Following childbirth, it is common to experience fatigue and discomfort—but for some new moms, complications can be more severe. New moms can lack the information they would need to differentiate between a normal recovery and a cause for concern, and even when they do have information, other factors can prevent their receiving appropriate care.1 Postpartum complications can be life-threatening and every year in the US they lead to the death of about 700 women—about 18 deaths per 100,000 births —as well as larger numbers of significant long term or short term health consequences (maternal morbidity). High levels of maternal mortality and morbidity are associated with lack of maternal and other health care services, and illustrate how systemic health inequities can lead to sometimes heartbreaking outcomes.
The U.S. maternal mortality rate pales in comparison to rates in poor and developing nations. But compared to other developed countries, U.S. rates of maternal mortality and morbidity reflect the failure of the U.S., both to provide necessary health services for women and to address social determinants of health and existing health disparities.
In the U.S., African-American, American Indian, and Alaska Native women are three times as likely as white women to die from a pregnancy-related cause. Many of maternal deaths are caused by identifiable health conditions or complications such as cardiovascular conditions, infection or sepsis, hemorrhage, diabetes, heart disease, or hypertension.2 However, the presence of specific health conditions—and even access to health services and insurance—are only parts of the puzzle. Dr. William Callaghan, Chief of the Maternal and Infant Health Branch within the Division of Reproductive Health at the Centers for Disease Control, echoes health equity activists who say that implicit bias, together with ways in which race and ethnicity are encountered and addressed in a medical setting, directly impact maternal mortality.3 Follow this link to view U.S. data on race/ethnic disparities in pregnancy-related deaths between 2007 and 2016.
In 2016, Texas gained nationwide attention after research suggested that its 2012 maternal mortality rate soared past the national rate to over 30 deaths per 100,000 births.4 The Texas Maternal Mortality and Morbidity Task Force later disputed this data and found the alarming rates to be a result of data collection errors. The Task Force discovered the actual rate to be 14.6 deaths per 100,000 births. While this rate is not as disturbing as initial reports suggested, it still raised an immediate cause for concern.5 As Texas struggled to handle maternal mortality and morbidity, states like California made tremendous strides by cutting their maternal mortality rate by over half between 2008 and 2013 from 16.9 deaths to 7.3 deaths per 100,000 births. Moreover, the Task Force determined that, just as is the case in the U.S. generally, African American mothers in Texas were more at-risk and had higher rates of maternal mortality than other mothers, at about 27 deaths per 100,000 births, regardless of income, education, or other health factors. Researchers at the University of Texas Health Science Center at Tyler found that maternal morbidity rates varied across the state’s zip codes, with rates significantly higher in rural counties and among both Hispanic and non-Hispanic black women.
The Texas maternal mortality rate is calculated based on the number of women who died during pregnancy or 42 days postpartum. But most maternal deaths in Texas actually occur more than 42 days postpartum. When researchers followed women a year postpartum, they found that the leading cause of death was drug overdose, signaling that Texas mothers are not immune to the substance abuse challenge in the state.6
Fortunately, with adequate care and attention, maternal mortality is a health challenge Texas can address: nearly 80 percent of pregnancy-related deaths in Texas have some chance of preventability.
Statewide efforts are underway to improve maternal health outcomes in Texas. The Texas Department of State Health Services (DSHS) is collaborating with several efforts to improve maternal health throughout the state, including the implementation of Texas AIM—a collaborative of DSHS, the Texas Hospital Association, and the Alliance for Innovation on Maternal Health. Other notable efforts in Texas include The Texas Collaborative for Healthy Mothers and Babies along with their maternal early warning system, and the Healthy Texas Women program.
To create lasting changes for women in Texas, efforts must continue to eliminate gaps in maternal care, especially for high-risk populations. Managing care during pregnancy, such as screening for chronic conditions, and continuing care postpartum are also essential to improving maternal mortality, morbidity, and other postpartum complications. It is vital that women who are of childbearing age in Texas are educated on healthier behaviors to have healthier pregnancies and reduce the risk of complications during or after pregnancy.
- “Healthy Lifestyle: Labor and Delivery, Postpartum Care,” Mayo Clinic, n.d., https://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/in-depth/postpartum-complications/art-20446702.
- “Pregnancy Mortality Surveillance System,” Centers for Disease Control and Prevention, n.d., https://www.cdc.gov/reproductivehealth/maternal-mortality/pregnancy-mortality-surveillance-system.htm.
- Rachel Jones, “American Women Are Still Dying at Alarming Rates While Giving Birth,” National Geographic, December 13, 2018, https://www.nationalgeographic.com/culture/2018/12/maternal-mortality-usa-health-motherhood/#close.
- Kirsty Johansen, Zachary Green, and Ivette Feliciano, “The Fight to End Texas’ High Maternal Mortality Rate,” PBS, May 25, 2019, https://www.pbs.org/newshour/show/the-fight-to-end-texas-high-maternal-mortality-rate.
- Sonia Baeva et al., “Identifying Maternal Deaths in Texas Using an Enhanced Method, 2012,” Obstetrics & Gynecology 131, no. 5 (May 2018).
6. Peter Clark, “Maternal Mortality Report Shows Texas Has Work To Do,” Texans Care for Children, August 21, 2018,https://txchildren.org/posts/2018/8/21/maternal-mortality-report-shows-texas-has-work-to-do.