Brazos Valley rural areas underserved in reproductive care, women’s health

That’s the scenario a recent study depicts of Texas, ranking the state 49th in the country for reproductive care and women’s health.

The Commonwealth Fund’s 2023 Scorecard ranked Texas just above Mississippi and New Mexico — the study included the District of Columbia — based on 12 indicators of the quality of care women, mothers and infants receive. The ranking points to an increase in preventable maternal deaths, especially for women of color.

Robin Page, an associate professor in Texas A&M University’s School of Nursing, said Texas’ low ranking may be a result of its large size and high number of rural communities. 

“Because Texas is so large, we’re a very vast state with a lot of rural areas that are highly underserved,” she said. “We know by nearly every metric that compares rural versus urban, rural communities tend to fare worse and that is really more of an access issue. They just don’t have care available in those areas.”

The state’s rural areas are often maternity care deserts, meaning expectant mothers may have to travel far distances to receive medical care, or go without it, Page said. This issue is something the school of nursing is aiming to tackle, specifically in rural communities of the Brazos Valley, she said.

“Here at the school of nursing, we take our status as a land grant university very seriously,” Page said. “Meaning that we have particular strengths in the area of serving the underserved communities, and also rural communities. We have a number of initiatives here at the school of nursing that specifically focus on rural and/or underserved areas.”

As of 2020, Brazos County was not considered a maternity care desert, but surrounding counties Grimes, Burleson, Madison and Leon were considered areas with low access to maternity care, according to March of Dimes Peristats.

March of Dimes, a nonprofit organization that uses research, education and advocacy to promote the health of mothers and babies, gave Texas a D-minus for preterm birth with 11.4% of babies being born prematurely.

Alicia Lee, Director of MCH Collective Impact at March of Dimes, said the organization is working to improve the disparities in women’s health care across the state.

“We fight each and every day for the health of both mom, her baby and the support person and the family,” Lee said. “We believe that to have healthy communities, we have to have healthy pregnancies and healthy families. We, right now, live in a country where it is dangerous and we’re in a crisis for women who are giving birth. We know that crisis is even larger for our communities of color and it’s important to us to change that trajectory.”

In Brazos County, 18.4% of infants are born to women who received inadequate care during pregnancy, according to March of Dimes data. Adequacy is measured by the Adequacy of Prenatal Care Utilization Index which uses information about timing of prenatal care, the number of visits and the infant’s gestational age.

One of the A&M School of Nursing’s initiatives, the Program of Excellence for Mothers, Children and Families (POEMCF), was created to improve the care of pregnant women, infants, children, youth and families across the state.

March of Dimes works closely with POEMCF to lower the maternal morbidity rate in Texas, specifically lowering the rate of women who suffer from high blood pressure during pregnancy, Lee said.

“In working with our partners across the state with organizations, with community-based organizations, with hospitals in the Bryan-College Station area, specifically working with the Nurse-Family Partnership Program out of Texas A&M, we’ve received funding from our funders, the corporate partners, and the like to build a hypertension kit,” she said. “Then that hypertension kit, we are providing a blood pressure monitor as well as other tools and information for our partner organizations to then share and provide and give to their patients.”

The Nurse-Family Partnership, another initiative by the school of nursing, offers support to first-time mothers by connecting them with specially trained nurses who work with vulnerable moms starting early in their pregnancy through the child’s second birthday.

The partnership aims to support the mental health of expecting and current mothers, Page said, as suicide is one of the leading causes of maternal mortality. In Texas in 2022, 5% of maternal deaths are the result of suicide, according to the National Library of Medicine.

“Let’s say they had a perfectly healthy pregnancy, normal delivery, healthy baby, yet, they feel depressed,” said Page, who specializes in maternal mental health research. “There’s a lot of stigma about that. It’s like, ‘Well, why are you feeling depressed? You just had a healthy pregnancy and a healthy delivery, and you have a healthy baby. You have no reason to be depressed.’ So, a lot of times women didn’t talk about it, they just kind of kept it to themselves and you could say they suffered in silence.”

Though it may be disheartening to see data showing the amount of new and expecting mothers who struggle with anxiety and depression, Page said it brings attention to the serious issue of poor mental health that may come along with pregnancy.

