Texas’ Maternal Mortality Committee Loses Advocate, Adds Anti-Abortion Doctor

A womb model at a crisis pregnancy center in Austin (Photo by Maggie Q. Thompson)

Nakeenya Wilson almost died as a result of one of her pregnancies. As a Black mom and doula from the county with the lowest life expectancy in the state, she’s seen other pregnancy complications unfold firsthand.

That experience is what she brought to her role as the sole “community advocate” on the state committee tasked with scrutinizing almost every pregnancy-related death in Texas.

“The voice in the story of the woman who lost her life and her family is not present,” Wilson said, describing documents the committee reviews. “So in the absence of that, someone like myself on the committee serves as a proxy and a lens.”

Beyond her work on individual cases, she very publicly advocated for accountability from the state, particularly in 2022 when leaders decided to delay publication of the biannual maternal mortality report, saying it wouldn’t publish until after the looming legislative session and the midterm that pitted Gov. Greg Abbott against Beto O’Rourke. (After public pressure, the report ultimately published before the legislative session.)

Now, with the new 2024 report set to publish in December, Wilson’s six-year term on the committee has been cut short.

She wasn’t fired. Rather, as part of a move to expand the committee overall, the legislature eliminated her position, as the Chronicle reported in March. She threw her hat in the ring for a newly created community-focused position on the committee, but the state informed her May 17 that she was not selected. Now, she says her last day is June 1.

Among the seven new members of the committee – all of whom are licensed doctors – is a vocal anti-abortion advocate and OB/GYN who has testified in support of strict anti-abortion legislation. As the Houston Chronicle reported, in 2021 Dr. Ingrid Skop told members of Congress that even a 9- or 10-year-old child could safely carry a pregnancy to term, saying “If she is developed enough to be menstruating and become pregnant and reach sexual maturity, she can safely give birth to a baby.”

Adding Members, Crossing Out “Advocate”

Texas’ Maternal Mortality and Morbidity Review Committee is one of dozens across the country. Although the legislature opted out of a CDC maternal mortality data collection system, the committee still operates under a similar model to other MMRCs nationwide.

After the state gathers documentation on almost every death during pregnancy in a given year, members of the committee review each case, looking for potential problems in the care that mothers received.

Based on the committee’s findings, every two years, the Department of State Health Services releases a report. Their latest biannual report found that 9 in 10 pregnancy related deaths in Texas were preventable, and one in 10 deaths were caused in part by discrimination.

Across the nation, these committees aren’t made up of all doctors. That follows the CDC guidelines for MMRCs, which state that they should include diverse members who are “working in and representing communities that are affected by pregnancy-related deaths.” Many MMRCs include advocates who work at nonprofits, doulas, and other non-medical professionals.

Following the new appointments, 22 of the 23 members on the Texas’ MMRC now hold a doctorate, while the remaining member is a registered nurse.

The bill that removed the “community advocate” role passed with broad bipartisan support, as its main purpose was to add more seats to the committee.

The initial version of the bill that the Texas House approved had added an additional community advocate position, along with three new seats for physicians. But the version that the Senate passed later had a crucial tweak: it crossed out the word “advocate” and replaced it with “community members,” while adding a requirement for experience in a healthcare field analyzing data.

“The only people who know the original intent are the people who authored, and co-authored, and altered the language of the deal,” Wilson said. “Those people would be (State Rep. Shawn) Thierry and (State Sen. Lois) Kolkhorst. I think it is important that when at all possible that government is transparent and accountable to constituents.”

Rep. Thierry and Sen. Kolkhorst had not responded to the Chronicle’s requests for comment as of publication.

State Sen. Donna Howard, who leads the Texas Women’s Health Caucus, points out that the amendment that removed the word “advocate” happened quietly.

“There’s a lack of transparency about how this came about, and why the committee structure was set up such that the one person there with lived experiences, which is valuable information to have, was eliminated,” Howard said. “All the new participants are physicians whose input is obviously valuable, but a broader perspective is needed.”

She points out that the state opting out of the CDC’s Maternal Mortality Review Information App also happened under the radar. “It’s still not clear what the benefits are to having a Texas-created system that we haven’t seen yet. And we don’t know how it’s going to be different. Is it going to include additional information? Is it going to omit information? We don’t know.”

As for the new “urban community member” role Wilson applied for, DSHS told the Chronicle they received 19 applications. While the DSHS Commissioner Jennifer Shuford makes the appointments, a screening group made up of state employees and two members of the MMRC scored every applicant. Overall, Wilson was scored tenth out of 19.

Dr. Meenakshi Awasthi, a pediatric emergency medicine fellow at the University of Texas Health Science Center in Houston, is in the seat now. She has done advocacy around intimate partner violence, and holds a master’s degree in global policy studies from the UT-Austin, per a DSHS press release.

Wilson said she welcomes the addition of new doctors with varied experience, but said in the future it will be crucial for the composition of the committee to include non-academics and non-healthcare professionals who have themselves witnessed discrimination in obstetric care.

“It doesn't have to be me, and that’s an important distinction,” Wilson said. “But what are we losing when we don't have people representing community voice and who have lived experience?”