Texas advocates optimistic about the work ahead to reform maternal health


Boram Kim


The Texas Maternal Mortality and Morbidity Review Committee’s (TMMMRC) key recommendations, released in a joint report with the Department of State Health Services (DSHS) in December, listed 12 months of postpartum healthcare coverage as a foundational recommendation. 


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After facing some hurdles, the committee’s recommendation is now law with Gov. Greg Abbott’s signing of House Bill 12 on Sunday. Black maternal health advocates believe the legislation, authored by Rep. Toni Rose (D – Dallas), will have a big impact on the well-being of mothers and infants. 

“We know that most women haven’t even had the chance to really get settled in and to know whether they need additional healthcare services. We also know that the majority of the complications can extend from 60 days to one year, which is the true definition of maternal mortality. So to now have that coverage go for the full year is huge, because that will give women on Medicaid—Black moms who are already having a huge disparity in maternal health outcomes—that will just give them and us the longevity [and] continuity of care.”

— Rep. Shawn Thierry (D – Houston) 

The report revealed that the severe maternal morbidity (SMM) rate rose to 72.7 cases per 10,000 delivery hospitalizations in 2019. These 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 for white women (56.3 cases per 10,000 deliveries) . 

While obstetric hemorrhage remained the leading cause of SMM, rates of hemorrhage-related cases fell across every population tracked in Texas, except for Black moms where rates actually increased. 

Based on those results, TMMMRC urged lawmakers to implement statewide maternal health safety initiatives, incorporate health equity principles, and increase public awareness and community engagement to foster culturally responsive care aimed at reducing deaths.

Thierry worked closely with DSHS Commissioner Dr. Jennifer Shuford last fall on releasing the key findings from the 2022 Maternal Health and Safety Initiatives Biennial Report and putting forth this session’s legislative recommendations. Thierry said she will continue to work with Shuford on the implementation of HB 12 and strategies for improving outcomes for Black mothers. 

“What I told [DSHS] is that I want to work in tandem—the state should have every interest in supporting these [state] agencies because that’s who we’re relying upon to provide us with the data. And so given that we’ve had such a data backlog, increasing resources, and increasing the breadth and scope of [TMMMRC], I believe will be helpful.

[Shuford’s] office has stayed in constant communication with my office. I really can’t ask for much more than that. I look forward to continuing to work with DSHS so that the next report that comes out will be prepared—ready [to] come out on time. We continue to craft policy that I believe will best serve mothers and babies.”

— Rep. Shawn Thierry

Thierry’s HB 852, which expands TMMMRC from 17 to 21 members, also became law on June 12th. The bill was amended to have two community members with experience in healthcare, one representing rural areas and the other urban areas, instead of community “advocate” as it was initially drafted. 

TMMMRC will have its next quarterly meeting in August and be looking to expand its roster starting in September. The committee has led the work on maternal health equity and its expansion will serve to bring more community health and medical perspectives into its future work. 

TMMMRC’s sole community representative, a Black doula and mom named Nakeenya Wilson, was part of a collaborative effort last fall calling on the state to release health system data on maternal deaths in 2019. 

She told State of Reform that she felt “grateful” and optimistic about the impact HB 12 will have on the health of new moms and their little ones. 

“For the [legislation] to be most effective, there’s going to have [to be] a collaborative effort to increase awareness that comes from multiple places. Social support services—social workers [and] case managers are also going to be integral in maximizing the benefit for the moms.” 

— Nakeenya Wilson, TMMMRC member

Along with her duties on the TMMMRC, Wilson works as a community advocate with the Texas Maternal Health Equity Collaborative (MHEC), which aims to make birth safer for Black and brown families. 

HB 465, another bill from Thierry that would have established a medical assistance pilot program to cover doula services under Medicaid, failed to advance out of the Senate. 

Black Mamas ATX has been providing free community access to doulas services statewide and knows the guidance and support it provides throughout the birthing process have successful outcomes for Black mothers. 

The organization will be hosting a summit this weekend that will inform strategic planning around healthcare system reform and community engagement. Improving maternal health outcomes for Black moms starts by addressing the institutional racism inherent within the [Texas] health system, according to Kellene Blake-Fallon, executive director of Black Mamas ATX. 

“The theme [of the summit] is ‘Birthing Black Community’ and the intention is not only to center Black birthing folks and get their perspectives but to also ask the question, ‘What could [birthing] look like for us if we did things differently?’”

—Kellene Blake-Fallon, executive director of Black Mamas ATX. 

Wilson will be a panel speaker at the summit and told State of Reform the healthcare system should take a patient-centric approach to reforms that starts with centering the Black birthing experience. 

“The reality is, and especially in the state of Texas, that in almost every system, Black people have the worst outcomes. If you’re looking at the [carceral] system, education system, healthcare system—the reason [being] those systems were literally built on racism … the inception of many of these systems and the way that they were building the policies were anti-Black. I think that if we want it to change for all people, the most effective place to start is going to be improving for Black [people].”

— Nakeenya Wilson