Black mothers in Texas are dying at a rate 2.3 times as high as white mothers regardless of income, education, marital status, or other health factors. The good news is that we can change this because in almost 80 percent of pregnancy-related deaths, there is at least some chance of preventability.
Three bills under consideration at the Texas Legislature would help Texas make great strides in reducing maternal health disparity by extending Medicaid benefits for a full year, supporting doula programs and requiring a curriculum on implicit bias and systemic inequities for health care practitioners. More state lawmakers ought to support these bills.
Maternal mortality and traumatic birth experiences affect black mothers across the economic spectrum. Serena Williams brought this issue to the national forefront by telling how she almost died of complications after the birth of her daughter because the health team wasn’t listening to her. Here in Texas, through my work with the Black Mammas Community Collective, I have witnessed how traumatic birth experiences happen to mothers covered by Medicaid as well as mothers who can rely on private insurance. In one case, a mother covered by Medicaid crowned her baby in the hospital’s toilet because the nurse had not informed her that the pressure of the baby’s head moving past the dilated cervix wasn’t a sign to use the bathroom. In another case, a mother who relied on private insurance experienced severe hemorrhaging during the birth of her second child. The medical staff gave her a medication to alleviate the hemorrhaging that aggravated a pre-existing condition, causing her blood pressure to increase to dangerous levels.
According to a recent report, the majority of maternal deaths during 2012-2015 occurred between 43 and 365 days postpartum. Currently, Medicaid coverage ends 42 days (six weeks) after a woman gives birth. The bipartisan-supported HB 411, currently under review at the state Capitol, would extend Medicaid for one full year after delivery. Passing this bill would be a first step in the right direction for Texas.
Doula programs can also be effective in reducing maternal health disparities. Doulas are nonmedical professionals who provide continuous physical, emotional and informational support to a mother before, during and shortly after delivery. Research shows that doula-assisted mothers are a quarter as likely as mothers without doulas to have a baby with low birth weight and half as likely to experience a birth complication involving themselves or their baby, and they are significantly more likely to initiate breastfeeding. Unfortunately, doula services are rarely covered or reimbursed by health insurance providers.
Texas HB 4301 proposes to provide medical assistance reimbursement for doula services, including childbirth education and emotional and physical support during pregnancy, labor, birth and the postpartum period.
Passage of this bill would strengthen organizations such as Austin’s Black Mamas Community Collective, which offers doula postpartum home visits and then transitions new black mothers to “sister circles,” where they receive support in addressing self-care, holistic wellness, relationships and stress reduction. The organization also offers training to understand systemic inequities in the health care system.
Health care professionals seek to help and do no harm, but they are socialized beings like all of us. It is not surprising therefore that research suggests they exhibit the same levels of implicit bias as the wider population. House bills 719 and 607 require coursework and continuing education in cultural competence and implicit bias for physicians. This is another crucial first step in improving maternal health outcomes, particularly given the grave underrepresentation of black professionals in the health care industry in Texas.
The cost to families and communities of losing mothers to preventable pregnancy-related complications can be changed. These bills have the potential to keep more Texas mothers from dying. Extending Medicaid coverage will provide mothers with essential comprehensive health care for a full year. Supporting doula services ensures mothers are receiving culturally relevant and patient-centered care. And educating health care professionals about the impacts of bias and systemic inequities is critical to address inequities in access and quality of care. We must and can do better as a state. State lawmakers have a chance to lay the groundwork.
Michele A. Rountree is an associate professor in the Steve Hicks School of Social Work and associate director of the Institute for Urban Policy and Research Analysis at The University of Texas at Austin.This opinion piece was produced for Texas Perspectives, and represents the views of the author, not of The University of Texas at Austin or the Steve Hicks School of Social Work.