Becoming a new mother is a time of celebration and joy. Yet for many Texas women the journey to motherhood can be perilous and potentially deadly.
According to new data from the state’s panel of maternal health experts, too many women die during pregnancy or in the year following, though 9 in 10 of these deaths were potentially preventable.
Black women account for 31% of maternal deaths but only 11% of births. For every maternal death, 50 to 100 women suffer a severe illness or complication that can interfere with a new mother’s ability to care for her child, which may influence the child’s development.
Many factors contribute to poor maternal health such as chronic health conditions, care delivery, poverty, and community. Each must be addressed by community stakeholders through collective and complimentary efforts. But the number one factor the state can address is ensuring women have access to comprehensive health care coverage across their reproductive lifespans.
Healthy pregnancies do not begin at conception, but in the months and years before. Once a woman gets pregnant, it is much harder – and more expensive – to manage a chronic condition. Conditions such as diabetes and hypertension can result in serious pregnancy-related complications and birth defects, even if the mother received early prenatal care. Likewise, women need ongoing treatment throughout the “fourth trimester” – the year following delivery – to identify and treat any underlying chronic health conditions or complications.
Pre-pandemic, 25% of Texas working-age women lacked health insurance – a number that has grown as a result of the COVID-19 economic fallout. Too often, uninsured women struggle to obtain the care they need. Medicaid provides coverage during pregnancy, but its coverage ends 60 days postpartum, coinciding with the timeframe in which nearly 1 in 3 maternal deaths occurs.
Before and after pregnancy, the state’s women’s health programs – the Family Planning Program (FPP) and Healthy Texas Women (HTW) – fill important gaps in preventive and primary care. HTW Plus, launched in Sept. 2020, builds on HTW by providing one year of specialty care coverage for the three conditions and illnesses most likely to contribute to maternal mortality or morbidity: postpartum depression, cardiovascular and other coronary conditions and substance abuse disorders.
Women living in states with comprehensive health care coverage have better health outcomes, including fewer maternal complications and deaths.[5, 6, 7] Recalibrated, HTW Plus could become the backbone of such a program for Texas women, ensuring access to a full array of benefits across their reproductive lifespans.
Health inequality , the “health differences that are avoidable, unnecessary, and unjust, further undermines maternal health and increases health care costs. Women of color and low-income women suffer disproportionately from these health disparities, including higher chronic disease burden and less timely care. Health care coverage throughout a woman’s lifespan greatly diminishes these gaps, resulting in better health care outcomes for mothers and infants. But health care alone does not improve health Texas also must address the non-medical factors, such as food insecurity, unsafe housing, domestic violence, and systemic racism, that make motherhood unnecessarily risky for too many women.
TMA's Legislative Recommendations:
- Extend comprehensive coverage to low-income uninsured working-age parents and adults.
- Build on HTW Plus to provide 12-months comprehensive postpartum coverage.
- Maintain robust funding for Texas’ women’s health programs.
- Preserve funding for TexasAIM, a state-run collaborative with hospitals, physicians, and nurses to advance the adoption of proven maternal safety protocols.
- Reduce health inequality by screening, connecting, and coordinating care across medical and social domains throughout a woman’s lifespan.
 Texas Maternal Mortality and Morbidity Review Committee and Department of State Health Services Joint Biennial Report, Sept. 2020
 Obesity and Pregnancy, American College of Obstetricians and Gynecologists
 ibid. Data are for the year 2013, the most recent cohort reviewed by the review committee.
 High Rates of Perinatal Insurance Churn Persist After The ACA, Jamie Daw, Katy Backes Kozhimannil, and Lindsay K. Admon, Health Affairs, Sept. 2019
 Effects Of Medicaid Expansion On Postpartum Coverage And Outpatient Utilization, Sarah H. Gordon, Benjamin D. Sommers, Ira B. Wilson,and, Amal N. Trivedi, Health Affairs, Jan. 2020
 Adoption of Medicaid Expansion is Associated with Lower Maternal Mortality, Erica L. Eliason, MPH, Women’s Health Issues, Feb. 25, 2020