State, feds must address postpartum depression
For pregnant women in America, there is no more dangerous state than Texas. While U.S. Sens. John Cornyn and Ted Cruz push proposals on the federal level that would cut Medicaid and take away access to maternity care, the state they are supposed to represent remains the deadliest in which to give birth, and the deadliest state for new mothers.
Last year, the maternal mortality rate was found to be rising in the United States, despite death rates dropping by nearly half in the past several decades globally — with Texas leading not only our country, but most of the developed world, in the number of women who die from pregnancy-related complications during or up to a year after birth.
There is a devastating story to tell for every one of these maternal deaths. Several years ago, one of us, Donna Kruezer of Austin lost her daughter, Kristi, to postpartum depression — found to be a leading cause of maternal mortality by the Texas Maternal Mortality and Morbidity Task Force. Kristi had hidden her condition for weeks, trying to be strong and all too aware of the stigma that comes from mental illness.
In April, we testified before the Texas Legislature in support of a bill that would have helped address this crisis. In addition to keeping the task force running, the bill would have directed the state to examine ways to lower the rate of maternal mortality, including treatment for postpartum depression for low-income women. While Donna shared her daughter’s story, I discussed the public health and economic consequences of maternal death. What I didn’t tell the state Legislature is that I had just found out I was pregnant with my first child.
In the aftermath of her personal tragedy, Donna has become a powerful advocate for all mothers in Texas suffering from postpartum depression, serving as a board member of Pregnancy and Postpartum Health Alliance of Texas. Donna often says she is doing the work that Kristi would have done if she had survived. As she spoke to lawmakers about her daughter, who sounded so much like me — a lawyer with a loving family, focused on addressing social inequalities — I imagined myself in Kristi’s place.
The New York Times has called the record number of maternal deaths in Texas “shocking.” Many of Texas’ leaders have claimed to feel the same — including an “alarmed” Gov. Greg Abbott. But the bill Donna and I testified in favor of was blocked in the final days of the legislative session because some at the Texas Capitol insisted on passing a bathroom discrimination bill. Among our U.S. senators attempting to repeal the Affordable Care Act, the subject hasn’t come up.
On the state level, the bathroom-focused legislators ran out the clock and got their wish of another chance to pass their bill: A special session of the Texas Legislature, which began last week. The silver lining is that maternal mortality also has a chance to be considered again.
State policymakers did advance some legislation on postpartum depression — incremental, though still vital, steps forward. But in addition to failing to pass the bill Donna and I testified about, the Legislature neglected to send any proposals to the governor that would have actually provided for greater coverage for the treatment and care of women struggling financially. And the U.S. Senate’s “health care” proposal would only worsen mortality rates.
Kristi’s condition was identified too late, even though she and her family had the means to pay for treatment. Donna told me she shudders to think, however, of the many other women who may even receive a timely diagnosis but do not have the ability to access care. And there are many. Even if the Senate health-care proposal never goes into effect, parents of two children in Texas must earn less than $386 a month to qualify for Medicaid coverage. The monthly income of a family of four living at the federal poverty level is $2,050.
Maternal deaths affect families of all incomes, races and ethnicities, but there are clear disparities that should serve as guideposts for state lawmakers.
The state has found that African-American and low-income women are disproportionately likely to experience maternal death. These women didn’t want to die any more than Kristi wanted to — or than I do, as I spend my evenings reading up on swaddling techniques and sleeping schedules.
Expectant parents everywhere worry about coping with the newborn months. Too many mothers-to-be in Texas, however, must also wake up worried about whether they will even survive those months. This reality cannot continue. The U.S. Senate — including Cornyn and Cruz — must drop their attack on the health care of financially struggling families and women.
And the state must use the special session to pay more than lip service to the issue. Our federal and state officials have a responsibility to turn their supposed concern over the deaths of Texas mothers into meaningful, life-saving action.