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Is it more dangerous to be pregnant in Texas than any other state?

Dallas Morning NewsOctober 6, 2016Articles

Yes. More pregnant women die in Texas than in any other state.

While pregnancy is becoming safer across the world, it’s becoming more dangerous in the United States. Maternal mortality dropped in 157 countries between 2000 and 2013 but went up 27 percent in the U.S. over a similar time period. The U.S. ranks lower than Kazakhstan, Kuwait and Libya when it comes to keeping pregnant women alive.

In a study published last month in the journal Obstetrics and Gynecology, researchers looked at the number of women dying during pregnancy, childbirth and in the months after delivery. “The U.S. maternal mortality rate is moving in the wrong direction,” the researchers concluded.

They had to analyze the data on maternal mortality in Texas separately because the state is such an outlier compared with the rest of the country. The number of pregnant women and new moms who died in Texas doubled between 2010 and 2012.

To stop a problem you have to understand it, and that requires information. Sounds straightforward, but that’s not the case in Texas, where the data public health researchers need is kept secret by the state. If it were available, public health officials could use this data to design and implement interventions that save lives.

“They say they’re trying to protect patient privacy, but they could just cross out patient names and any identifiers,” said Dr. Robert Gunby, acting chair of the department of obstetrics and gynecology at Baylor University Medical Center. “We’ve got to be able to get access to the data and to see why these deaths are occurring and why we’re different to California where things are improving.”

While more women are dying in Texas, fewer are dying in California. The maternal mortality rate there decreased 30 percent between 2003 and 2014. The experts said that’s because “California has made concerted efforts to reduce maternal mortality” including a statewide review of maternal deaths and the use of tool kits to prevent two common causes of maternal deaths: bleeding during delivery and preeclampsia.

Why are pregnant women and new moms dying in Texas?

Bleeding to death, heart attack and infection were some of the most common causes of death, according to a study published last year. A researcher at Texas Tech looked at the records of 557 Texas women who died during or shortly after pregnancy.

One in 3 mothers died during the first day of hospitalization, the study found. The majority of pregnant women in the study were sick enough to be admitted to the ICU. Gunby said it’s a scenario he has witnessed. “Women present late to the hospital so a problem that could have been solved earlier becomes very serious,” he said.

Debunked

Drug overdose were the second-leading cause of maternal death in Texas in 2011 and 2012, according to a report published in July by the Texas Maternal Mortality and Morbidity Task Force. Drug overdoses ranked second only to hypertension, a more commonly seen cause of maternal death around the world.

“The majority of these maternal deaths involved licit or illicit prescription opioids. This finding is alarming and may represent an ongoing shift in maternal causes of death,” the authors said.

“We see that in our clinic,” said Gunby. “We have lots of pregnant women who come to the clinic who have overdosed.”

Black women at highest risk of death

About 11 percent of babies in Texas are born to black mothers. But black women account for almost a third of all maternal deaths. The report by the Texas Task Force found huge racial disparities in maternal mortality.

“Black women bear the greatest risk for maternal death,” the authors wrote.

Hispanic women account for nearly half of all births in Texas and make up a third of maternal deaths. They also have a lower rate of severe illness during pregnancy compared with black women.

Why is maternal mortality on the rise in Texas?

Texas saw a steady rise in the maternal mortality rate from 2000 to 2010 and then a rapid doubling of the death rate within  two years. The researchers asked if the dramatic rise was due to a change in the way the deaths are coded or changes in death certificates. They concluded that wasn’t the case.

What did happen over the same period as maternal deaths in Texas were skyrocketing was this: the state’s family planning budget was cut by two-thirds in 2011. This led to direct funding cuts of prenatal care clinics especially those for poor women. The cuts also affected clinics where women could have safe abortions.

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