The number of pregnancy-related deaths in the U.S. rose in 2020, the first year of the pandemic, according to a recent report from the Centers for Disease Control and Prevention. The report finds there were 23 deaths per 100,000 births, which is up from 20 in 2019. The report did not examine what role the pandemic played in the increase, but it could have been related to people delaying visits to health-care providers.
The report also cited racial disparities, as the maternal mortality rate for Black women was three times higher than for white women. The U.S. has the highest maternal death rate among developed countries and is the only industrialized nation where the numbers are increasing. (See factsheet.)
Black women in Texas are “disproportionately” impacted as they account for 11% of live births but 31% of maternal deaths. Texas has the highest number of uninsured residents in the U.S. and the highest percentage of uninsured women of childbearing age. Black women have higher rates of preterm birth, low birthweight, and increased infant mortality, according to Babyscripts, a virtual maternal care company. Black women are most likely to be uninsured, fall into coverage gaps when Medicaid is not expanded, and experience higher rates of chronic disease. The upcoming Black Maternal Health Week (April 11-17) will focus on these challenges in maternal health.
Some leading causes of maternal death include infection, hemorrhage, preeclampsia, and cardiovascular conditions. Studies indicate 80% of maternal deaths are preventable. Symptoms include severe headaches, dizziness, vision impairment, fever, swelling in the hands or face, depression, vaginal bleeding, suicidal thoughts, and difficulty breathing. If you have friends with these symptoms, listen to their concerns and encourage them to seek immediate care. You can also offer to go with them to the provider and talk with the doctor.
A Texas maternal mortality and morbidity review committee in 2013 found approximately one-third of pregnancy related deaths in Texas in 2013 occurred 43 days to a year after the end of pregnancy. The committee also discovered that a very high percent of these deaths could have been prevented. Since 2016, the committee’s most important recommendation has been to extend Medicaid postpartum coverage for low-income mothers to a year. The American Medical Association and the American College of Obstetricians and Gynecologists advocate for longer postpartum care.
To address maternal deaths, the American Rescue Plan Act, signed into law by President Biden in 2021, allows states to extend Medicaid coverage for a full year postpartum. Texas’s most recent legislative session addressed postpartum coverage. The state House passed a bill to extend our postpartum coverage to 12 months — meaningful legislation to address disparities in maternal health care. Unfortunately, the legislation was modified in the Texas Senate to reduce the coverage to six months. While we are glad to have increased maternal coverage, the legislation fell short of what is needed in Texas, though allowed by Medicaid. Dallas House member Toni Rose said, “When it comes to saving lives of Texas mothers, ‘splitting the difference’ is not appropriate.”
When our legislature convenes next year, two items will save lives in Texas: extending postpartum coverage to 12 months and expanding Medicaid coverage to approximately 1.5 million Texans. Many of these uninsured residents are people of color and the most vulnerable to maternal mortality.
We can help the maternal mortality problem in Texas by working collaboratively for increased health-care coverage, access, and outcomes for the good of all Texans.
Stephen Love is President/CEO of the Dallas-Fort Worth Hospital Council.