THE TEXAS TRIBUNE – Texas’ maternal mortality committee should be allowed to review abortion-related deaths and have more voices from impacted communities at the table, the group’s chair said at a Friday meeting.
These comments represent the committee’s most forceful critique yet of the system by which the state reviews deaths related to pregnancy and childbirth.
Dr. Carla Ortique, a Houston OB/GYN who chairs the committee, called for the reversal of recent legislative changes that redrew committee membership and began the process to remove Texas from the federal maternal mortality tracking system. She said the Legislature should consider lifting the redaction requirements that keep these deaths anonymous and allow the committee to review deaths related to abortion, which they learned in March had been excluded from their files for more than a decade.
“Each maternal death, each life that is lost, has value,” she said. “We can't make comments about what caused an increase in maternal death in our state if we're not really reviewing all of them.”
These calls for reform come amid a recent report showing a significant spike in maternal deaths in 2020 and 2021, reversing several years of improvements. The data from this report documents the period before the state banned nearly all abortions, which is expected to increase maternal mortality.
This month, ProPublica reported on two Georgia women who died after they couldn’t access legal abortions and timely medical care because of the state’s abortion restrictions. Georgia’s maternal mortality committee deemed those deaths to be preventable, public records show.
Dr. Ghazaleh Moayedi, a Dallas OB-GYN, abortion provider and chair of Physicians for Reproductive Health, told The Texas Tribune she is certain there are similar stories in Texas, a state three times as large as Georgia with even stricter abortion laws.
“The framing around these being the first recorded deaths is deeply painful, because I know there are people that have died right here, but their stories are never going to be told in that way,” she said.
The Texas Legislature, which reconvenes in January, would have to change the law to allow the committee to review abortion-related deaths.
Disparities persist
In 2020, as a pandemic raged in hospitals and homes, 85 Texas women died from complications related to pregnancy and childbirth, found the committee’s latest report, which is released every two years. While the number pales in comparison to the devastation of COVID, these deaths represent another public health crisis — that of avoidable maternal mortality, especially in Black communities.
More than a decade ago, Texas began a bipartisan push to improve health outcomes for pregnant women. The Legislature created a maternal mortality review committee. State agencies, hospitals and advocacy groups began working together on targeted improvements for persistent challenges like obstetric hemorrhage and substance abuse issues.
This effort has yielded results — for some. Pregnancy-related mortality rates among white women decreased from 20.3 deaths per 100,000 live births in 2013 to 16.1 in 2020.
For everyone else, maternal death rates have increased in the last few years. While Hispanic women generally have lower rates of maternal mortality than their peers, the numbers have increased steadily since 2013 to a high of 14.2, excluding COVID-19 deaths.
And Black women remain 2.5 times more likely to die from pregnancy and childbirth than white women. For every 100,000 live births, 39 Black women die.
There’s no genetic reason Black women should be dying at higher rates than their peers, said Dr. Amita Vyas, the director for Maternal and Child Health at the Milken School of Public Health at The George Washington University. Rather, she said, these statistics are reflective of a medical system that’s weighted against Black mothers.
“Systemic racism that particularly Black women have experienced in pregnancy and childbirth is one of the most significant drivers of maternal deaths across the country,” Vyas said.
Texans, as a whole, face a host of challenges that lead to maternal mortality, from lack of access to contraception and sex education and growing maternity care deserts, to delayed prenatal care, rising rates of chronic conditions, lack of insurance and poverty.
There are strategies to improve these barriers to healthy pregnancies, but researchers have yet to critically analyze why they aren’t working in communities of color, specifically Black communities, Moayedi said.
“We can’t just say, ‘Oh, the OB-GYN was racist,’” she said. “I wish it were as simple as that … What I'm talking about is systemic institutional racism, the ways that we set up our health care systems from top to bottom that are actually designed to perpetuate racial harms.”
Proven solutions to improve maternal health outcomes in Black communities include increasing access to doulas, midwives and birthing attendants, training health care providers in culturally sensitive care, and improving prenatal and preconception care models. Last legislative session, Texas took the long-awaited step of extending Medicaid coverage for one year postpartum, rather than the two months previously offered.
