This week, as millions of Texans prepare to celebrate the birth of a healthy baby to an unwed teen mother of color, the Texas Department of State Health Services finally released their 2022 biennial report from the Texas Maternal Mortality and Morbidity Review Committee after months of delay. The sobering report focuses on deaths and does not address morbidities, which means it is just the tip of the iceberg regarding the state of maternal health in Texas.
In 2013, SB 495 established the Texas Maternal Mortality and Morbidity Review Committee within the Department of State Health Services. The committee’s primary duty is studying and reviewing pregnancy-related deaths. The 2022 report is the first time the committee used data from cases after 2013. The committee reviewed 118 cases from 2014-2018. Those 118 pregnancy-associated deaths resulted in 184 children forever without their mothers.
The committee found that 90 percent of the pregnancy-related deaths were preventable. Six causes accounted for 79 percent of the deaths: obstetric hemorrhage, mental health conditions, non-cerebral thrombotic embolism, cardiovascular conditions, and infection. The report omits the sixth ranked cause.
In addition to causes, the report also notes contributing factors. Violence, including intimate partner violence, are known to have contributed to 27 percent of the cases. Discrimination contributed to 12 percent of the pregnancy-related deaths.
Demographically, the report identifies black women as the most at-risk population. In the pre-2013 data, black women were more than twice as likely to die than white women and more than four times higher than Hispanic women. The trend for the 2014-2019 cases persists. Other “at-risk” populations include women without private payer coverage for delivery, women with less than a 12th grade education, and women of “advanced maternal age (35 or older).
The committee also reviewed best practices from other states and made 11 recommendations. A summary of those recommendations are:
- Increase access to comprehensive health services during pregnancy, the year after pregnancy, and throughout the preconception and interpregnancy periods to facilitate continuity of care, implement effective care transitions, promote safe birth spacing, and improve lifelong health of women.
- Engage Black communities and those that support them in the development of maternal and women’s health programs.
- Implement statewide maternal health and safety initiatives and incorporate health equity principles to reduce maternal mortality, morbidity, and health disparities.
- Increase public awareness and community engagement to foster a culture of maternal health, safety, and disease prevention.
- Improve integrated behavioral health care access from preconception throughout postpartum for women with mental health and substance use disorders.
- Improve statewide infrastructure and programs to address violence and intimate partner violence at state and community levels.
- Foster safe and supportive community environments to help women achieve their full health potential.
- Support emergency and maternal health service coordination and implement evidence-based, standardized protocols to prevent, identify, and manage obstetric and postpartum emergencies.
- Improve postpartum care management including education and health care coordination for those with mental health and/or high-risk medical conditions.
- Prioritize continuing education, diversification, and increasing capacity of the maternal health workforce.
- Apply continuous process improvement strategies for maternal mortality review protocols to support and increase case review capacity, quality, and recommendation development.