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HEALTH RISKS IN THE HOUSTON METRO
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 region 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
66.2%
9.9%
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.*
SOURCE: TEXAS DEPARTMENT OF STATE HEALTH SERVICES COMMUNITY IMPACT NEWSPAPER
SOURCE: BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEMCOMMUNITY IMPACT NEWSPAPER
*2019 SURVEY
for Health Statistics. Hall said the state’s maternal mor- tality rate consistently ranks higher than the U.S. average. The 2021 March of Dimes Report Card, which grades states on the health of mothers and infants nationwide, gave Texas a D grade and Harris County an F due to high rates of preterm births, infant deaths, inadequate prenatal care, social vulnerability factors and state policies. While Montgomery County was not graded, Surgo Ventures—a nonprot that works to solve health and social problems—assigned Mont- gomery County a “moderate” mater- nal vulnerability score, while Harris County received a “high” maternal vulnerability score. Dr. Ericka Brown, interim local health authority at Harris County Public Health, said the state’s ele- vated maternal mortality rates also correlate to its high rate of uninsured residents and other barriers to care for underserved communities. “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 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 residents and 14.7% of Montgomery County residents were uninsured in 2020 compared to 17.3% statewide and 8.7% nationwide. In comparison, 13.6% of Lake Houston- 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.” Lake Houston-area ZIP code 77365 had among the highest rates of severe maternal morbidity between 2014-16, according to a study from The Univer- sity of Texas Health Science Center at Tyler. About 15.7% of the population in ZIP code 77365 was uninsured in 2020, according to 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 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 co-morbidities often
need to be treated before conception and more than six months after deliv- ering their babies. Brown said Black women tend to have higher rates of risk factors, such as hypertension, obesity and diabetes. Dr. Rakhi Dimino, an OB¡GYN with the Houston Methodist Hospital Sys- tem, said more than half of births in Texas are covered by Medicaid, but access is a challenge. Many women do not receive prenatal care until later in pregnancy due to the lengthy process of obtaining Medicaid cover- age, she said. 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 hav- ing a family,” she said. “And then once they are in that position, they are 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 69 births per 1,000 women in 2010 to 58 in 2020, while Montgom- ery County’s birth rate dropped from 62 to 52 in the same time period, according to U.S. Census Bureau data. Dimino said that trend has since been exacerbated as women have delayed pregnancy due to the pandemic.
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death, and we also know that there are specic groups that bear the great- est burden of maternal mortality, meaning … Black women,” Hall said. The average national maternal mortality rate was 23.8 per 100,000 births in 2020, an 18% year-over-year increase, which local health care pro- viders 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 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.
SOURCES: HARRIS COUNTY PUBLIC HEALTH, TEXAS DEPARTMENT OF STATE HEALTH SERVICESCOMMUNITY IMPACT NEWSPAPER
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COMMUNITY IMPACT NEWSPAPER • COMMUNITYIMPACT.COM
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