Texas delays publication of maternal death data until after midterms, legislative session

Texas health officials have missed a key window to complete the state’s first major updated count of pregnancy related deaths in nearly a decade, saying the findings will now be released next summer, most likely after the Legislature’s biennial session.

The delay, disclosed earlier this month by the Department of State Health Services, means lawmakers won’t likely be able to use the analysis, covering deaths from 2019, until the 2025 legislative cycle. The most recent state-level data available is nine years old.

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In a hearing this month with the state’s Maternal Mortality and Morbidity Review Committee, DSHS commissioner Dr. John Hellerstedt said the agency wanted to better align its methodology with that of other states, and that there hadn’t been enough staff and money to finish the review for a scheduled Sept. 1 release.

“The information we provide is not easily understood, and not easily and readily comparable to what goes on in other states,” Hellerstedt told the committee. “And the fact it isn’t easily understood or easily comparable in my mind leaves room for a great deal of misunderstanding about what the data really means.”

In a statement, DSHS spokesman Chris Van Deusen said the agency is reviewing its “internal processes” to try to develop more timely data.

“I expect we’ll be having conversations with legislators about what could be done to speed up the lengthy review process,” he said.

The setback comes four months before the start of the legislative session and two months before the midterm election, which has been dominated in part by the state’s new Republican-led abortion ban. Those restrictions have placed more scrutiny on the state’s maternal mortality rate, which is among the 10 highest in the country, according to national estimates that track pregnancy-related complications while pregnant or within a year of giving birth.

“There are a lot of us that want to know whether or not pregnancy in Texas is a death sentence,” said state Rep. Ann Johnson, a Houston Democrat and member of the Texas Women’s Health Caucus. “If we’ve got a higher rate of maternal mortality, we sure want to figure it out. You can’t figure it out if somebody’s sitting on the numbers, and that’s my worry.”

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Like in other states, maternal outcomes in Texas are worse for Black women, who have died at about three times the rate of non-black women. This year’s findings were expected to drill further into the causes behind those disparities.

Rep. Shawn Thierry, a Houston Democrat who has described going through her own dangerous birthing experience, said the data is critical for understanding the role cesarean sections play in maternal deaths and whether implicit bias is playing a factor in the quality of maternal care for Black women.

“There is so much to unpack from the data,” Thierry said, adding that “no woman who chooses life should have to do so in exchange for their own.”

Members of the state’s maternal mortality committee, which compiles the official report, said they were disappointed by the decision to hold the preliminary findings.

“(We) do the work to honor the lives of women who lost their lives, and families that are forever impacted by the loss of a mother,” said Dr. Carla Ortique, the committee chair. “So there’s disappointment on both fronts: that we’re not honoring those women and families, and that we may be negatively impacting efforts to improve maternal health outcomes in our state.”

Ortique said the state has already identified 149 potential maternal deaths in 2019, of which 118 have been analyzed by the committee to see if they were pregnancy-related. Six newly identified deaths may be added to that group, she said. The numbers cover deaths during the pregnancy through one year after giving birth.

The state has published a maternal death report every other year since 2014, often based on preliminary data updated later. For example, the maternal death report in 2018 identified 29 deaths in 2012 that were not included in the previous report. The committee also released updating findings from its most recent report, studying deaths from 2013, at the Sept. 2 meeting.

Out of 175 potential maternal deaths in 2013, 70 have since been determined to be pregnancy-related.

The state has been collecting the updated numbers as part of the requirements of a new CDC grant, awarded to the DSHS in 2019. The balance, according to advocates, is in making sure data is as accurate as possible, but also released quickly enough to be of use to researchers and policymakers.

The reports usually come with wide-ranging recommendations to improve maternal health in the state, including expanding Medicaid to one year postpartum, proactively treating chronic conditions and addressing the disproportionately high number of maternal deaths among Black women.

Texas has extended Medicaid coverage for pregnant women until six months after they give birth or miscarry, but the state has declined to expand coverage to the recommended 12 months.

The unexpected delay has frustrated advocates, who are gearing up to push Republicans in the Senate and the governor to back the full 12-month extension, as many other states have done.

“State leaders will be able to make better policy decisions for Texas moms if they have more recent data on maternal deaths as well as health challenges like infections or postpartum depression that new moms are facing in Texas,” said Diana Forrester, director of health care policy at Texans Care for Children.

Republican leaders, including Gov. Greg Abbott, who is running for re-election, have celebrated the overturning of federal abortion protections this summer by the U.S. Supreme Court.

Many have committed to boosting resources for pregnant women and new mothers. A spokesman for Abbott did not respond to a request for comment. Republican House Speaker Dade Phelan, who supports the 12-month extension, was critical of the delay, saying it “comes at a time when Texas must support moms and families.”

“Our work will start with passing legislation that further extends postpartum health coverage for new Texas mothers to a full year, which our chamber approved overwhelmingly in 2021 and I expect will do so again next year,” Phelan said in a statement.

In addition to providing updated recommendations for lawmakers, the report also helps nonprofits compete for grants that support new or expectant mothers, said Nakeenya Wilson, an Austin-based maternal health advocate and member of the state’s maternal mortality committee.

Her group, the Maternal Health Equity Collaborative, used data from past reports to earn a $1 million grant that provides childcare for new mothers in Central Texas.

“If they don’t have the most up-to-date information, then we run the risk of disenfranchising some of the most vulnerable in our state,” she said.

Johnson said the delay was “unacceptable” given the high rate of maternal mortalities.

“It is a crisis that we claim on bipartisan grounds to want to investigate,” Johnson said. “And yet here we are told at the last minute on the date that the report was supposed to be due, ‘Sorry, we couldn’t get around to it.’”