Maternal Mortality is Back on the Legislative Agenda

By Kamia Rathore, Health and Wellness Policy Intern
This blog was updated on August 3rd, 2017.
Last summer, Texas’ Maternal Mortality and Morbidity Task Force issued a stark assessment of maternal health in Texas that pointed to a high rate of women dying during pregnancy, childbirth, or in the months after delivery and serious racial disparities in maternal deaths across the state. The Legislature originally established the Task Force in 2013 to review statewide trends and individual cases of pregnancy-related deaths and illnesses.
This summer, the Task Force is back in the spotlight. Governor Greg Abbott added to the special legislative session the consideration of the extension of the Task Force, which is set to expire in September 2019. Legislation that would have continued the Task Force was collateral damage in an end-of-session standoff between the House and Senate; however, legislators have filed several bills for the special session that would extend the Task Force’s authority. Here are a few reminders of why maternal health in Texas is at a tipping point and what lawmakers can do to reverse troubling trends:
The maternal mortality rate in the state has continued to climb, nearly tripling from a rate of 8.6 maternal deaths per 100,000 live births in 2005 to 32.8 in 2014, according to the Department of State Health Services. The Task Force’s report came on the heels of research published in Obstetrics & Gynecology that found Texas’ sharp rise in maternal deaths to be higher than any other state. This alarming trend is most severe among Black women, who face a disproportionately higher risk for maternal death than any other racial or ethnic group. Bills to extend the Task Force alone are not enough. Legislators must act on the recommendations of the Task Force, including by addressing huge racial disparities.
The Task Force also pointed to a troubling rise in Neonatal Abstinence Syndrome (NAS) cases in Texas, a condition affecting newborns exposed to opiate drugs during pregnancy that can lead to severe symptoms of withdrawal and drug dependency from birth.  The increase in NAS tracks the rise of illicit and licit prescription opioid overdoses as a leading cause of maternal death in the state.  Of the cases the Task Force reviewed from 2011 to 2012, drug overdoses emerged as the second most common cause of maternal death. The state faces a severe shortage of behavioral health services for all populations—Texas lawmakers can and should do more to strengthen mental health and substance use disorder services in the state.
The majority of maternal deaths reviewed occurred in the period between six weeks and one year following birth, highlighting a need for comprehensive post-delivery care. Medicaid for pregnant women in Texas (which covers more than half of all births in Texas) currently expires 60 days after delivery, leaving many women without adequate access to the care they need. Closing the Coverage Gap in Texas would improve health care access before, during, and after a pregnancy, promoting better maternal outcomes. Comprehensive care that extends before and after a pregnancy provides an opportunity for risk assessment and management of post-pregnancy issues such as perinatal depression. Promoting continuity of care in the inter-conception period, or time between pregnancies, also supports family planning counseling and safe pregnancy spacing to avoid too-short intervals between births that are associated with maternal and fetal health risks.
Texas lawmakers should expand the Maternal Mortality and Morbidity Task Force during this special session. However, lawmakers must also look beyond just these next few weeks at the Capitol to put in place solutions that seek to address Texas’ maternal health crisis, in part by ensuring women have access to care before, during, and after their pregnancies.
Update: The House and the Senate have passed a package of bills aimed at extending and expanding the authority of the Maternal Mortality Task Force House. HB 9 – Burkett, HB 10 – Walle, and HB 11 – Thierry would direct the Task Force to review trends in maternal mortality, study disparities in health outcomes based on socioeconomic status, and identify best practices for reducing pregnancy-related deaths, while HB 28 – Ortega would expand the groups of providers included in the Task Force’s membership. The Senate has also passed SB 17 – Kolkhorst to extend the Task Force’s authorization.
All bills were amended on the floor, and now move to the opposite chamber for a committee hearing and vote.

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