After notable delay, the Texas Maternal Mortality and Morbidity Review Committee (TMMMRC) and the Department of State Health Services (DSHS) presented the key data and recommendations from the joint 2022 Maternal Health and Safety Initiatives Biennial Report on Friday.
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At the time of the report’s expected release in September, DSHS announced that it would be delayed until the middle of next year due to the emergence of additional cases, a development that was met with criticism.
Interim Commissioner Dr. Jennifer Shuford testified during the committee’s most recent hearing, saying DSHS has reviewed 140 of the 147 deaths that occurred during or within 365 days of pregnancy in 2019. The final seven cases will be reviewed in the spring. She added that the full report is expected to be released sometime this week.
“I want to thank the committee for allowing me to talk with you all yesterday, and to seek your input about whether what we know about these additional cases changes your draft findings or recommendations from earlier this year,” Shuford said.
“And you have all assured me that the findings and recommendations are still applicable. Based on our discussions, I feel confident that the data from cases reviewed by the original deadline is representative of the full cohort. And in light of that I expect DSHS to release the report once staff can put the finishing touches on it as early as next week.”
Of the 140 deaths reviewed from 2019, 44% were pregnancy related. The review committee found that 58 of the 64 pregnancy related deaths were preventable, outlining the six underlying causes of death accounting for the majority of those preventable cases: obstetric hemorrhage, mental health conditions, non-cerebral thrombotic embolism, cardiovascular conditions, injury, and infection.
The severe maternal morbidity (SMM) rate rose to 72.7 cases per 10,000 delivery hospitalizations in 2019. SMM rates were disproportionately higher for Black women than other racial groups at 117.3 cases per 10,000 hospital deliveries. This was more than double the rate (56.3 cases per 10,000 deliveries) for white women.
Obstetric hemorrhage remained the leading cause of SMM and while rates of hemorrhage-related deaths decreased for every population tracked in Texas, the rate rose among Black women. Referencing post-COVID data, DSHS noted that beginning in April of 2020, SMM associated with COVID-19 had a disproportionately high impact on Hispanic women.
Nakeenya Wilson, the only community advocacy member on the committee, has been critical of the report’s delay and vocal about addressing the issues that lead to such disparate outcomes. She gave an emotional plea on behalf of the lives represented in the report that were lost.
“Today, this is a memorial and their lives should be seen as a sacrifice for what we will do better for women in Texas,” Wilson said on Friday. “We will do better and I appreciate the doctors on this committee because I did not have much faith in doctors before joining this committee. And you give me hope oftentimes unmuted. You don’t see me cry when we talk about these cases and it’s not because it doesn’t affect me or doesn’t hurt me. But it’s protective.
But I see you shed tears. I see your humanity and I feel hopeful that you’re going back into the field with your colleagues and that is being spread. So I just wanted to let you know, there are a lot of times and places where black people and women are told not to take up space and I’m taking my space today and I appreciate everyone who’s sitting here.”
During the meeting, TMMMRC Chair, Dr. Carla Ortique outlined the committee’s recommendations for the upcoming legislative session, which she noted are very similar to the committee’s previous policy guidance.
“Our first recommendation has been our top recommendation for the past three reports,” Ortique said. “That we will increase access to comprehensive health services during pregnancy, the year after pregnancy and throughout the preconception and interconception periods to facilitate continuity of care, implement effective care transitions and promote safe birth spacing.
These efforts will help improve lifelong health of women. We really have to engage black communities and those that support them in the development of maternal and women’s health. programs.”
Ortique added that the state should implement statewide maternal health and safety initiatives, incorporate health equity principles to reduce maternal deaths and health disparities, and increase public awareness and community engagement to foster a culture of maternal health safety and disease prevention.
State Representatives Donna Howard (D – Austin) and Shawn Thierry (D – Houston) both testified before the committee that they, as mothers who experienced complications during pregnancy, would draft legislation based on the recommendations to address and improve maternal health.
“It’s clear that without additional data, findings, and recommendations from this committee, the legislature and other stakeholders in this space will not have the necessary tools to address and implement change,” Howard said. “That’s why the release of the full maternal mortality and morbidity report as required by statute is so very critical. As legislators, we depend on the information given to us by state agencies to inform our policy decisions.
We’re already behind the curve in terms of drafting and filing legislation. Luckily, we still do have a window of time here in which to do so. And I am very grateful to learn this morning that we will be getting the full report within a week. Hopefully so, because it is going to be absolutely necessary that we have that information to ensure that we draft legislation and put funding into the budget that will allow us to address this and save the lives of Texas moms and help their babies and their families to thrive.”
Thierry emphasized she will work to address cultural competency and implicit bias for those in the maternal health system, specifically by those that affect care for Black women.
“So intuitively, and what we’ve seen even in my county, Harris County, from our maternal mortality steering committee, is that the issue of implicit bias and cultural competency must be spoken about [and] it must be addressed,” Thierry said. “I would ask if that issue is not included in the report that’s forthcoming, that a supplemental report come out to make recommendations so that the Texas Legislature has an opportunity to drill down on these issues of cultural competency.
I would also request that the data, as I said, looks at disparities in outcomes for Black moms that essentially have the same health status as all other moms … I would like to see data comparing birth outcomes [between white and Black mothers] because what we’re trying to really understand is, why are black women dying in childbirth at this rate, when we see for example, that the AIM safety protocols are being implemented?
I would like to add that the way to attack this crisis is to start with the group most effective first, not last. That is why we continue to sound the alarm for Black women in helping understand why black mothers die. We are helping prevent mortalities and morbidities for all women. If Black women are the group that is most affected, we start with them first, not last. We are not a footnote in the report. Black mothers cannot continue to be a miniscule portion of the report. I would go as far to say [that] at this point, we are the report.”