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In Texas, the rate of women who died due to causes related to pregnancy or childbirth soared in 2020 and 2021, hitting the highest mark since the state began tracking maternal deaths in 2013. Even excluding COVID-19-related deaths, the numbers were worse than usual, reversing two years of progress in lowering maternal mortality.
The Texas Maternal Mortality and Morbidity Review Commission released a report this month analyzing pregnancy-related deaths within a year of birth. The commission, which works on a multiyear delay, detailed the 2020 cases.
The maternal mortality rate in 2020 was 27.7 deaths per 100,000 live births, up from 17.2 in 2019. Excluding COVID-related deaths, the mortality rate was 24.2.
But the report again shows that maternal mortality does not affect all communities equally. Black women are about 2.5 times more likely to die during pregnancy or childbirth than white women. Both black and Hispanic women saw a sharp increase in pregnancy-related mortality rates from 2019 to 2020. For Hispanic women, the rate increased by about 9 percentage points, to 22.2, while for black women, it increased by more than 11 percentage points, to 39. But mortality rates for white women have actually improved, with the rate falling by about 3 percentage points, to 16.1.
The committee found that there was at least some chance of saving the patient’s life in 80 percent of these cases, down from 90 percent in the previous report. A quarter of the women died of infection, the most common cause of death, followed by cardiovascular disease, obstetric hemorrhage, embolism and psychiatric disorders.
The commission’s initial recommendation to improve the state’s maternal mortality rate has remained the same for years: Allow mothers of newborns to stay on Medicaid for 12 months after giving birth, instead of the two months Texas offers. In 2023, the state Legislature approved an extension.
Among the key recommendations in the latest report are more general calls to improve access to comprehensive health care services, prioritizing resources for pregnant women and postpartum patients during public health emergencies, and engaging Black communities to close disparities.
The latest case analysis is from 2020, so it does not reflect the impact of changes to Texas abortion laws. In 2021, Texas banned nearly all abortions after about six weeks of pregnancy. In 2022, following the overturning of Roe v. Wade, the state banned nearly all abortions from the moment of conception. While the law allows for abortions to save the lives of pregnant patients, dozens of women have come forward with stories of medical procedures being delayed or denied because doctors were confused or afraid to provide care.
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Rep. Donna Howard, an Austin Democrat and chair of the Women’s Health Caucus, said in a statement Wednesday that lawmakers should work “bipartisan” to address rising maternal mortality rates.
“Texas has tremendous resources that can and must be leveraged to improve the health outcomes of Texas mothers,” she said.
Committee under criticism
The Maternal Mortality Commission, established with bipartisan support in 2013, has come under intense scrutiny in recent years.
In 2022, the report was delayed, with state officials saying they needed more time to fully investigate the 2019 cases. Activists who pushed for the report’s release argued that Republican leaders, including Gov. Greg Abbott, did not want it released before the fall elections. The report was released in December of that year and outlined many of the same challenges reflected in this more recent report.
During the 2023 legislative session, lawmakers added new positions to the committee, including two for local residents to replace existing advocate roles. While the previous positions were filled by Black women who had experienced birth trauma, both new positions are filled by physicians. The positions reserved for rural community members were filled by an anti-abortion obstetrician-gynecologist from San Antonio, rather than a labor and delivery nurse from the Rio Grande Valley, The Texas Tribune reported in August.
Additionally, the Legislature appropriated $6 million in 2023 to create a new maternal mortality tracking program at the state level, which would result in Texas being removed from the Centers for Disease Control and Prevention tracking program.
The report said the new system would allow “cases to be identified more efficiently and quickly.” But at a committee meeting in June, committee chair Dr. Carla Ortique said joining the national system with nearly every other state is key to reviewing cases “efficiently and effectively.” Dr. Ortique said at the meeting that it was unclear whether the bill would allow the state and federal systems to run simultaneously, but she felt it was important for such a large state to continue contributing to the national system.
Howard said in a statement that the Texas Health and Human Services Commission also recently declined to participate in a federal maternal and child health program that would have provided funding and technical assistance. The commission said it needed legislative direction and funding to participate, he said.
