Texas Maternal Mortality Rate Soars
Local health department examining deaths: Is the Lege to blame?
By Mary Tuma, Fri., Sept. 9, 2016
Two recently released back-to-back studies showing unusual jumps in maternal deaths in Texas are drawing concern over women's health, and moving the local health department to examine its own figures on mortality rates.
One study, published by researchers from Boston University, the University of Maryland, and Stanford, found that after 2010, the maternal mortality rate in Texas doubled within a two-year period to "levels not seen in other U.S. states." (Maternal mortality is a pregnancy-related death from causes related to the pregnancy, excluding accidental or incidental causes.) In 2010 the rate was 18.6 per 100,000 live births, but by 2013 that jumped to 36.1. Comparatively, the U.S. maternal mortality rate was 23.8 deaths per 100,000 births in 2014 (excluding California and Texas). The steep rise is difficult to explain in "the absence of war, natural disaster, or severe economic upheaval," researchers concluded.
Bolstering those findings, a 15-member state task force similarly showed an alarming increase in maternal mortality, and moreover, found that black women "bear the greatest risk" for maternal death. While black women accounted for only 11.4% of all births in Texas, they made up 28.8% of all maternal deaths. "One of the most important findings is the disparity in maternal mortality among African-American women, who are at the highest risk for death. That imbalance is a major problem that needs to be addressed," Dr. Lisa Hollier, chair of the Maternal Mortality and Morbidity Task Force and professor of obstetrics and gynecology at Baylor College of Medicine, tells the Chronicle. Her group plans to delve deeper into the stats for more information on the societal and medical factors accounting for the stark figures.
So what's going on? The obvious culprit for the startling death rate is the Texas Legislature's deep and politically motivated slashes to family planning in 2011, which led to the closure or reduction in services of more than 80 health clinics. There's also the sustained destruction of the women's health care safety net, which includes the removal of providers like Planned Parenthood from Medicaid programs that offered exams and basic preventative care like screenings for diabetes, high blood pressure, and cancer. But researchers are hesitant to draw a direct link, saying the problem is more complex. While the first study noted changes in women's health services in Texas from 2011 to 2015, including the closure of several clinics, they refrained from attributing the high rates to the cuts, saying they plan to further examine the Texas data to "better understand this unusual finding." Hollier, who called the cuts "significant," also strays from drawing any causation.
However, others feel more certain the Lege's decimation of women's health is at least partly to blame. Researchers with the Texas Policy Evaluation Project (TxPEP), a UT-Austin based multiyear study tracking the impact of state policy on reproductive health, conclude that the spike in deaths is "partially a consequence" of the severe cuts to family planning services made by the Lege. In a joint op-ed for local dailies, Dr. Joseph Potter and Kari White argue that as more women experience unplanned pregnancies due to strained contraception access and fewer options for abortion care, their risk for pregnancy-related complications has also risen.
What else should be considered: The state task force reported cardiac events, drug overdose, and hypertension/eclampsia as the top three reasons for maternal deaths. They also noted that most maternal deaths occurred later than 42 days after delivery, in the hands of postpartum care, where some of those leading causes of deaths may have been detected. With so many shuttered clinics in local communities, it's feasible women could not reach a provider. Additionally, Medicaid benefits for many mothers run out two months after delivery, and in a state that refuses to expand Medicaid under the Affordable Care Act, coverage could be a possible contributing factor atop the clinic closures.
"When women get sick, a lot of them just don't go back for postpartum checkups. If they do, they usually go to some outpatient clinic that may be either closed down or working reduced hours – that's when you've got a problem," Potter tells the Chronicle. (He stresses that his comments can only be taken as speculation and is "exchanging ideas" with the researchers in ongoing talks.)
Dr. Philip Huang, medical director and health authority for the Austin/Travis County Health and Human Services Department, says the statewide numbers are a cause for alarm. He says that in light of the recent studies, his department is examining local stats on maternal mortality. The number of maternal deaths in Travis County is relatively low; from 2010 to 2014, there were 17 maternal deaths, according to Texas Department of State Health Services data. As of now, there isn't detailed information on the cases from which to draw conclusions, but the local health department hopes to take a closer look into the numbers to detect the sorts of trends found on the statewide level. Unofficially, Huang says the leading causes of local maternal mortality over multiple years were indirect obstetric death (circulatory system disease, for example), hypertension, and eclampsia. "We certainly want to follow what the state is finding in terms of possible reasons for maternal deaths and see if that relates to what we're seeing here locally," says Huang.
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