Maternal deaths surged in Texas in 2020, 2021

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The rate of Texas women who died because of pregnancy or childbirth rose sharply in 2020 and 2021 to the highest since the state started tracking maternal deaths in 2013. Even excluding deaths related to COVID-19, the numbers were worse than usual, reversing two years of progress in driving the maternal mortality rate downwards.

The Texas Maternal Mortality and Morbidity Review Committee released its report this month analyzing pregnancy-related deaths within one year of childbirth. The committee, which works on a several year delay, closely analyzed cases from 2020.

The maternal mortality rate in 2020 was 27.7 deaths per 100,000 live births, compared to 17.2 in 2019. With COVID-related deaths excluded, the rate was 24.2.

But the report shows, once again, that maternal mortality does not impact every community equally. Black women are about 2.5 times more likely to die from pregnancy and childbirth than white women. Both Black and Hispanic women saw a sharp increase in pregnancy-related mortality between 2019 and 2020 — for Hispanic women the rate increased nearly 9 points to 22.2, and for Black women more than 11 points to 39. But white women actually saw an improvement, with the mortality rate dropping nearly 3 points to 16.1.

In 80% of these cases, the committee determined there was at least some chance of saving the patient’s life – a decline from 90% from the previous report. A quarter of women died due to infections, the most common cause of death, followed by cardiovascular conditions, obstetric hemorrhage, embolisms and mental health conditions.

For years, the committee’s first recommendation to improve the state’s maternal mortality rate was the same: allow new moms to stay on Medicaid for 12 months after giving birth, instead of the two months Texas offered. In 2023, the Legislature approved that extension.

In the latest report, the top recommendations are a more general call to improve access to comprehensive health care services, as well as prioritizing resources for pregnant and postpartum patients in public health emergencies and engaging Black communities to address disparities.

Since the most recent case analysis is from 2020, it does not reflect any impact from changes to Texas’ abortion laws. In 2021, Texas banned almost all abortions after about six weeks of pregnancy. In 2022, after the overturn of Roe v. Wade, the state banned almost all abortions from the moment of conception. The law allows for an abortion to save the life of the pregnant patient, but dozens of women have come forward with stories of medical care delayed or denied because their doctors were confused or scared to treat them.

State Rep. Donna Howard, a Democrat from Austin and chair of the Women’s Health Caucus, said in a statement Wednesday that legislators should work “across partisan divides” to address the increase in maternal mortality.

“Texas has vast resources at our disposal that can, and must, be leveraged to improve health outcomes for Texas moms,” she said.

Committee under fire

The maternal mortality committee, which was formed with bipartisan support in 2013, has come under increased scrutiny in the last few years.

In 2022, the report was delayed, with state officials saying they needed more time to do a complete review of 2019 cases. Advocates, in pushing for the report to be released, claimed Republican leaders, including Gov. Greg Abbott, didn’t want it published ahead of the fall elections. It was released in December of that year, and showed many of the same challenges reflected in this more recent report.

During the 2023 legislative session, lawmakers added additional positions to the committee, including two community member spots to replace the existing advocate role. While the previous position was filled by a Black woman who herself experienced birth trauma, both of the new spots were filled by doctors. The position reserved for a rural community member went to an anti-abortion OB-GYN from San Antonio over a labor and delivery nurse from the Rio Grande Valley, The Texas Tribune revealed in August.

Additionally, the Legislature appropriated $6 million in 2023 to create a new state-level tracking program for maternal deaths — and remove Texas from the Centers for Disease Control’s tracking program as a result.

The report said the new system will allow “for more efficient and timelier case identification.” But at a committee meeting in June, chair Dr. Carla Ortique said participating in the national system alongside almost all other states was key to “efficiently and effectively” reviewing cases. She said at the meeting that it was unclear whether the legislation would allow for them to run the state and federal systems simultaneously, but she felt it was important for such a big state to continue to contribute to the national system.

Texas Health and Human Services Commission also recently declined to participate in a federal maternal health program that would have provided funding and technical assistance, Howard said in a statement. The agency said it would need legislative direction and appropriations to be able to participate, she said.