New policies are vital to cut maternal deaths
The statistics on maternal mortality in Texas are staggering. For every 100,000 live births, there are between 14.6 and 18.6 maternal deaths. Among black women, who are still severely disproportionately affected, the rate leaps to 27.8 maternal deaths per 100,000 live births.
These numbers, according to data published in the Journal of Obstetrics & Gynecology last year, were both astounding and unacceptable to the medical community. A key fact to remember about maternal mortality is more than 60 percent of deaths occurred after 42 days post-delivery. That statistic highlights the importance of continuous Medicaid coverage for new moms and their children, which several House and Senate bills aim to achieve.
As the legislative sessions rapidly comes to a close, the clock is running out on these bills. That does not mean we should stop working on a solution to make sure Texas mothers and their children have access to life-saving care.
Two things we do know about deliveries and maternal mortality in Texas: first, more than 50 percent of births in Texas are covered by Medicaid; second, a large portion of women covered by Medicaid do not have access to health care prior to pregnancy. Not surprisingly, delayed access to quality obstetrical care, increasing maternal age and low socioeconomic status are all contributors to maternal mortality. black women in all socioeconomic groups are bearing the burden of maternal mortality nationally, with rates two to three times higher than their white and Hispanic counterparts. Maternal mortality doesn’t just happen. It’s usually preceded by severe maternal morbidity, which often arises from underlying medical conditions such as hypertension, diabetes or heart disease. The Texas Maternal Mortality and Morbidity Task Force, a collaborative of more than 50 leaders chosen to address poor maternal health outcomes in our state, has worked tirelessly to outline the gravity of the problem and determine solutions.
The task force illuminated several important concepts. The leading causes of maternal deaths are drug overdose, heart disease, homicide and suicide. Medical conditions such as hypertensive disorders, hemorrhage and sepsis are also linked to maternal deaths.
For the last year, one of us, Dr. Erica Giwa, participated in the work group tasked with reducing maternal mortality. The team outlined potential improvements in data collection, developed an awareness campaign to improve postpartum maternal support and addressed ways to improve hospital best practices.
We also began to understand the significance of a shift in the mindset of the medical community and the community at large: Care for mothers does not end immediately after delivery. The finish line isn’t reached when we hold that newborn in our arms. The data indicate that to provide the best care for mothers and their babies, we need to move our finish line out at least 12 months.
Think of it this way: Clinicians are in the community providing the best care possible for our patients. We spend the months of prenatal care emphasizing the importance of blood sugar control, blood pressure monitoring and reporting any abnormal symptoms to the provider. We deliver the baby and continue the message for another 60 days. Then on Day 61 … radio silence. We don’t fall silent because we want to. We fall silent because their Medicaid coverage ends.
Without coverage, we can’t continue to refill the blood pressure and blood sugar medications mothers need to prevent long-term complications or diseases. We can’t make the referrals to specialists that are needed to help with maintenance of chronic diseases. We can’t make sure mothers receive the postpartum care they need. The bills lawmakers are now weighing help us better care for Texas families.
They move the finish line to that 12month mark for mothers enrolled in Medicaid. They would make it possible for children to remain covered by eliminating the spot checks on income, extending the timeframe to attest to Medicaid qualifications, and keeping children enrolled. Where one aims to ensure that low-income children maintain full coverage, a separate bill complements this goal by bridging the gaps in maternal health coverage and synchronizing it with the Healthy Texas Women’s program.
In the final days of the 86th legislature, we urge lawmakers to support bill language that lengthens the coverage period offered to new mothers in Medicaid and streamlines the income verification process for children enrolled in the program. These policies are a longterm investment in the health of Texas families. At the end of the day, we should provide Texas mothers and children with the coverage and care they need to raise a healthy family and continue their path of health and self-sufficiency.