The Texas Maternal Mortality and Morbidity Investigation Commission recently released a report on deaths occurring between conception and the first 12 months of pregnancy. In 2019, more than 50 Texans died of causes directly related to pregnancy, according to reports. This is an unacceptable number. Many others have experienced severe pregnancy complications that, while not fatal, can have long-term effects on maternal health.
The panel found that deaths during pregnancy often have multiple causes, but more than half of the contributing factors occurred at the provider, health facility, or health system level. This means that there is greater responsibility for the systems with which people interact than for individual choices. Ninety percent of these pregnancy-related deaths are considered preventable, higher than nationally reported, so state-level policy changes are needed to address these heartbreaking statistics.
Another key takeaway from the report is the disproportionate incidence of deaths and severe complications among Texas’ black communities and those without private insurance.
As public policy and inequality researchers, we are not surprised by these findings. Research clearly shows how unequal access to quality care and systemic racism undermine people’s health and well-being before, during and after pregnancy.
Texas has the highest percentage of uninsured residents because state policymakers have not expanded Medicaid, but the expansion of Medicaid is supported by most Texans and has reduced maternal mortality. Comprehensive Medicaid coverage helps manage health conditions that, if left untreated, can increase the risk of pregnancy complications. It may provide access to treatments for depression and substance use disorders, which are common causes of related deaths.
Our research found that women of color without insurance or public insurance were more likely than white women to report health care barriers. found that they frequently reported serious and ongoing postnatal health conditions they were unable to manage because they were left uninsured 60 days after giving birth when their Medicaid or CHIP coverage ended.
Because more than a quarter of all pregnancy-related deaths in Texas occur between 2 and 12 months postpartum, the State of Texas provides all low-income Texans with a Publicly funded insurance coverage should be extended. 27 states do this. Why not Texas?
Texas can also do more to address discrimination, which accounts for 12% of deaths. Efforts should be made to engage and listen to the calls of black women’s advocates to expand access to doulas that have been shown to improve pregnancy outcomes.
Another reason these health indicators continue to go wrong is Texas law criminalizing abortion, except in medical emergencies, which went into effect in 2021 and 2022. Not endorsed by the majority of Texas. Maternal deaths, such as those from ruptured ectopic pregnancies, increased the number of pregnancy-related deaths from bleeding in 2019 as doctors feared providing needed medical care. and is expected to increase. A Texas abortion ban will also lead to more cases of severe pregnancy complications. Our research and other reports show that fear of legal repercussions has compelled physicians to delay treatment of pregnant women experiencing premature rupture of their membranes. Sepsis is a life-threatening infection that was already on the rise.
Getting pregnant in Texas has never been so dangerous. State leaders must take bold action and adopt policies supported by evidence and a majority of Texans. They can start by extending Medicaid coverage for 12 months after pregnancy ends and passing legislation to fairly compensate everyone who wants a doula. Texas, which ensures a safer pregnancy and postpartum period for all residents, especially blacks and low-income Texans, isn’t coming anytime soon.
Vohra-Gupta is an Assistant Professor at the Steve Hicks School of Social Work. University of Texas.
White is an associate professor at the Steve Hicks School of Social Work.