This week, the Texas legislature passed—and the Governor signed into law—a bill to address the state’s maternal mortality crisis. As it stands, Texas is the deadliest state to give birth in, and it’s the deadliest state for new mothers—especially for African American women, who are at the most risk. Among OECD member countries, Texas’ maternal mortality rate comes second only to Mexico.
It took the entirety of both the state’s regular legislative session and a month-long special session, but the bipartisan bill finally crossed the finish line. The new law will extend the state’s Maternal Mortality and Morbidity Task Force’s expiration date to 2023 and require it to report on disparities in pregnancy-related deaths (including socio-economic status) and best practices in lowering mortality rates in other states, as well as actually evaluate options to reduce maternal deaths.
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The task force, which was created in 2013, has already identified a lack of early pregnancy care as a significant contributor to death. In some ways, that’s unsurprising: Nearly 25 percent of Texas women are uninsured, and the state leads the country in the total uninsured rate. Because of cost, over the past year 52 percent of Texas women reported skipping a doctor’s appointment or test, not getting specialist care, or being unable to fill a prescription. This is a far higher percentage than what was found in states with similar uninsured rates, such as Florida, as well as in states with similar populations, such as California.
Despite this bleak picture for women in need of care, the legislature failed to send any proposals to the governor that would have actually provided for greater coverage for the treatment and care of women struggling financially.
One reason for the high uninsured rate is the state’s extremely restrictive Medicaid eligibility standards: In addition to failing to expand Medicaid under the Affordable Care Act, parents of two children in Texas must earn less than $386 a month to qualify for Medicaid coverage. (That’s only one-fifth of the federal poverty level, which is $2,050 for a family of four). Texas allows more women to gain care through Medicaid during the duration of their pregnancy, but drops them 60 days after delivery. The task force also found that the majority of deaths occur more than 42 days after birth—likely after many women at risk for death lost access to the program.
In discussing Texas’ maternal mortality rate, many advocates have noted that births paid for by Medicaid (which are unfortunately higher-risk than those paid for by private insurance) significantly increased after the state cut family planning programs by tens of millions in 2011. The cuts must also be factored into understanding why Texas’ mortality rate has stayed consistently high for years after the initial spike.
But, though the state has undoubtedly been slashing family planning funds and shuttering clinics at a reckless rate for several years now, the fact is that the dramatic increases in deaths began before these reckless policies were passed and implemented.
There are other early findings that do not have clear answers yet. Despite being among most likely to be uninsured, Latina women were found to have an even lower mortality rate than white women. In contrast, African American women are disproportionately likely to experience maternal death: While only accounting for approximately 11 percent of births, these women make up about 29 percent of deaths.
The task force’s new responsibility to evaluate approaches in other states will prove illuminating for some of these unanswered questions: North Carolina, for example, implemented a variety of programs to incentivize doctors examining women for conditions that could lead to high-risk pregnancies and provide wraparound supports for those expectant mothers facing health dangers. By doing so, the state made a huge stride forward that should—and must—catch the attention of Texas’ policymakers: It closed the racial gap in the rate of maternal deaths in white and black mothers.
After an onslaught of statistics, it’s important to remember that behind every death statistic is a woman who suffered. Expectant parents everywhere wake up worried about coping with the newborn months. Too many mothers-to-be in Texas, however, must also wake up worried about whether they will even live to see their child crawl or walk.
Given that mothers are the primary or co-breadwinners in more than 60 percent of Texas households, these deaths are not only personal tragedies but ones that can devastate the economic standing of a family. Already, 1 in 4 Texas children live in poverty. And since the average age of new mother is 26, health problems related to birth may hit as a young woman is still working to launch her career with little savings built up.
It would be unacceptable to allow this to continue. The legislature passed a law that will spur research that will illuminate a greater understanding of how to effectively improve maternal health and lower the rates of maternal death. It will be essential, however, for those who truly care to turn that analysis into meaningful change.