These are welcome changes, Moayedi said. But in a state that is currently restricting even conversations about diversity, equity and inclusion, she feels these are band aid solutions on a much deeper wound.
“Racism is not necessarily an individual moral failure, but it is within the fabric of our nation,” she said. “It is all of our work and duty, especially as health care providers, to educate ourselves on this, to understand how it shows up within our systems, and to actively work to dismantle these systems that undo any good work that we can possibly do.”
Committee changes
The review committee, in its report, recommended the state “engage Black communities” in the work of improving these disparities. But when the group met Friday, one voice was notably absent.
Nakeenya Wilson, a Black woman who experienced a traumatic birth, previously served on the committee in the community advocate role and helped review all of the deaths that were laid out in the most recent report. But after the Legislature redrew the makeup of the committee in 2023, she was removed.
“I gave three years of my life, some of the most difficult years of everyone’s lives, in the middle of a pandemic, with two small children … to ensure people like me don’t die,” Wilson told the Tribune ahead of Friday’s meeting. “And the state made a choice to remove my voice and my ability to speak for those who don’t have a voice.”
Wilson’s role was replaced by two community member positions, one for an urban representative and one for a rural representative. Wilson re-applied for the urban position, but a Houston pediatric emergency medicine fellow was appointed instead. The rural position was awarded to Dr. Ingrid Skop, an OB/GYN from San Antonio, the state’s second largest city, instead of a labor and delivery nurse from the Rio Grande Valley.
In a statement at the time, Skop said she had “often cared for women traveling long distances from rural Texas maternity deserts, including women suffering complications from abortions.”
In her role as vice president and medical director of the Charlotte Lozier Institute, an anti-abortion think tank, Skop has testified before Congress and state legislatures, as well as in court cases, in favor of abortion restrictions.
In September 2023, Skop wrote an article claiming that maternal mortality may actually improve in states that ban abortion because fewer women will have mental health issues related to regretting an abortion and having a child may reduce a woman’s chance of later getting breast cancer.
At the meeting Friday, Ortique said she hoped lawmakers would consider restoring some of the community voices to the committee.
“There is value in having that voice at the table,” she said, adding, “it's something that has been recognized on the national level that it brings greater depth, greater breadth, greater opportunities for rich and actionable recommendations.”
Abortion impacts
The maternal mortality committee’s next report, which is released every two years, will look at deaths from 2021, and then “leapfrog” ahead to deaths from 2024, Ortique said at the meeting Friday. The committee is hopeful that reviewing more recent deaths will allow for more timely recommendations to the Legislature in 2027.
Reviewing deaths from 2024 will cover a period during which abortion was banned in Texas. But without the ability to review abortion-related deaths, it will be hard for the committee to determine the impact of these laws on maternal health outcomes.
While legal abortion is safer than childbirth, the risk of complications increases when people seek abortions outside of the usual health care system.
“If you're in a state where abortion is restricted, you're going to have an increased number of pregnancies that women are forced to carry to term,” said Vyas. “Just by sheer number of more pregnancies, we're going to have more maternal deaths. That’s the simplest piece of it.”
Vyas applauded Georgia’s maternal mortality committee for reviewing and making available information about abortion-related deaths. Earlier this month, ProPublica reported on the death of Amber Thurman, a 28-year-old nursing assistant and mother, who died after doctors delayed performing a common procedure to remove fetal tissue that hadn’t properly passed after a medication abortion.
They also reported on Candi Miller, a 41-year-old mother of three with lupus, diabetes and hypertension, who feared that another pregnancy might kill her. She ordered abortion-inducing medication online but after a rare complication, failed to expel the fetus entirely. Fearful of seeking care because of the state’s abortion bans, Miller stayed at home, battling infection by herself until she died with her 3-year-old by her side.
Georgia’s maternal mortality review committee deemed both deaths preventable. Last week, Skop wrote a blog post in which she agreed that these deaths were preventable and the women “deserve justice.”
“But it’s past time to stop the misinformation,” she said. “We must place the blame where it belongs – not on pro-life laws that protect both mother and child, but on abortions intended to end the lives of three unborn children that ended up taking the lives of their mothers, too.”
This article originally appeared in The Texas Tribune.