Spring - Klein Edition | June 2022



COMMON CAUSES OF MATERNAL MORTALITY Cardiovascular and coronary conditions, mental disorders, obstetric hemorrhage, preeclampsia and eclampsia, infection, embolism, cardiomyopathy and pulmonary conditions accounted for 82% of maternal deaths in Texas.

The rate of severe maternal morbidity, or health problems resulting from pregnancy and childbirth, in Harris County was 238 per 10,000 deliveries in 2015— about 20% higher than the Texas average. Of women in the Houston-The Woodlands-Sugar Land MSA surveyed in 2020:

Cardiovascular and coronary conditions (13%) Mental disorders (13%) Obsteric hemorrhage (11%) Preeclampsia and eclampsia (11%)

Deaths while pregnant Deaths within 42 days after delivery Deaths 43 days to a year after delivery



20% 27.5% 75.5%

Infection (11%) Embolism (11%) Cardiomyopathy (6%) Pulmonary conditions (6%)

are considered overweight or obese based on body mass index.

have been diagnosed with diabetes.

have been diagnosed with a depressive disorder.

have been diagnosed with

had a routine checkup in the past year.

high blood pressure.*



*2019 SURVEY

Robin Townsend said while Texas ranked in the middle of the country when it came to the quality of infant and maternity care, Texas had the lowest percentage of women ages 18-44 with insurance coverage at 73.6% and the lowest percentage of women who had access to a primary care provider at 57%. “So not only are they not able to access a primary doctor, but they really don’t have a lot of options for paying for that,” she said. According to the U.S. Census Bureau, 20.4% of Harris County res- idents were uninsured in 2020 com- pared to 17.3% statewide and 8.7% nationwide. Locally, 14.15% of Spring- area residents were uninsured. “The way mortality is ranked for both mothers and infants, there are what we would consider provider causes and then there are what’s con- sidered nonprovider causes,” Brown said. “For Black moms, the provider causes, unfortunately, are higher than they are for our white mom counter- parts, and I think that speaks a lot to the inequity in the social systems and the support around our Black moms and our Black babies.” ZIP code 77068 had among the high- est rates of severe maternal morbidity between 2014-16, according to a study from The University of Texas Health Science Center at Tyler. About 21.9% of the 77068 population is Black, and 14.5% of 77068 residents were unin- sured in 2020, per census data. A single woman making less than $26,916 a year—a threshold nearly 30% of one-person households in the Houston-The Woodlands-Sugar Land metro area falls below—could qualify for Medicaid to cover prenatal visits, labor and delivery, and checkups up

cardiomyopathy and pulmonary con- ditions accounted for 82% of maternal deaths in Texas. “We know what we see as far as those leading causes of maternal death, and we also know that there are speci c groups that bear the great- est burden of maternal mortality, meaning … Black women,” Hall said. The national maternal mortality rate was 23.8 per 100,000 births in 2020, an 18% year-over-year increase, which local health care providers said could partially be attributed to COVID-19. But Black women died at a rate of 55.3 per 100,000 births that year, according to the National Center for Health Statistics. Hall said Texas’ maternal mortality rate consistently ranks higher than the U.S. average. The 2021 March of Dimes Report Card gave Texas a D and Harris County an F due to high rates of preterm births, infant deaths, inad- equate prenatal care, social vulnera- bility factors and state policies. Dr. Ericka Brown, interim local health authority at Harris County Public Health, said the state’s elevated maternal mortality rates also correlate to its high rate of uninsured residents and other barriers to care. “The Texas Medical Center sits in Harris County, and it’s a little bit astounding that unfortunately we still have some of the highest rates of Black maternal and infant mortality,” Brown said. Identifying root causes Researchers at ValuePenguin, an online data analysis tool, gave Texas the lowest score of all 50 states in a May study about access to and the quality of prenatal and maternal care. Health insurance research analyst

to two months after giving birth. The Texas Legislature passed House Bill 133 in 2021, extending that coverage to six months after birth, but experts said women with comorbid- ities often need to be treated before conception and more than six months after delivering their babies. Brown said Black women tend to have higher rates of risk factors, such as hyperten- sion, obesity and diabetes. Dr. Rakhi Dimino, an OB¡GYN at Houston Methodist Willowbrook Hos- pital, said more than half of births in Texas are covered by Medicaid, but many women do not receive prenatal care until later in pregnancy due to the lengthy process of obtaining coverage. Texas has declined to expand its Medicaid program, which the Kaiser Family Foundation reported in 2020 would make 1.4 million additional nonelderly uninsured adults eligible for coverage. Postponing pregnancy Dimino said when she started her career 17 years ago, many of her patients were having children in their 20s, and now she is seeing more women wait until their 30s and even 40s to have children. “For many of them, it’s getting to a point in their career that they’ve invested in in order to support having a family,” she said. “And then once they are in that position, they are nancially not having as many kids not just because of age, but the cost of raising a child is expensive.” Harris County’s birth rate dropped from 81.5 births per 1,000 women in 2007 to 65 in 2019, according to the Centers for Disease Control and Pre- vention. Dimino said that trend has been exacerbated as women delayed


Dr. Manda Hall is the associate commissioner of community health improvement for the Texas Depart- ment of State Health Services and is one of 17 members of the Texas Maternal Mortality and Morbidity Review Committee. The committee’s September 2020 report stated cardiovascular and cor- onary conditions, mental disorders, obstetric hemorrhage, preeclampsia and eclampsia, infection, embolism, ADDRESSING THE ISSUE Both state- and county-level entities are working to reduce maternal mortality and morbidity. House Bill 133 was passed in 2021, allowing Texas mothers to keep Medicaid coverage for six months after childbirth— up from the two months previously allotted. The Texas Department of State Health Services launched the

TexasAIM initiative in 2018 to better equip hospitals to prevent pregnancy and birth complications.

Harris County Public Health is launching a program geared toward Black maternal health by the end of the year. The Texas Maternal Mortality and Morbidity Taskforce Review Committee reviews pregnancy- related deaths for trends and recommends best practices.




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