Rise in Texas maternal deaths absent from legislative agenda

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Every Texas legislator should know by now that more mothers are dying less than a year after giving birth. At least that’s what Lisa Hollier believes.

Hollier is chairwoman of the state’s Task Force on Maternal Mortality and Morbidity, which reported in July that 189 Texas mothers died less than a year after their pregnancy ended between 2011 and 2012 — the culprits were mostly heart disease, drug overdoses and high blood pressure. A month later, the medical journal Obstetrics and Gynecology published a study that found Texas’ maternal mortality rates had nearly doubled between 2010 and 2014.  

Despite the dramatic statistics — which drew the attention of The New York Times and other national media — Hollier says getting Texas lawmakers’ attention on maternal deaths is going to be tough.

“We need to work hard to make sure that this issue is not forgotten,” Hollier said. “The problem has been here for a while, and I think sometimes when problems are chronic, they can be easier to ignore.”

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Texas’ maternal deaths have been sparingly mentioned during the legislative session, overshadowed by issues such as child welfare, the so-called “bathroom bill” and sanctuary cities. Gov. Greg Abbott did not mention it during his State of the State address. It’s not one of Lt. Gov. Dan Patrick’s 25 legislative priorities. And House Speaker Joe Straus did not mention it during his acceptance speech.

Researchers and legislators say there’s no simple fix to curb maternal deaths. The state task force report found mental health disorders and substance abuse were key factors, particularly depression and overdoses from prescription opioids. The report also found inconsistencies in how maternal deaths are reported, which hampers prevention efforts.

They also found black women are disproportionately at risk of dying after giving birth.

The task force recommendations included increasing mental and behavioral health screenings, improving access to health services for women in the first year after their pregnancy and more education for women at higher risk of death from childbirth.

Hollier said some lawmakers have filed bills to address some of the issues in the task force report, such as a bill to provide post-partum depression screenings for mothers through their child’s health plan and another bill that would extend the task force's work until 2023.

Rep. Four Price, R-Amarillo, chairman of the House Public Health Committee, said he has not scheduled any hearings related to maternal mortality but he’s not ruling it out.

“Nothing is off the table as far, as I’m concerned,” Price said. “We’ll look at everything, try to figure out what we have time for and what makes sense, like any other committee.”

Sen. Charles Schwertner, R-Georgetown, chairman of the Senate Health and Human Services Committee, did not respond to a request for comment.

Sen. Jane Nelson, R-Flower Mound, chairwoman of the Senate Finance Committee said in an email statement that lawmakers "continue to work on many fronts to advance women's health and ensure that women in every part of the state have access to the care they need.”

Some lawmakers are quick to point to the Legislature funding the Healthy Texas Women Program in July. That program focuses on helping women receive cancer screenings, post-partum depression screenings, family planning services, STD testing, contraceptives and more. Legislators also point out that  low-income mothers are auto-enrolled in the program just as their Medicaid benefits expire 60 days after giving birth, saving them from a coverage lapse.

John Wittman, a spokesman for the governor, said in an email statement that Abbott “is committed to reducing the maternal mortality rate. Our office is actively engaged with the Legislature on this issue and the Governor looks forward to seeing legislation on his desk that addresses this alarming problem.”

Wittman also pointed to the governor's proposed budget, which said that additional resources for the Healthy Texas Women Program would help. The governor's proposed budget also said an effort to remove Planned Parenthood from Medicaid is “another step in providing greater access to safe health care for women."

Jason Embry, a spokesman for Straus’ office, said in an emailed statement the speaker “believes strongly in the importance of women’s health services” that reduce maternal deaths. The Healthy Texas Women Program “makes it less complicated to get information and access to women’s health and core family planning services.”

Patrick’s office did not return request for comment.

Rep. Sarah Davis, R-Houston, chairwoman of the House Appropriations Subcommittee on Article II, said she was “pretty shocked” when she received the task force report last summer but is hopeful her committee “will take significant strides to reduce the morbidity rate.”

She pointed to the House budget providing $373.9 million for substance abuse treatment, with specific funding for neonatal abstinence treatment and mothers dealing with addiction. She also pointed to the “historically high” $284.6 million the House is appropriating for women’s health programs.

“I'm very hopeful that we will not have another doubling of maternal mortality,” Davis said during a committee hearing last week. “I know that this committee is very mindful of behavioral health and mental health components.”

Rep. Jessica Farrar, D-Houston, chairwoman of the Texas House Women’s Health Caucus, said she is disappointed state leaders haven’t shown more interest on the maternal deaths. She said the Legislature was too hasty to remove Planned Parenthood from various women’s health programs (efforts to remove them as a Medicaid provider have been thwarted by federal courts).

Farrar said the Healthy Texas Women Program has not been easy for patients to access, and advertising on buses and billboards has not been enough to inform eligible women about the program and how to enroll.

“If I’m going to make such a big policy change I would make sure that there was something in place so that there was a seamless transition for Texas women to see another provider, and that wasn’t the case,” Farrar said.

For now, Hollier said she is focused on Friday, when her task force meets to do case reviews on maternal deaths from 2012. Those cases will mostly look at women who died from heart problems, high blood pressure and hemorrhaging. She said maternal deaths is  “a multifactorial problem” that’s “going to take a multifactorial solution.”

“Our charge from the Legislature was to review these deaths, so we really need to do that as quickly as possible and then be able to report on those deaths with recommendations to reduce morbidity and mortality,” Hollier said.

Read more of the Tribune's related coverage:

• Two recent studies have highlighted the increasing rate of maternal deaths in Texas, but researchers say they can't explain why it's happening. 
• Texas has seen an “unusual,” dramatic increase in the number of women who died from pregnancy-related causes in the last five years, according to a new study.

Disclosure: Planned Parenthood has been a financial supporter of The Texas Tribune. A complete list of Tribune donors and sponsors is available here.

Correction: An earlier version of this story attributed a quote to the governor's spokesman that should have been attributed to the governor's proposed budget.