For Immediate Release
Contact: Peter Clark, pclark@txchildren.org, 512-473-2274
Austin – Late yesterday, the Texas Maternal Mortality and Morbidity Task Force released its 2018 report on Texas women dying or experiencing serious health complications during pregnancy, childbirth, and the postpartum period following delivery. During the special legislative session of 2017, the state Legislature and Governor directed the Task Force to continue analyzing the issue and publish the report. Following the release of the report, Adriana Kohler, Senior Health Policy Associate at Texans Care for Children, issued the following statement:
“The report shows that state legislators and other Texas leaders have a lot of work to do to improve maternal health. In particular, the Task Force found that most of the maternal deaths it reviewed were potentially preventable.
“During the regular and special legislative sessions last year, the Governor and state lawmakers from both sides of the aisle stressed the importance of continuing the work of the Task Force and reducing maternal deaths. We are optimistic that these state leaders will now take action on the Task Force’s recommendations.
“The report is based in part on the Task Force’s in-depth review of maternal deaths in the state in 2012, which found ‘[t]he leading causes of pregnancy-related death in 2012 included cardiovascular and coronary conditions, obstetric hemorrhage, infection/sepsis, and cardiomyopathy.’ The report also includes an analysis of state trends in maternal deaths from 2012 to 2015. The report notes that a Texas Department of State Health Services (DSHS) analysis of 2012 to 2015 found 382 maternal deaths from pregnancy through one year after delivery but that ‘maternal deaths identified through this method underestimate the true number of maternal deaths in Texas during this timeframe.’ Additionally, the report includes an examination of statewide trends in severe maternal morbidity, which refers to labor and delivery complications with significant health consequences for mothers.
“Each death of a Texas mother is a tragedy, and the state’s inadequate maternal health policies also lead to other serious consequences that far outnumber maternal deaths. For example, many more Texas women experience very serious, often life-threatening complications during pregnancy, childbirth, and in the year following delivery. Major complications such as hemorrhage and eclampsia, among others, can have serious health consequences for mothers and their babies.
“Healthy pregnancies and moms’ postpartum health are also critical to the health and development of Texas babies. As the report notes, ‘[h]ealthier women are healthier mothers, and healthier mothers lead to healthier infants and families.’ Pregnancy complications can increase chances of preterm labor and premature births. Babies born too early or too small may have to stay in the hospital longer and may face long-term health issues, like developmental delays, asthma, or hearing loss. Maternal mortality and morbidity data are warning signs that we need stronger maternal health policies to support healthy Texas babies and kids.
“The report shows that Black moms face a much higher risk of maternal death or serious pregnancy-related complications compared to other Texas moms. Black Texans are more likely to be uninsured compared to White Texans. A growing body of research also points to the stress of institutional racism as a key explanation for worse birth outcomes for Black women in America. Additionally, low-income women of any race tend to face higher risk of maternal death or pregnancy complications. They are less likely to be insured, less likely to have a car and a flexible work schedule for reaching medical appointments, and more likely to face other challenges to healthy pregnancies.
“The report shows that overdose was a leading cause of maternal deaths between 2012 and 2015. Texas women of childbearing age are not immune to the substance use challenges facing Texas communities. Texas’ health professionals and substance use treatment programs need to pay particular attention to pregnant and postpartum women. The state has taken a good step by promoting resources on how health professionals can screen for substance use issues using validated tools and interventions, and if needed, refer to substance use services in the local area. As our recent policy briefdiscusses, there are additional steps that health providers and policymakers can take to address this challenge.
“One of the key recommendations from the Task Force is to ‘Prioritize care coordination and management for pregnant and postpartum women.’ While attention has traditionally focused on supporting women during their pregnancies, there is a growing awareness about the importance of providing support during the year following delivery. For many women, obstacles to that care include a lack of transportation and insurance.
“Another key Task Force recommendation is to ‘Enhance screening and appropriate referral for maternal risk conditions,’ including screening and support for chronic health conditions, mental health challenges, and substance use disorders. We agree this an important area for policymakers and health professionals to address. Maternal depression can interfere with mother-baby bonding, harming a baby’s emotional development. Moreover, suicide is one of the causes of maternal deaths. The Legislature took an important step last year by passing legislation to allow more new mothers to get screened for postpartum depression during their infants’ checkups. However, more work is needed to ensure that women also have access to treatment, particularly once Medicaid coverage ends two months after delivery.
“Additionally, the Task Force recommends that state policymakers ‘Increase access to health services during the year after pregnancy and throughout the interconception period to improve the health of women, facilitate continuity of care, enable effective care transitions, and promote safe birth spacing.’ We strongly agree that Texas women need greater access to health care during the year after they deliver a baby and during the time between pregnancies. Currently, under Medicaid policies determined by the state Legislature, very few low-income Texas women qualify for Medicaid insurance until they are pregnant, and then their insurance ends two months after delivery. Maternal health experts recommend that women receive comprehensive health care — which typically requires health insurance — before, during, and after their pregnancies in order to have healthy pregnancies and healthy babies. It’s harder for women to get healthy before their pregnancy and to start prenatal care on time when they can’t start signing up for health insurance until they are pregnant. Texas has the highest rate of uninsured adults in the country. In fact, more than 1 in 4 Texas women of reproductive age — about 1.5 million Texas women — lack health insurance.
“Finally, it’s important to note that the Trump Administration is reportedly close to announcing a new ‘public charge’ policy for legal immigrants that could significantly deter pregnant women from signing up for Medicaid insurance and getting prenatal care. If this policy takes effect, it could put legal immigrants seeking a green card at risk of being denied if members of their family — including U.S. citizen children and relatives — use programs like Medicaid, CHIP, or food assistance. This could force millions of Texans to choose between health care — including prenatal and postpartum care — and the ability of a family member to legally immigrate. With recent UT Health System research showing a high number of Texas women missing out on prenatal care, we should be doing more to get women into prenatal care – not punishing them for signing up for Medicaid or receiving prenatal care.”
