Texas maternal death rate study postponed until mid-2023

Texas health officials missed a key window to complete the first major updated tally of pregnancy-related deaths in nearly a decade, saying the results will now be released next summer, most likely after the biennial session of the Legislative Assembly.

The delay, disclosed earlier this month by the state Department of Health Services, means lawmakers likely won’t be able to use the analysis, covering deaths from 2019 through the 2025 legislative cycle. The data the most recent available at the state level are nine years old.

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During a hearing this month with the state’s Maternal Mortality and Morbidity Review Board, DSHS Commissioner Dr. John Hellerstedt said the agency wants to better align its methodology with that of the other states, and that there were not enough personnel and money to complete the review for a scheduled September 1 release.

“The information we provide is not easy to understand and is not readily and readily comparable to what is happening in other states,” Hellerstedt told the committee. “And the fact that they’re not easily understood or easily compared in my mind leaves room for a lot of misunderstanding about what the data actually means.”

In a statement, DSHS spokesman Chris Van Deusen said the agency was reviewing its “internal processes” to try to develop more timely data.

“I expect we will have conversations with lawmakers about what could be done to expedite the lengthy review process,” he said.

The setback comes four months before the start of the legislative session and two months before the midterm elections, which were dominated in part by the new Republican-led abortion ban. These restrictions have placed greater scrutiny on the state’s maternal mortality rate, which is among the 10 highest in the nation, according to national estimates that track pregnancy-related complications during pregnancy or in the year following pregnancy. ‘childbirth.

“Many of us want to know if pregnancy in Texas is a death sentence,” said state Rep. Ann Johnson, a Democrat from Houston and a member of the Texas Women’s Health Caucus. “If we have a higher maternal mortality rate, we certainly want to understand that. You can’t figure out if someone is sitting on the numbers, and that’s my concern.

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As in other states, maternal outcomes in Texas are worse for black women, who died about three times as often as non-black women. This year’s findings were expected to dig deeper into the causes of these disparities.

Rep. Shawn Thierry, a Democrat from Houston who described his own experience of unsafe childbirth, said data is key to understanding the role cesarean sections play in maternal deaths and whether implicit bias plays a role in quality. maternal care for blacks. women.

“There’s so much to discover from the data,” Thierry said, adding that “no woman who chooses life should have to do so in exchange for her own.”

Members of the state maternal mortality committee, which is compiling the official report, said they were disappointed with the decision to hold the preliminary findings.

“(We) do the work to honor the lives of women who have lost their lives and families who are forever touched by the loss of a mother,” said Dr. Carla Ortique, chair of the committee. “So there is disappointment on both fronts: that we are not honoring these women and families, and that we could negatively impact efforts to improve maternal health outcomes in our state. “

Ortique said the state had already identified 149 potential maternal deaths in 2019, 118 of which were analyzed by the committee to see if they were pregnancy-related. Six newly identified deaths could be added to this group, she said. The figures cover deaths during pregnancy up to one year after delivery.

The state has released a report on maternal deaths every two years since 2014, often based on preliminary data updated later. For example, the report on maternal deaths in 2018 identified 29 deaths in 2012 that were not included in the previous report. The committee also released updated findings from its most recent report, studying the 2013 deaths, at the September 2 meeting.

Of 175 potential maternal deaths in 2013, 70 have since been determined to be pregnancy-related.

The state collected the updated numbers as part of the requirements for a new CDC grant, awarded to DSHS in 2019. The balance, advocates say, is making sure the data is as accurate as possible. , but also published quickly enough to be useful to researchers and policy makers.

The reports typically come with far-reaching recommendations to improve maternal health in the state, including extending Medicaid to one year postpartum, proactively treating chronic conditions, and addressing the disproportionately high number of deaths. mothers in black women.

Texas extended Medicaid coverage for pregnant women up to six months after childbirth or miscarriage, but the state declined to extend coverage to the recommended 12 months.

The unexpected delay has frustrated advocates, who are gearing up to push Republicans in the Senate and the governor to support the full 12-month extension, as many other states have done.

“State leaders will be able to make better policy decisions for Texas mothers if they have more recent data on maternal deaths as well as health issues such as infections or postpartum depression that new mothers face in Texas,” said Diana Forrester, director of health care. policy of Texans Care for Children.

Republican leaders, including Governor Greg Abbott, who is running for re-election, celebrated the overturning of federal abortion protections this summer by the U.S. Supreme Court.

Many have pledged to increase resources for pregnant women and new mothers. A spokesperson for Abbott did not respond to a request for comment. Republican House Speaker Dade Phelan, who supports the 12-month extension, criticized the delay, saying it “comes at a time when Texas needs to support moms and families.”

“Our work will begin with the passage of legislation that will further extend postpartum health coverage for new mothers in Texas to a full year, which our chamber overwhelmingly approved in 2021 and I believe he will do it again next year,” Phelan said in a statement.

In addition to providing up-to-date recommendations for lawmakers, the report also helps nonprofits compete for grants that support new or pregnant mothers, said Nakeenya Wilson, an Austin-based maternal health advocate and member state maternal mortality committee.

Her group, the Maternal Health Equity Collaborative, used data from past reports to win a $1 million grant that provides child care to new mothers in central Texas.

“If they don’t have the most up-to-date information, we risk disenfranchising some of the most vulnerable in our state,” she said.

Johnson said the delay was “unacceptable” given the high maternal mortality rate.

“This is a crisis that we claim for bipartisan reasons for wanting to investigate,” Johnson said. “And yet here we’re told at the last minute on the date the report was supposed to be due, ‘Sorry, we couldn’t get there.'”

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Jacob L. Thornton