. When investigating maternal deaths, much of the information the committee reviews must be redacted – a laborious process that takes an average of 45 hours per case, according to the report.
The state initially missed the report’s required Sept. 1 release date and pushed off publication until mid-2023. At the time, former Department of State Health Services Commissioner John Hellerstedt said more time was needed to finish investigating every death. Some advocates accused the state of playing politics ahead of the midterm election.
