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Nakeenya Wilson received a phone call while attending a meeting of the Texas Maternal Mortality Research Commission.
Wilson rushes to the hospital, leaving behind piles of files documenting stories of women who have died from complications of pregnancy and childbirth. Many of the women in these files were black, like Wilson, who had a traumatic birth.
“Renaming these files reminded me that it could be me. It could be my sister,” said Wilson, who serves as the commission’s regional representative.
Ten years ago, when the first Maternal Mortality and Morbidity Review Board was established in Texas, black women were twice as likely as white women and four times as likely as Hispanic women to die in pregnancy and childbirth. there was a possibility.
Those gaps have not improved, according to the commission’s latest report released Thursday.
In 2020, pregnant black women were twice as likely to experience serious health problems like bleeding, pre-eclampsia and sepsis. In recent years, complications from obstetric bleeding have decreased across Texas, but increased by nearly 10% in black women.
Wilson said these statistics show the impact of a healthcare system that is biased toward black women.
“We’re still dead, and we’re disproportionately affected by bleeding while others are recovering,” Wilson said. No, it got worse.”
It’s not always easy to identify the cause of these discrepancies, and even harder to fix. It is a combination of reduced access to health care, systemic racism, and the impact of “social determinants of health” (the conditions under which someone is born, lives, works and grows).
Wilson said she and her sister were prime examples. They grew up in poverty, without health insurance, regular doctor visits, and consistent access to healthy foods.
“We started behind the ball,” she said. “By the time we were of childbearing age, so many painful things had happened to us that contributed to our health.”
Maternal health advocates in Texas say modifying labor and delivery practices alone will not be enough to address these disparities. This requires building a comprehensive health care system that addresses the needs of the entire community, long before conception.
Wilson’s sister eventually got over her postpartum health concerns. But the experience was a reminder of why Wilson volunteered time to read, review, and analyze the stories of women who died of pregnancy and childbirth.
“When you look at the work that marginalized people do, they do it because they feel they have no choice,” she said. “Things change, if we want to be safe, we have to insist on our own safety.”
Dandra Willis has been waiting for the release of the state’s maternal death report for more than three months. Willis has been a vocal advocate for black maternal health as a doula for the Afiya Center, a black-led reproductive rights organization in North Texas. A doula is a trained professional who assists pregnant women physically and emotionally during childbirth.
But when the report finally came out Thursday, Willis was in no rush to read it. No more evidence against women was needed, she said.
Her client had to juggle with other children, and previous experiences worried her about how she would be treated in the emergency room.
“She’s scared to go and needs to go,” said Willis. “She’s fighting for her life… I see how this can happen.
The panel found that discrimination played a role in 12% of maternal deaths in 2019, and for the first time considered discrimination as a contributing factor to maternal deaths. Wilson said that’s probably just the tip of the iceberg.
“We can define 12% with the system we are using today,” she said. “Can you figure it all out? Probably not.
Rakhi Dimino, M.D., an OB-GYN in Houston, said discrimination often manifests itself in subtle ways that may not be apparent to healthcare professionals, but it has a significant impact on patients.
“If you ask a hospital, ‘Are there any racist employees?’ they will say, ‘No, I would never allow that,'” she said. “But it’s not always the obvious situation. It’s in small conversations, notes and charts, and it can be just as dangerous.”
She said patients were sometimes recorded as not complying or leaving against medical advice. You may find that you have to stay in a hospital or that you don’t have transportation to a specialist’s office across town.
“These are barriers that we can solve if we are open to doing so,” she said.
One of the commission’s recommendations was to diversify the state’s maternal health care workforce. Willis also wants to see more black women using doulas who can advocate for pregnant patients who may be experiencing discrimination.
Rep. Sean Thierry (D-Houston) introduced a bill that would require health care providers and medical students to be trained in cultural competencies and implicit biases.
“In reality, a lot of this is happening on an unconscious, subconscious level,” Thierry said. “You can’t fix it until you start identifying it. It’s the elephant in the room.”
