action Texas Maternal Health

Author: Desiree Ingram
Women’s Health Policy Advisor
Texas Women’s Healthcare Coalition

Texas Maternal Health

 

The Texas Maternal Mortality and Morbidity Review Committee (MMMRC) and the Department of State Health Services (DSHS) released their 2024 Biennial Report, offering a detailed look into maternal health trends across the state. The findings reveal concerning increases in maternal mortality, persistent racial and demographic disparities, and preventable causes of death. The report offers twelve recommendations to improve maternal health outcomes and promote safer pregnancies for all mothers in Texas. Read the full report here.

 

Maternal Mortality Rates Surge in Texas

Texas saw an approximate 63% increase in maternal mortality between 2018 and 2020, with rates jumping from 17.0 to 27.7 deaths per 100,000 live births. Without counting COVID-19-related deaths, the rate remains high at 24.2 deaths per 100,000 live births. Severe maternal complications, or severe maternal morbidity (SMM), are also rising. 

Black women in Texas face the greatest challenges, experiencing 134.4 severe maternal morbidity cases per 100,000 delivery hospitalizations, nearly double the rate of White women (72.6). These statistics reveal significant gaps in care and support for mothers across the state.

These maternal health trends are concerning. To focus on timely analyses, the Texas Maternal and Morbidity Review Committee (MMMRC) will review 2024 cases and forgo comprehensive reviews for 2022 and 2023. This has raised concerns because it may overlook critical insights into maternal health trends during a period of significant policy and healthcare changes. However, the Texas Department of Health and Human Services (DSHS) Maternal and Child Health epidemiologists will analyze and publish 2022 and 2023 maternal mortality and severe maternal morbidity data on their public dashboard.

 

Preventable Deaths and Common Causes

One of the report’s most striking findings the MMMRC determined 80% of pregnancy-related deaths were preventable. Among the 85 deaths reviewed in 2020, multiple underlying conditions played a role in pregnancy-related deaths: 

• Infections: COVID-19, sepsis, and other infections played a significant role.
• Cardiovascular conditions: Conditions like hypertension and vascular aneurysms were common.
• Obstetric hemorrhage: Often linked to postpartum complications.

The MMMRC identified key factors contributing to pregnancy-related deaths, including mental health challenges like suicide and intimate partner violence, with firearm-related deaths accounting for 9% of deaths. Additional risks were worsened by substance abuse, housing instability, language barriers, obesity and inconsistent healthcare access. Tragically, Black and Hispanic women were overrepresented, making up a significant share of women who died during pregnancy or within 42 days postpartum. These deaths could have been prevented with timely interventions, including access to quality postpartum care. 

 

Disparities in Age, Education, and Race

The report highlights stark differences in maternal health outcomes based on age, education, race and ethnicity:

• Black women have a pregnancy-related mortality ratio (PRMR) of 39.0 deaths per 100,000 live births, 2.5 times higher than White women (16.1)
• Older mothers (40 years and up) face the highest risks, with a PRMR of 99.5 per 100,000 live births
• Educational attainment matters: Women with only a high school diploma or less have a PRMR of 32.6 per 100,000 live births, a much higher rate than their more educated peers
• Hispanic women are disproportionately affected by infections, which accounted for 43% of pregnancy-related deaths
• White women experience greater challenges with mental health conditions, which accounted for 31% of pregnancy-related deaths 
• Black women face heightened risks from non-cerebral thrombotic embolism, which accounted for 23% of pregnancy-related deaths 
• Non-Hispanic Women of Other Races: are unequally burdened by cardiovascular conditions, which accounted for 25% of pregnancy-related deaths

These statistics make one thing clear: targeted interventions are essential to protect the lives of Texas mothers.

 

Evidence-Based Solutions to Improve Maternal Health Outcomes 

The MMMRC report recommends implementing evidence-based initiatives such as Texas AIM (Alliance for Innovation on Maternal Health) bundles, focused on mental health and substance use disorders. These patient safety bundles target specific clinical conditions affecting pregnant and postpartum women. Standardized practices help ensure mothers receive timely and effective care in hospitals throughout the state 

The MMMRC also recommends prioritizing diversification and increasing maternal health workforce capacity. Expanding access to doulas, who provide personalized, continuous support during pregnancy, childbirth, and postpartum, help mothers navigate complex healthcare systems. For underserved communities, doulas serve as advocates, bridging gaps in communication and empowering mothers to take control of their health and well-being. 

 

Advocacy and Support for Maternal Health Initiatives 

As the 89th Texas Legislature approaches, the Texas Women’s Healthcare Coalition (TWHC) is committed to supporting initiatives that improve maternal health outcomes. By working towards evidence-based programs and advocating for legislative support we can ensure mothers and their families thrive across the state. Our priorities include:

• Increased funding for safety net programs: TWHC will advocate for increased funding for programs like Healthy Texas Women and the Family Planning Program which provide preventive care, screening for postpartum depression and treatment, and access to contraception for low-income women 
• Expanding access to doula services: TWHC will support bills that expand access to doulas in underserved communities, helping to reduce maternal risks and enhance care during the postpartum phase
• Support funding for Texas AIM bundles: TWHC strongly supports increased funding and full implementation of Texas AIM bundles. These initiatives target preventable causes of maternal mortality while offering essential care and support to mothers during and after pregnancy