When medical staff prepped Shawn Thierry for an emergency C-section, she knew something was very wrong. After an epidural, excruciating pain ran through her legs. Soon, she could barely breathe.
“I felt like my heart was going to jump out of my chest and that I might die,” she said.
She screamed for her doctor to put her under anesthesia – which happened to be the solution. The epidural, Thierry later found out, was given too high in her spine, causing a paralysis that inched toward her heart.
“I was an attorney who had full private healthcare coverage and I almost died,” said Thierry, of the birth of her daughter in 2012. “I cannot imagine what the outcome would be for the thousands of other African American women without health insurance.”
Years later, as a member of the Texas House, Thierry was “stunned” to learn of the state’s maternal mortality crisis.
The US has the highest maternal death rate among similarly developed countries and is the only industrialized nation where such deaths are rising. But according to data from the federal Centers for Disease Control and Prevention, in Texas the maternal mortality rate is above the US average, at 18.5 deaths per 100,000 live births.
Black women in the state are “disproportionately” affected, accounting for 11% of live births but 31% of maternal deaths. Wide racial and ethnic disparities exist nationally too.
“I was shocked that black mothers like myself are three times more likely to die than our white counterparts,” said Thierry. “And no one in the legislature was really talking about it.”
She has repeatedly filed legislation to combat the glaring problem. Her proposals included racial bias training for medical professionals and a bill to fix a “severe” maternal health data backlog by creating a centralized registry.
They did not advance in 2019, or in the current legislative session which ends this weekend. Focused on restricting abortion rights, the male- and Republican-dominated state legislature has dragged its feet on maternal mortality.
Health advocates were cautiously optimistic that in 2021 Texas lawmakers would at least usher through a proposal to extend Medicaid care to a year after birth.
Lawmakers did take action. A proposal was sent to Governor Greg Abbott on Friday. But it stopped short of providing the full Medicaid expansion.
‘A large racial disparity’
A state maternal mortality and morbidity review committee found that out of pregnancy related deaths in Texas in 2013, about a third occurred 43 days to a year after the end of pregnancy. It also discovered that nearly 90% of such deaths were preventable. Among the leading underlying causes of death with the highest chance of preventability were infection, hemorrhage, preeclampsia and cardiovascular conditions.
“It was really striking,” said Dr Amy Raines-Milenkov, a University of North Texas Health Science Center professor and member of the review committee. “We found that most of these deaths could have been prevented but the system is just not set up to prevent them. And we found a large racial disparity, which is a reflection of how we in society value women, especially African American women.”
Since 2016, the committee’s No1 recommendation to help save lives has been to extend Medicaid coverage postpartum for low-income mothers to a year. Currently, Texas kicks new moms off Medicaid after 60 days, leading to delayed and less preventative care. The American Medical Association and the American College of Obstetricians and Gynecologists support longer postpartum care.
“So many health problems can develop in this really sensitive time period, so it is critical that new moms have that full year of extended coverage,” said Raines-Milenkov. “To think new mothers can identify problems, get timely appointments and follow up with their doctors within just two months of having a baby is unrealistic. Anything less than 12 months is really insufficient.”
The Biden administration recently initiated incentives for states to expand postpartum coverage to 12 months. Illinois was the first to have its extension approved and other states including Florida and Virginia hope to implement measures soon.
Toni Rose, a Dallas representative, joined Thierry in filing HB 133, to do just that in Texas. The Republican-dominated House passed the bill with rare bipartisan approval and nearly 70 groups, from the Texas Medical Association to the rightwing Texas Public Policy Foundation, expressed support.
However, the ultra-conservative Texas Senate – which ushered through extremist anti-abortion bills in March – did not pass the bill until the final minutes of its session. Even then, the legislation was not what was proposed. Without explanation, Republican Lois Kolkhorst of Brenham reduced the year of coverage to six months.
Rose called the legislation a “victory” but said it still “falls short”. Thierry expressed dismay.
“The data is clear that women are still at risk of maternal mortalities and pregnancy related complications for up to one year postpartum,” she said. “While the six months negotiated by the Texas Senate is better than the status quo, many new mothers will still be deprived of quality healthcare at a time when they are most vulnerable.
“Given that this is an issue in which I have both personal and professional experience, I am disappointed. When it comes to saving the lives of Texas mothers, ‘splitting the difference’ is not appropriate.”
Marsha Jones, executive director of the Afiya Center, a Dallas group that supports Black women with reproductive healthcare, said the lack of substantial progress was partly a reflection of the legislature’s misplaced priorities and lack of diversity.
The Texas legislature is comprised mostly of white males: 61% of lawmakers in the House and Senate are white, even though white Texans make up just 41% of the population. Women are vastly outnumbered by men.
“Black women are dying at an alarming rate for reasons that could be prevented and our state leaders cut down the main proposal that a state-appointed committee recommended to help them – why would that even happen?” said Jones. “I think it’s because it’s so easy to dismiss Black women’s lives.”
The legislature expended time and energy on restricting abortion access, including passing one of the most extreme bans in the country, which allows any citizen to sue an abortion provider, as well as a “trigger” bill that bans the procedure in the event Roe v Wade, the 1973 ruling which safeguards the right to abortion, is overturned by the US supreme court.
Both measures were “top legislative priorities” for the Senate leader, Lt Gov Dan Patrick, who did not make maternal mortality a listed priority.
“It seems the only time we want to stand up and care about a life is when it’s in the womb,” Rose told Republicans on the House floor in May.
‘Women are obviously choosing a life’
In an ideological quest to punish abortion affiliates, Republicans have decimated the Texas reproductive health safety net by blocking low-income Medicaid patients from receiving life-saving preventative care at Planned Parenthood, a move resulting in reduced access to contraception and increased rates of Medicaid births, according to the Texas Policy Evaluation Project.
A recent study in the medical journal Contraception showed a correlation between high maternal mortality rates and states that pass abortion barriers.
“We have a maternal health crisis and conservative legislators once again made anti-choice bills a priority,” said Thierry. “They fail to realize all the women threatened by maternal deaths are obviously choosing life – they shouldn’t have to do so in exchange for their own.”
Lawmakers made no significant gains for Medicaid in general. Texas is home to the highest number of uninsured residents in the US as well as the highest percentage of uninsured women of childbearing age, but it has declined to expand Medicaid under the Affordable Care Act and Republicans blocked legislative efforts to help extend healthcare coverage for the working poor.
Texas has one of the steepest Medicaid eligibility requirements in the US. Of 1.4 million Texans who would benefit from expanded Medicaid, 75% are people of color.
“Once again, we are kicking the can down the road with many of these solutions,” said Thierry. “It’s absolutely imperative we continue to work on reducing maternal mortality. One death is too many, especially when it’s preventable.”