Two maternal health wake-up calls for state leaders

When Texans are getting ready to have a baby, they may wonder about car seat options, if their baby will grow up to play soccer, what they can do to ensure their child will succeed in school, and many other questions big and small.

But recent reports on two separate yet intertwined subjects show that pregnancy is also a prelude to tragedy for many Texas families and — because of our state’s inadequate maternal health policies — a time when many children’s long-term health and development is likely compromised.

First, reports by The Texas Tribune and University of Maryland and Boston University researchers shed more light on our state’s startling maternal mortality crisis. The latter report uncovered some flaws in the state’s data but confirmed an increase in the number of Texas women dying during pregnancy, childbirth, or the first weeks after delivery.

Then, the University of Texas System and UT Health Northeast released a report showing that the state’s infant mortality problem is worse than the statewide data suggests. Their research shows that disturbingly high numbers of babies are dying before age 1 in several communities. For example, they found high infant mortality rates in particular Fort Worth ZIP codes and among white women in certain parts of Longview and Wichita Falls, black women in certain parts of Houston, and Hispanic women in certain parts of San Antonio.

It is a tragedy each time a Texas child is left to grow up without a mother or a family lowers a tiny casket into the ground.

But those tragedies also signal a broader policy problem. For each of these deaths, there are many more cases in which the mom and baby survive but the lack of support for healthy pregnancies and postpartum care in Texas means that more children grow up in our families, our schools, and our communities with disabilities, developmental delays, or other challenges.

The maternal and infant mortality rates both have some distinct causes and solutions, such as improving delivery protocols to reduce pregnancy complications and investing in proven home visiting programs to prevent tragic infant injuries.

However, improving women’s access to health care must be at the heart of efforts to save the lives of mothers and babies and to ensure that more children get a healthy start to life.  

Major causes of maternal deaths in Texas are often linked to overdose or a lack of access to health care before, during and after pregnancy. In the case of infant mortality, the leading cause in Texas is birth defects. For our state’s black families, who are twice as likely to lose their babies compared with other Texans, the leading cause is babies being born too early or too late. Inadequate prenatal care and short intervals between pregnancies lead to higher numbers of these birth defects, preterm births, and low birth weight babies.

Texas moms often have difficulty getting prenatal care and other help they need for a healthy pregnancy because of our state policies. Texas Medicaid typically doesn’t cover working-age adults unless they have a disability or they’re pregnant, making it harder for women to manage health conditions before they are pregnant. Uninsured women can’t begin the Medicaid application process, much less start scheduling a prenatal appointment with an Ob-Gyn, until after they know they are pregnant. In a state still recovering from huge cuts to family planning, many pregnancies are unintended and therefore identified later, further delaying prenatal care. Two months after delivery, Texas cuts off the mom’s Medicaid. For women addicted to opioids or other substances — either before, during, or after pregnancy — access to treatment programs is limited.

State leaders have recognized some of these challenges. Last year, they took some small steps, maintaining funding for family planning through the Healthy Texas Women program, continuing the state task force that studies maternal mortality, expanding access to postpartum depression screenings, and instructing legislative committees to spend 2018 looking into some of these issues, including substance use.

But, at a time when many politicians would like to cut critical health programs or create new hoops for Texans to jump through to stay eligible, Texas leaders should instead ensure that our state’s maternal health programs and policies meet the needs of women, babies, and the next generation of Texans.

The University of Texas has been a financial supporter of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune's journalism. Find a complete list of them here.

Adriana Kohler

Senior health policy analyst, Texans Care for Children

@AKohlerTX

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