Being pregnant in Texas should not be this dangerous

Texas' Maternal Mortality and Morbidity Review Committee recently released its report on deaths that occurred during the time from pregnancy through 12 months after pregnancy. The report showed that more than 50 Texans – an unacceptably high number – died for reasons directly related to pregnancy in 2019. Many others experienced severe pregnancy complications that, while not fatal, can lead to long-term maternal health consequences.

Although the committee found that there were often multiple reasons for a pregnant person's death, more than half of the contributing factors occurred at the provider, health care facility or health systems level – meaning greater responsibility lies in the systems people interact with than their individual choices. With 90% of these pregnancy-related deaths considered preventable, higher than national reports, state-level policy changes are needed to address these heartbreaking statistics.

Another key takeaway from the report: Deaths and severe complications occur disproportionately in Texas' Black communities and among those who lack private insurance.

As public policy and disparities scholars, we are not surprised by these findings. Research clearly shows the ways that unequal access to quality care and structural racism undermine people's health and well-being before, during and after pregnancy.

Texas has the highest rate of uninsured residents because state policymakers have not expanded Medicaid, but Medicaid expansion is supported by most Texans and has been shown to reduce maternal mortality. Comprehensive Medicaid coverage would help people manage health conditions that, if left untreated, can increase their risks of pregnancy complications. Coverage could also provide access to treatment for depression and substance use disorders, which are common causes of pregnancy-related death.

According to our research, women of color with no insurance or public insurance are more likely to report barriers to health care than white women are. In another study, we found that low-income Texans frequently reported acute and ongoing postpartum health conditions that they were unable to address because they were left uninsured 60 days after delivery, when their Medicaid or CHIP coverage ended.

With more than 1 in 4 pregnancy-related deaths in Texas taking place between two and 12 months postpartum, Texas should extend publicly funded insurance coverage for all low-income Texans for one year after delivery. Twenty-seven states have done this. Why not Texas?

Texas also could do more to address discrimination, which accounted for 12% of deaths. Efforts are needed to engage with and listen to the calls of Black female advocates to expand access to doulas, who have been shown to improve pregnancy outcomes.

Another reason these health indicators will continue to head in the wrong direction: Texas' laws criminalizing abortion except in medical emergencies, laws that were implemented in 2021 and 2022 and are not supported by the majority of Texans. Maternal deaths, such as those from ruptured ectopic pregnancies – the leading cause of pregnancy-related death from hemorrhage in 2019 – are expected to increase because physicians are afraid to provide essential medical care. Texas' abortion bans will also lead to more cases of severe pregnancy complications. Our research and other reports demonstrate that fear of legal repercussions has forced physicians to delay care for pregnant people experiencing premature rupture of membranes, which can lead to sepsis – a life-threatening infection that was already on the rise.

It should not be this dangerous to be pregnant in Texas. State leaders need to take bold actions and adopt policies that are supported both by evidence and by the majority of Texans. They can start by extending Medicaid coverage for 12 months after pregnancy ends and passing legislation to fairly compensate doulas for all who want them. A Texas that ensures that pregnancy and the postpartum period is safer for all residents – and especially for Black and low-income Texans – can't come soon enough.

Vohra-Gupta is an assistant professor in the Steve Hicks School of Social Work at the University of Texas.

White is an associate professor in the Steve Hicks School of Social Work.

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Shetal Vohra-Gupta and Kari White

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