Central Texas has significant maternal health challenges, including the highest rate of maternal death among black women, in part because of barriers to health care coverage and because resources are underused, according to a report by the nonprofit Texans Care for Children.
Improving the health of mothers who have just given birth will require the improved use of existing services, increased education, the promotion of best practices, and an expansion of local programs, according to the report, "Healthy Moms Raising Healthy Babies."
"There is no 'silver bullet' for improving maternal health," the report said. "Addressing challenges of the postpartum year will require comprehensive, multi-system reforms at the health system, community, and statewide levels to ensure all Texas moms have the supports they need to stay healthy and raise healthy families."
The maternal health problems identified in the report mirror the situation statewide – as do the recommended interventions.
In 2012, the last year for which there is accurate data, Texas' maternal death rate was 14.6 per 100,000 live births, according to the Texas Department of State Health Services. While that put Texas slightly below the national average of 15.9 per 100,000 for 2012, as reported by the U.S. Centers for Disease Control and Prevention, the U.S. rate is alarmingly high compared with other developed countries.
African American women in Texas have the highest rate of maternal mortality at 27.8 per 100,000. That compares with 13.6 for white women and 11.5 for Hispanic women.
The report focused on the health of Texas mothers in the year after birth. It examined conditions in Bastrop, Caldwell, Hays, Travis, and Williamson counties. However, it also used data for the 30 counties in Texas Health and Human Services Region 7, which encompasses Central Texas.
Some problems were specific to Central Texas. For instance, the region's maternal mortality for black women is the highest in the state, at 61 deaths per 100,000 live births for 2012 to 2015, according to a presentation done when the report was released.
The report called for four major areas of action:
- Maximize existing state programs to improve health care services for women in the year before and the year after pregnancy, a top recommendation of the Texas Maternal Mortality and Morbidity Task Force. This includes extending Medicaid coverage for new mothers from 60 days to one year after birth and increasing access to community-based mental health and substance use treatment that serves Texans regardless of insurance status. It also includes identifying the best ways to use new federal funding under the Family First Prevention Services Act when it takes effect in Texas in 2021.
- Improve public awareness and training. Support public awareness campaigns like those for Healthy Texas Women and its Family Planning Program to increase the number of mothers using care before and after pregnancy. This also includes promoting training specific to maternal depression, using the expertise of local addiction and recovery experts, and investing in race-equity training for a range of professionals, from clinical staff to hospital administrators.
- Promote health system changes, including the implementation of TexasAIM in Central Texas hospitals and birthing centers. TexasAIM helps these facilities adopt best practices in caring for mothers and babies at birth and postpartum. Health facilities also need to consider ways to include behavioral health counselors on site at primary care or family planning clinics. Telemedicine visits and initiatives should be promoted whenever possible.
- Expand and support effective local programs. This can include increased investment in community health workers and promotoras as well as increased support for doula, or birthing coach, programs. This also includes expanding local child car seat donation programs so that more families can get child safety seats.
The Texas Medical Association has adopted an eight-point plan to address Texas’ maternal health crisis with the goal of eliminating deaths among pregnant women and new mothers. TMA’s statewide plan overlaps many of the action items in the Texans Care for Children report and the recommendations of the Maternal Mortality and Morbidity Task Force.