But 90% of pregnancy-related deaths that occurred in 2019 were preventable, according to a new report from the Texas Maternal Mortality and Morbidity Review Committee.
The long-awaited report was published Dec. 15, over three months after its required due date. State law mandates the committee must submit a report to the governor and other state leaders by Sept. 1 of each even-numbered year.
This is the the MMMRC’s fifth report. The committee was established by the Texas Legislature in 2013 and is made up of 17 members, including obstetricians, nurses, physicians, a medical examiner and more.
Grim findings
Cases of severe maternal morbidity increased significantly in recent years, rising from 58.2 cases per 10,000 deliveries in 2018 to 72.7 in 2020. Severe maternal morbidity refers to severe pregnancy complications, which can result in short- and long-term consequences to a woman’s health.
According to the report, Black women were much more likely to experience severe complications than other racial and ethnic groups. In 2020, Black women had severe complications for every 117.3 in 10,000 deliveries, compared to 56.3 in 10,000 for white women and 72.2 in 10,000 for Hispanic women.
Discrimination was a factor in 12% of pregnancy-related deaths in 2019, the committee found. Obstetric hemorrhage—excessive internal bleeding during or after pregnancy—was the leading factor in deaths at 25%, while other causes included mental health conditions, obesity, injury, violence, substance use and more. Some deaths were caused by more than one issue.
In 2013, Black women were twice as likely as white women and four times as likely as Hispanic women to die from pregnancy-related causes. The committee is still reviewing data from 2019 but reported this trend has likely persisted.
During the early months of the pandemic, pregnant Hispanic women were disproportionately impacted by compilations related to COVID-19, the report shows. From April-December 2020, they made up 48.3% of in-hospital births, yet 70.1% of deliveries with severe coronavirus complications involved Hispanic women.
These cases occurred before the COVID-19 vaccine was available. According to the report, the committee will further analyze COVID-19’s involvement in maternal mortality in future reports.
Violence accounted for 27% of pregnancy-related deaths, which includes suicide and homicide. The committee found firearm use and airway restriction—such as hanging, strangulation and suffocation—were the most common causes in violent deaths, while intimate partners typically committed homicides.
Committee recommendations
The committee shared 11 recommendations, led by a push to expand access to comprehensive health services during and a year after pregnancy. This includes “removing provider barriers to strengthen appropriate diagnosis, referral, and treatment for maternal health populations, regardless of an individual’s financial or health care coverage status,” the report said.
In 2021, the Texas House voted to extend Medicaid coverage to 12 months after pregnancy, but the Senate cut it to six months. The plan was not approved by the federal government, so low-income Texans have access to two months of coverage after their child is born. As of Oct. 27, over half of U.S. states provided Medicaid coverage for 12 months postpartum, according to the federal Department of Health & Human Services.
State Rep. Evelina Ortega, D-El Paso, filed House Bill 56 to extend postpartum Medicaid coverage to 12 months in 2023.
Dr. Joanne Stone, president of the Society for Maternal-Fetal Medicine, told Community Impact that expanding Medicaid will help “greatly increase the access [to] care.”
She said it is important to continue to develop strong maternal health programs in Texas and increase the public awareness of maternal mortality and morbidity.
“We urge policymakers to take this and other MMMRC recommendations seriously because lives depend on it,” Stone said in a statement.
To close the gap in pregnancy-related deaths and complications for Black women, the committee called for a focus on Black communities in health programs, including engagement, education, bias reduction training, patient-centered care and more.
The committee also recommended improving access to behavioral and mental health care before, during and after pregnancy; expanding state programs to address intimate partner violence and trauma; and increasing coordination between maternal and emergency services in Texas.
The report will be available to lawmakers during the 88th Texas Legislature, which will begin Jan. 10.
