Texas must do better for moms and babies
About 1 in 10 births in the U.S. happen in Texas. So, it is a bit of good news for the state and the nation that Texas’ preterm birth rates declined slightly last year, along with rates from 32 other states.
But don’t celebrate on behalf of moms and babies just yet. Texas is still in the midst of a maternal and infant health crisis. With a preterm birth rate of 10.8 percent, too many babies are being born too soon. Too many moms experience complications during pregnancy and childbirth, and in the year after may die of causes related to pregnancy. In Texas, the maternal mortality rate is 6 percent higher than that of the U.S. overall.
To make inroads against this ongoing crisis, Texas must focus on equity and access to care. In Texas, as in the rest of the nation, Black and Indigenous moms and babies are suffering unequally. The preterm birth rate among Black Texans is 41 percent higher than the rate among all other women in the state. Across the United States, Black and Indigenous babies die before their first birthdays twice as often as white babies do.
Texas’ disparities in preterm birth among racial and ethnic groups have not budged in the last year, according to the March of Dimes’ annual report card on maternal and infant health. The state earned a D for preterm birth, as more than 1 in 9 babies in Texas are born preterm. Brownsville, Corpus Christi, Houston and San Antonio all earned Fs.
The Report Card also points out that in Texas, more than 1 in 5 women receive inadequate prenatal care, which means care begins in the fifth month of pregnancy or later or involves fewer than half of the appropriate number of visits. And 28 percent of Texas births are low-risk cesarean births — births to first-time moms, carrying a single baby, positioned head-first and at least 37 weeks pregnant.
Not all cesarean births can be avoided. But many women not at risk for medical complications have this procedure, which is associated with increased risk of problems like infections and blood clots, increased rates of NICU admission and newborn respiratory problems.
The pandemic has put pregnant Texans even more at risk. Pregnant people who experience COVID-19 symptoms are more likely to be admitted to the hospital or ICU than people who are not pregnant. And they and their babies may also be more likely to experience complications. While we are working to develop a greater understanding of latepreterm birth and the data during the COVID-19 pandemic overall, what we do know is that more research and real-time data collection are needed to better understand and track changes in preterm birth rates during the pandemic.
We commend Texas for the steps it has already taken to protect moms and babies. Since 2013, the Texas Maternal Mortality and Morbidity Review Committee has studied pregnancyrelated deaths, tracked trends and recommended ways to reduce preventable pregnancyrelated deaths and severe pregnancy complications in the state.
The Texas Collaborative for Healthy Mothers and Babies works to promote quality improvement interventions. These include increasing on-time access into prenatal care and reducing failed inductions of labor to ultimately reduce primary cesarean sections.
Texas also allows certified midwives and certified nurse midwives to practice, which makes prenatal and birth care available to more women.
And in San Antonio and Houston, March of Dimes is forming partnerships with the local community and public and private organizations to improve health outcomes for moms and babies through what is known as a Local Collective Impact Initiative.
There is still much more the state can do. This year, Texas passed legislation to extend postpartum Medicaid coverage from 60 days to 6 months in 2021. We urge Texas lawmakers to extend coverage further, to one year after birth, a period when maternal health complications — including mental health issues— continue to occur. And the state should pass Medicaid coverage for doula care, which supports women during pregnancy and birth and has been shown to improve access to care in underresourced areas and possibly improve birth outcomes.
Finally, Texas must acknowledge that present-day structures and systems, rooted in racist, biased and unfair policies and practices, contribute to and magnify racial differences in access to resources, social conditions and opportunities. These policies have systematically disadvantaged communities of color and low-income communities for generations and led to the inequitable maternal and infant health outcomes we see today. Leaders across the state must address inequities in transportation, housing, jobs and food. And health care leaders must commit to erasing bias and institutionalized racism from their systems, starting with implicit bias training for health care workers.
We all want moms and babies to thrive. Texas can do better, and it must.