A long-awaited report by the Texas Maternal Mortality and Morbidity Review Committee on maternal deaths in the state was released Thursday night, confirming the fears of birthing justice advocates concerning disparities in pregnancy outcomes faced by Black women in Texas.
The Texas Department of Health Services information includes data and statewide trends related to pregnancy deaths from 2016 to 2020. During a Dec. 9 meeting, the committee warned about unnecessary deaths and disparities that would be highlighted in the data.
Severe medical complications from pregnancy and childbirth increased significantly between 2018 and 2020, ranging from 58.2 to 72.7 cases per 10,000 deliveries in Texas.
The report determined that discrimination contributed 12% of pregnancy-related deaths in 2019. This was the first report since the federal Centers for Disease Control and Prevention added discrimination, including structural and interpersonal racism, as a potential cause of maternal death. The report said that the specific nature of discrimination varied between the cases identified by the committee and did not show a specific trend.
“We also know that disparities persist in maternal mortality with non-Hispanic Black women being the most disproportionately impacted,” said Department of State Health Services representative Dr. Manda Hall, one of the committee members to speak on the forthcoming reports’ findings.
The delayed report comes months after the Society for Maternal-Fetal Medicine threatened to sue Texas for withholding information. Democracy Forward, a legal non-profit representing the group, issued a statement on Thursday in reaction to the report.
“The failure of DSHS to release this report in the timeframe required by law is the latest example of the Abbott Administration’s apparent belief that it is above the law,” said Skye Perryman, President & CEO of Democracy Forward, in a statement. “It shouldn’t take being threatened with a lawsuit to do what the state legally requires for the health of mothers in Texas. As our clients review the joint report closely, we encourage Governor Abbott, Lt. Governor Patrick, and Texas lawmakers to finally step up and protect the health of all Texans, especially Black women, whom the report shows disproportionately experience adverse maternal health outcomes.”
For example, according to the report, despite obstetric hemorrhages decreasing statewide, the rate of severe maternal morbidity increased in Black women. Moreover, the report states that discrimination contributed to 12 percent of the reviewed 2019 pregnancy-related deaths.
Like past reports, Black women were disproportionately impacted in every severe maternal morbidity rate from 2016-2020. Hispanic women were also negatively impacted by pregnancy-related deaths from COVID-19.
According to the Center for Disease Control’s latest statistics, Black women are three times more likely to die from a pregnancy-related cause than white women, such as ectopic pregnancy. Various factors contribute to these statistics, including inadequate healthcare, underlying conditions, structural racism, and implicit bias by healthcare providers.
Birthing Justice Advocate Qiana Arnold from The Afiya Center, a reproductive justice organization, believes Texas’ maternal mortality report may have been held intentionally until after November’s midterm elections. Arnold also expects the numbers reflected in the coming report to be worse than past figures due to the COVID-19 pandemic. Foremost in her thoughts is a desire for the U.S. healthcare system to address systematic racism she says contributes to disparities in maternal outcomes.
“It’s no reason why rich, poor, old, young, fat, insured moms, moms on Medicaid, Black folks are just not doing well when they’re having their babies,” Arnold said. “So many Black folks go in to have their children, and they’re never the same afterward, or they leave with lifelong health issues.”
In 2020, the maternal death rate for Black or African-American women was disproportionately higher than those seen in white, non-Hispanic women—53.3 deaths per 100,000 live births versus 19.1 per 100,000 live births, according to a U.S. Government Accountability report.
“We have to look at race because, at this point, we’ve looked at everything else,” Arnold said.
Statewide maternal mortality data reflects national trends, with Black women as a demographic being the likeliest to die in childbirth or have pregnancy-related deaths.
Arnold added that regardless of socioeconomic status, or education, Black people still die at alarming rates during and after birth.
“The report is going to help us more realistically see that the only thing that most of the highest number of folks who did not survive have in common is the fact that they’re Black,” Arnold said. “It’s not their Blackness that’s causing them to die; it’s this system’s reaction and connection to their Blackness that’s causing them to die.”
According to a 2022 March of Dimes report, which grades states on the health of mothers and infants nationwide, Texas received a D- while Houston and Harris County received an F. The grades were based on the region’s high pre-term birth rates, infant deaths, insufficient prenatal care, social vulnerability factors and state policies.
As a certified doula, which is a trained labor assistant who provides physical and emotional support through pregnancy-related life stages, Arnold said she has witnessed firsthand in hospitals how her white clients are treated compared to how her Black clients are treated. She recommends Black pregnant people advocate for themselves in the birthing room, have a doula or another person they trust, educate themselves, and listen to their bodies.
“Tap into community, be brave and advocate for yourself, ask questions and listen to your gut,” Arnold said.