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The rate of pregnancy-related deaths in Texas decreased from 2013 to 2019, according to an updated report released Wednesday by the state health department, but Black patients continue to die during or after their pregnancy at higher rates than other racial groups.
The newly published findings expand on a preliminary analysis of 2019 pregnancy-related deaths, published last year by the Texas Department of State Health Services amid controversy over the state’s decision to delay its release. The completed report offers a more detailed and updated look at maternal deaths compared to existing federal and state data.
The U.S. has the highest maternal mortality rate among developed countries, and data from the Center for Disease Control and Prevention places Texas above the national average.
BACKGROUND: Maternal health advocates in the dark as Texas stalls on new mortality data
The completed report, compiled by the state’s Maternal Mortality and Morbidity Review Committee, shows that mental health conditions surpassed obstetric hemorrhage, or excessive bleeding, as the leading cause of pregnancy-related death in 2019. The overall rate of pregnancy-related deaths dropped from 18.1 per 100,000 live births in 2013 — the last year for which comparable data is available — to 16.7 per 100,000 live births in 2019. The rate also dropped for Black women from 47.6 per 100,000 live births to 27.9, according to the report.
Despite those trends, the rate of pregnancy-related deaths among Hispanic women increased from 10.8 per 100,000 live births in 2013 to 13.4 in 2019. The rate for non-Hispanic women who fell into the “other” race group also increased in the same period, from 8.2 per 100,000 live births to 10.4.
The report did not address the underlying reason for the rate changes. Dr. Manda Hall, associate commissioner for community health improvement at DSHS, said the committee will have to review future cases to understand ongoing trends better.
“There’s much work for us to continue to do,” said Hall, who also sits on the maternal mortality committee. “As we’re looking forward to the 2020 cases that we’re reviewing now, we know that there are other factors such as the COVID-19 pandemic that are also going to impact what we see.”
The disparity between white and Black pregnant women persisted in 2019, the report said, though on a smaller scale than in 2013. The rate of pregnancy-related deaths for Black women was 1.5 times greater than for white women, compared to 2 times greater in 2013, the report said. State data released last year also shows that from 2016 to 2020, the rate of deliveries involving a life-threatening condition increased over all racial groups but most prominently among Black patients, who experienced the highest rates of hemorrhage, sepsis and a blood pressure condition known as preeclampsia.
Obesity, mental disorders, discrimination and substance use disorder all contributed to maternal deaths in 2019, the updated report said. Mental health conditions caused 14 of the 63 pregnancy-related deaths that year. Depression accounted for the highest share of those deaths, followed by substance use disorder, bipolar disorder and psychotic disorder, the report said.
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The prevalence of pregnancy-related anxiety and depression is one of the reasons why the recent expansion of postpartum Medicaid coverage from two months to a full year is so important, said Nakeenya Wilson, who serves as a community advocate on the state’s maternal mortality committee. The data also highlights the importance of reducing the stigma around postpartum depression, she said.
In its biennial legislative reports, the state’s maternal mortality committee has recommended improving behavioral health care access from preconception throughout postpartum for women with mental health and substance use disorders. Texas also recently launched the Perinatal Psychiatry Access Network. This pilot program gives physicians, midwives and mental health care professionals free phone consultations with psychiatrists who have experience treating pregnant and postpartum patients.
After mental health conditions, the other leading causes of pregnancy-related death were obstetric hemorrhage, uterine rupture and ruptured ectopic pregnancy, when a fertilized egg implants outside the uterus. Violent deaths, including deaths deemed a homicide or suicide, represented 27 percent of pregnancy-related deaths in 2019, the report said.
The preliminary report had estimated that deaths reviewed by the committee accounted for a total of 6,162 years of “potential life lost” and left an estimated 184 living children “forever impacted by the loss of their mothers.”
People who are having thoughts of suicide are asked to call the National Suicide Prevention Hotline at 988. Counselors can also chat at http://www.suicidepreventionlifeline.org/.
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