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Dying after childbirth: Women in Texas are at high risk, especially if they’re black

Texas state Rep. Shawn Thierry (D-Houston) is pushing for lawmakers and health officials to focus harder on maternal mortality given increasing death rates, especially among black women. (Jeremy Carter/ Houston Chronicle)

Black women in Texas are dying with frightening frequency after childbirth — at a rate up to nearly three times higher than that of white women. And no one has figured out why.

In a state with the worst overall maternal mortality in the nation, the Texas legislature opened a special session this week that will address the issue as one of 20 items that Gov. Gregg Abbott (R) listed in calling lawmakers back to work. The most they may do, however, is extend and expand the scope of a task force that started studying the problem a few years ago.

That 15-person panel, set up by the legislature in 2013, initially looked at cases from the previous two years and identified 189 such deaths. Last July, it completed a report showing rates of maternal mortality had roughly doubled between 2010 and 2012 — and that black women were far more likely to become seriously ill and die during pregnancy or within the first year after having a baby.

But the task force has yet to explain the root cause or recommend how to avert future tragedies.

For state Rep. Shawn Thierry, a Democrat from Houston and a black woman who had a complicated delivery in 2012, the report hit uncomfortably close to home.

“This one statistic was blazing right off the page, which is that African American women make up 11 percent of births in Texas but 30 percent of maternal deaths,” she said. “I hadn’t heard anyone discuss it.”

The data spurred her to propose a bill this spring that called for a study on how race and socioeconomic factors affect access and care for pregnant black women.

“A woman who chooses to bear life shouldn’t pay for it with her own,” Thierry stressed last week.

Despite having bipartisan support, the legislation died because of a parliamentary move by the House Freedom Caucus — one of dozens of measures caught up in what was dubbed a “Mother’s Day massacre.”

Our maternal mortality rate is a national embarrassment

On July 10, one minute after lawmakers could officially file bills for the special session, Thierry again filed hers. Now she’s rallying her constituents and local activists to ensure it gets a hearing.

House Bill 51 asks the task force to look at “factors and health conditions that disproportionately affect the most at-risk population” — already identified as black women — and to evaluate options for reducing maternal deaths.

“If [Thierry’s bill] gets heard, I’m fairly confident it will pass,” said Deane Waldman, director of the Center for Healthcare Policy at the Texas Public Policy Foundation. “It’s not highly contentious, and it’s not going to cost us. So, who is going to stand up and say, ‘Let’s not solve this’?”

As lawmakers began working this week, a coalition of reproductive health and justice rights organizations was watching, with plans to hold sit-in protests in the capitol rotunda and other events on each of the session’s 30 days — all to press for greater attention to women’s health in Texas.

“There’s a combination of reasons why this is happening in our community, but one common denominator is there don’t seem to be any concerns with our legislators, and that’s because this is about black women. There’s no other reason the bills should not have passed already,” said Marsha Jones, a 55-year-old activist from Dallas.

Jones quit her job as an accountant in 2008 to set up the Afiya Center, a Dallas nonprofit organization run by local black women to champion reproductive rights for women of color. And despite her work on issues including HIV, homelessness and domestic violence among black women in her city, she was shocked when she read the state task force’s report last summer.

“We knew our women were dying, because we were burying them. But were we making the connection with maternal mortality? Did we realize it was because of underlying health issues? Or access to care? No,” she said.

Jones had lost her own daughter-in-law to cardiac disease diagnosed during pregnancy and helped to raise her young grandson. But she had not connected that death to larger, systemic issues.

“They’re not talking about it in the pulpit in the black churches. I’m not hearing women come to my office and say, ‘You know, my sister died after she had her baby.’ I needed to know why black women are dying, and nobody was talking about it,” Jones said.

She now easily cites the statistics: In Texas, 27 percent of black women live in poverty, and 22 percent are uninsured. Nearly a third of those older than 18 do not see a doctor regularly because of cost, according to the Center for Reproductive Rights.

“It’s not just poverty and lack of access to health care — it’s also our fear and limited understanding of the health-care system,” she explained earlier this month. “We also have this thing about black women being strong all the time, so admitting you’re sick is a sign of weakness.”

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The task force found that 60 percent of the state's maternal deaths occurred between 42 days and a year after delivery. It noted that Medicaid coverage for low-income mothers ends 60 days after birth and suggested that many women were falling into a gap and receiving no health care soon after childbirth. In September, research published in the journal Obstetrics and Gynecology found that Texas's rate of maternal deaths had spiked from 18.6 deaths per 100,000 live births in 2010 to 35.8 in 2014 — higher than the rate of virtually any country in the developed world.

Lisa Hollier, a maternal fetal-medicine specialist at Texas Children’s Hospital and chairwoman of the task force, who wrote its report, agreed with Jones about obvious socioeconomic and racial inequalities. The panel’s report identified five factors linked to maternal death: diabetes, high blood pressure, late prenatal care, Caesarean delivery and obesity.

“Yes, black women were at increased risk for these complications. And many did not have any health care at all,” Hollier said. “We haven’t yet identified the ‘why,’ but there is no question that is very important to us.”

The task force has only 18 months left unless it is extended by lawmakers to 2023. Hollier says it needs more time to finish reviewing specific medical cases and to recommend potential solutions. But Jones's goal is twofold. First, she wants to increase awareness among the people who matter, by telling black women's individual stories. She is working to get these stories out into the community every chance she gets: on a Tuesday evening radio program she hosts, in local churches, during Texas Health Department meetings.

She also wants to help improve outcomes using culturally familiar methods, like training more doulas and midwives to help with local pregnancies and births among women of color.

As for Thierry, she has spent the past two months drumming up support in her own city, including hosting a town hall for 120 people at a Houston YWCA chapter and a tour of 12 district churches to educate them about the issue. She talks about her own near-tragedy, when she had a serious allergic reaction to a drug during delivery.

“My childbirth almost cost me my life,” she said. And she mentions what her grandmother used to tell her: “When a woman gives birth, it’s the closest to death that she’s ever gonna get.”

“In some ways,” Thierry says, “it’s still true.”