Following a rally at the Capitol by maternal health advocates this week, members of the Texas Maternal Mortality and Morbidity Review Committee (MMMRC) are calling on state leaders to address maternal health equity in the upcoming legislative session.
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Nakeenya Wilson, who sits on the review committee at the sole community advocate, is calling for the immediate release of the state’s report on maternal mortality and morbidity. The data in that report is crucial to guiding draft legislation ahead of the next session to address deaths of mothers that are in most cases preventable.
At the rally on Tuesday in Austin, Rep. Donna Howard (D – Austin) shared data from the report released to her by DSHS that showed Black patients were the only ethnic group to see a rise in pregnancy-related deaths from hemorrhaging.
In 2018, DSHS implemented the Alliance for Innovation on Maternal Health’s (AIM) maternal safety bundles in Texas, a quality improvement initiative to support best practices that make birth safer, improve maternal health outcomes, and save lives. The bundles included measures on obstetric hemorrhages.
“This is beyond something that even a bundle can fix,” Wilson said. “We’re talking about institutional racism, structural racism, and in some cases, interpersonal racism.”
Amy Raines-Milenkov, DrPH, MMMRC member and Director of the University of North Texas Health Science Center’s (UNTHSC) Healthy Start program, a federally-funded intervention to reduce perinatal health disparities, said the most effective way to address maternal mortality would be to expand Medicaid.
“The clearest and the easiest [thing]to do would be to expand Medicaid,” Raines-Milenkov said. “It just is clear, with up to 53% of the deaths occurring after 7 to 365 days following delivery, it’s clear that the easiest thing to do, the low-hanging fruit, would be to expand Medicaid so that women are covered [for] at least a year.”
Last session, the Texas legislature amended a bill on postpartum Medicaid coverage that passed reducing the coverage support from 12 months to 6 months. Raines-Milenkov believes the state should extend that coverage to 12 months and do more to ensure all women have access to reproductive care.
“What’s being lost in the conversation is that people of reproductive age need access to care even before pregnancy, because we know that what can be considered a pregnancy-related death could be a situation where she had a pre-existing condition, and the pregnancy just made it worse,” Rainers-Milenkov said. “If you don’t have insurance before, or access to care before you become pregnant, it’s unlikely that those conditions are going to be identified, and they’re going to be addressed prior to pregnancy.
It’s great having this conversation on the postpartum and that’s a clear policy implication, but I don’t think we should lose sight of the bigger picture which is expansion of Medicaid to this population of reproductive-aged people. [Expansion] would address a lot of conditions before people even become pregnant.”
MMRC will convene its next meetings Dec. 7th-8th, the first of which will review additional cases and be closed to the public. The second hearing will be open to the public where committee members are expected to be briefed by DSHS Commissioner Dr. Jennifer Shuford on the release of the report and a joint recommendation.
Wilson, along with the members from Maternal Health Equity Collaborative (MHEC), an Austin-based coalition of 6 community-based birthing organizations, plan to be at the meeting to advocate on behalf of marginalized mothers.
Wilson said that while expanding Medicaid is one solution to addressing the disproportionate number of Black maternity deaths, it is not the only solution.
Most of the organizations that comprise MHEC, including Black Mamas ATX and Mama Sana Vibrant Woman, provide free doula services to women regardless of income. Giving Austin Labor Support is the only organization in Texas providing Medicaid reimbursable doula services, which have been shown to reduce mortality and improve healthier outcomes for infants.
House Bill 2685, which proposed a statewide Medicaid pilot program for doula services, died in committee last session. Wilson believes doula services should be a Medicaid reimbursable benefit and will be working with Rep. Toni Rose (D – Dallas) to draft and advance such legislation.
“There are opportunities for local and state governments to provide funding to nonprofits who are providing [doula] services,” Wilson said. “In addition to that, the Medicaid plans can choose to reimburse for their Medicaid patients … Our hope is that other insurance carriers, both private and public and Medicaid will take them.”