“We just have more data available, more information that people are reading about and hearing about, and people are shocked,” she said. “It’s like, ‘Oh, my gosh, that’s so sad to think about, that a woman may have been suffering in silence and just didn’t know where to go or felt too ashamed to ask for help.’ Sometimes, the partner might not recognize the symptoms or might not also know where to go or might also feel ashamed, so it’s a complex issue, but definitely, one that we have to keep looking at to see how we can help new mothers.”

New and expecting mothers can receive Medicaid coverage for up to two months after giving birth. With the start of COVID-19 pandemic in 2020, expecting mothers received benefits from Medicaid for an extended three years as a result of the federal government’s Public Health Emergency Declaration. Continued coverage expired May 11, leaving many mothers scrambling for insurance.

In order to extend Medicaid benefits for new and expecting mothers, Rep. Toni Rose of Dallas authored Texas House Bill 12, which extends medical and mental health coverage from two months to 12 months. Signed by Gov. Greg Abbott on June 16, HB 12 extends aims to combat the rising death rate of new mothers in Texas.

In 2013, a majority of maternal deaths were women previously enrolled in Medicaid programs who were unable to receive critical postpartum care after the two-month extension deadline. Additionally, 31% of pregnancy-related deaths took place between 43 days to a year after the end of a pregnancy.

In a statement released by Rose’s office, the representative shared how postpartum deaths affect Black women at a higher rate compared to their white counterparts. 

“While all women are impacted, severe maternal morbidity and delivery hospitalizations involving hypertensive disorder disproportionally affects Black mothers in Texas,” the statement read. “Although Black women made up only 11% of live births across the state, 31% of all maternal mortality deaths were among Black women.”

Rose said she believes this legislative change will lower the rate of preventable medical issues in Texas mothers.

“I’m elated that women will be able to maintain comprehensive care postpartum,” she said in the statement. “I am confident this measure will help eliminate our state’s upward trend of postpartum deaths by providing health care earlier to women with medical and mental health issues.”

As a result of preventable death, nearly 200 families across the state have been left without a mother, Lee said.

“Those are actual children who no longer have them because of what could have been a preventable death,” she said. “When our report says 90% of deaths could be preventable by the change of at least one circumstance. … It’s going to take all of us working together and collaboratively in order to make those changes for our communities.”

In addition to lowering the rate of preventable deaths, Lee said extended coverage will help the nearly 1 in 5 mothers who suffer from postpartum anxiety or depression receive the care they need.

“If she doesn’t have that insurance coverage, she doesn’t necessarily have the ability to pay for mental health counseling with a licensed social worker, with a physician or to get the medication she may need,” she said. “With this extended coverage, she will be able to access that for 12 months. … And in Texas, we are excited that approximately 480,000 individuals will now have coverage for up to a year after delivery, which is huge.”

Nearly 1 in 4 women of child-bearing age are uninsured in Texas, according to March of Dimes Peristats. Undocumented immigrants face added barriers when looking for help or coverage during pregnancy, as they often don’t qualify for state programs and services for expecting families, Page said.

For expectant mothers who cannot receive Medicaid, such as undocumented immigrants, Children’s Health Insurance Program (CHIP) Perinatal is a state government program created to bridge the gap in maternal health care for individuals not eligible for Medicaid and is available to undocumented immigrants. With CHIP Perinatal, newborns receive additional care including regular checkups, immunizations and prescriptions, but mothers stop receiving care 60 days after giving birth.

Page said this causes many undocumented mothers to go without care as they continue to struggle with post-partum-related issues long after the 60-day deadline. 

“I see this a lot in the clients, the patients, who I care for at the prenatal clinic,” Page said. “We see a lot of undocumented immigrants in that clinic and it’s really tough because we know that 60 days after they have their baby, they’re going to get dropped from any kind of insurance. If they do have a complication or a problem, or we need medication to treat depression, something like that, there’s not a whole lot of resources for them, because they’re going to lose their insurance after 60 days. In particular, those immigrant women really fall through the cracks.”

Despite disappointing data and low rankings, Page said she believes the future of women’s health care in Texas is heading in the right direction.

“I think there are good things on the horizon,” she said. “We know that programs like Nurse-Family Partnership can help. We know that the state is funding those programs, and the more people we can get into programs such as that, I think the better off the Texas women will be. So, there’s hope.”