Nearly two-thirds of black women are on Medicaid during childbirth compared to less than one-third of white women. The report found that women without private health insurance were at particularly high risk of severe maternal morbidity.
Women who do not have consistent health insurance are less likely to access timely antenatal care, contribute to complications of pregnancy and childbirth, and suffer from obesity and other health complications such as gestational diabetes. more likely to occur.
Until recently, women who gave birth on Medicaid in Texas lost their health insurance after two months. According to the report, 15% of her maternal deaths occurred more than 43 days after giving birth.
In 2021, the Texas House of Representatives voted to extend postpartum Medicaid for 12 months. This is the top recommendation of the Maternal Mortality Commission. The Senate has shortened it to six months. The federal government has said the proposal is “unacceptable” in its current form.
Now that no one has been taken off Medicaid due to the pandemic public health emergency, lawmakers will have a second chance to get through Medicaid 12 months postpartum before someone loses coverage. I can do it.
Thierry said the proposal should be an easy win for both lawmakers and black women.
“But our work doesn’t end there,” she said. “It is very important that the Texas legislature understands that it is not enough.”
Thierry is preparing what she calls “Momnibus”. This is a series of bills aimed at expanding access to health care, gathering better information and strengthening the maternal mortality research process. While the bill is intended to improve maternal health across the board, it pays particular attention to the experience of black women.
“Black women shouldn’t be footnotes in this report,” she said.
Thierry, who is black, has experienced these issues firsthand. While she had an emergency caesarean section, her doctor positioned her epidural too high. She knew something was wrong and begged to be put under her anesthesia, which probably saved her life.
For years she blamed herself and kept silent about her experiences. After she was elected to the Texas State House of Representatives in 2017 and read her maternal mortality report, she began to put her own experiences into a larger context.
“I almost died. I was treated badly. No one saw me,” she said. “I don’t think a woman has to be a sitting member of the Texas Legislature to feel comfortable sharing her story.”
The latest maternal mortality report data is from 2019, nearly three years before Texas became the nation’s largest state to ban nearly all abortions. These bans are expected to disproportionately affect black women, who account for approximately 40% of all abortions nationwide.
A University of Colorado Boulder study estimated that a nationwide abortion ban would lead to a 24% increase in maternal mortality, with the steepest increase seen in 39% of black women.
Of particular concern is the treatment of ectopic pregnancy, which occurs when a fertilized egg implants outside the uterus and is life-threatening if left untreated. Ruptured ectopic pregnancies were the leading cause of obstetric hemorrhage deaths in Texas in 2019, the report found.
Although ectopic pregnancies are specifically exempt from Texas abortion law, doctors are reportedly delaying treatment of these nonviable pregnancies due to confusion and fear.From the Texas Medical Association A central Texas doctor was instructed by a hospital not to treat an ectopic pregnancy until a rupture had occurred, according to a letter from .
Dimino, an OB-GYN in Houston, said the new law will make doctors more cautious, which will inevitably result in delays.
“Instead of providing treatment based on the best evidence we have, we’re keeping these farther than we used to,” she said. This pregnancy can grow and burst into life-threatening or life-ending situations.
Qiana Arnold, a doula at The Afiya Center, said she was particularly concerned about the number of women dying from murder and suicide in light of the new abortion ban. accounted for 27% of all deaths.
“People are trying to kill themselves,” she said. “People would kill themselves because they didn’t want him.”
In the first post-Roe legislative session, which begins Jan. 9, Democrats hope their proposals to improve maternal health will get more support than before.
“It is my hope that all my colleagues in the legislature will stand up and say that it is time to put black mothers first,” said Thierry. You don’t have to do that in exchange for your life.”
Disclosure: The Texas Medical Association and Afiya Center are financial backers of The Texas Tribune, a non-profit, bipartisan news organization funded in part by donations from members, foundations and corporate sponsors. Financial backers play no part in Tribune journalism. Find their complete list here.