Last week, the state of Texas issued a long-awaited report that found at least 118 women in the state died from causes related to pregnancy in 2019. Most of those deaths were preventable. The report’s top recommendation was a familiar but often-bypassed way to reduce maternal mortality: Ensure that all people have access to health care during pregnancy and for at least a year afterward.
Congressional Democrats in Washington scrambled this month to make that a federal requirement for every state’s Medicaid program. They didn’t quite make it.
As part of a sweeping end-of-year package, Democrats struck a deal with Republicans to let states begin kicking ineligible people out of the Medicaid program in April — before a freeze linked to the public health emergency ends — as long as children now enrolled in the program were covered for a year after their circumstances change, and recent states’ moves to cover people for a year postpartum were made permanent.
But the ultimate agreement is a far cry from Democrats’ desire to require every state, including 17 holdouts, to cover postpartum care through Medicaid for a year.
The stunted legislative language now reflects the Helping MOMS Act rather than the MOMMA’s Act, which would have required all states to provide coverage. It comes amid staggering maternal mortality rates — the worst in the developed world — that have only further deteriorated during the pandemic. While 33 states opted into a Biden administration offering this April to extend Medicaid postpartum care for a year, most of the resistant states are in the Midwest. Several of those states have among the country’s worst maternal mortality rates, and many have implemented stringent abortion restrictions in the wake of Roe v. Wade’s upheaval. Texas is one of them.
Such abortion restrictions, coupled with limited health-care access for pregnant people, create “an uneven playing field where the pregnant people and infants in their state – especially people of color – are more likely to die than their counterparts in states with access to public insurance and abortion care,” said Joanne Stone, president of the Society for Maternal-Fetal Medicine.
Texas officials submitted a six-month postpartum Medicaid coverage plan to federal regulators earlier this year. The state has the eight-highest maternal mortality rate in the country, though some states analyze their data differently; for instance, not all assess deaths up to a year after pregnancy or childbirth.
But Texas’ findings, released late Thursday, echo trends across the country. The Texas Maternal Mortality and Morbidity Review Committee found that 90% of maternal deaths in the state in 2019 were preventable and 12% were tied to discrimination. As has long been the case in the U.S., Texas noted that its report that Black women were more likely than white and Hispanic women to die in pregnancy-related deaths. The state is still analyzing demographic figures. But its early numbers track with national figures supplied by the Centers for Disease Control and Prevention, which finds that Black women are three times more likely than white woman to die from pregnancy-related causes.
For instance, even as overall cases of complications from obstetric hemorrhage declined compared to previous years’ assessments, their rates actually rose nearly 10% among Black women between 2016 and 2020s. This is also the first Texas report to include deaths related to discrimination since the Centers for Disease Control and Prevention in May 2020 added discrimination including racism to the potential causes for pregnancy-related deaths.
“Maternal health outcomes are worsening as American women, especially women of color, face renewed threats to their reproductive health,” Rep. Robin Kelly (D-Ill.), the sponsor of both the Helping MOMS and MOMMA’s bills, said in a statement. “While there is still room to grow this policy to benefit more mothers and babies, this provision is an essential step toward addressing the maternal mortality crisis that claims the lives of so many mothers, a disproportionate number of whom are Black and Indigenous.”
The congressional plan coincides with the Biden administration’s efforts to move forward a White House blueprint to improve maternal care which includes expanding Medicaid coverage. Top health officials last week touted a new logo to distinguish “birthing-friendly hospitals” from lower performers on quality and safe maternal care, a designation that more than 25 health insurers have signed onto advertising.
But the birthing-friendly distinction is relatively limited, particularly when many people who need better care have little to no options, Stone said.
“Depending on where you live, there’s huge [health care] deserts where you don’t even have access to prenatal care,” she said.
The geographical disparities in pregnancy care and related deaths are only expected to worsen. Texas and many of the other states holding out against year-long coverage are also among the 26 most abortion-restrictive states, which together account for more than half of annual births, according to a recent study by The Commonwealth Fund. Abortions can be necessary to avoid fatal complications from pregnancy.
Nearly 40% of counties in those states could also be considered maternity care deserts, compared to a quarter of counties in abortion-access states.
Outside of pressing for extended Medicaid coverage and unveiling its birthing-friendly designation, the administration also released a report last week assessing the impact that doula care could have on pregnant peoples’ health. The same day, White House and federal health officials convened a panel to discuss pregnancy care shortfalls, where they acknowledged that these efforts and the omnibus provisions are just the beginning.
“In the United States of America, giving birth should never be a death sentence,” said White House domestic policy adviser Susan Rice.