The increasing number of Black people in Texas dying during pregnancy or shortly after giving birth has gone largely unacknowledged by Texas legislators, while some lawmakers and advocates call for the state to investigate.

The maternal mortality rate has increased in the United States over the past quarter-century, even as it has decreased worldwide. In 1990, 12 women died for every 100,000 births in the United States; by 2015, that number had increased to 14 women for every 100,000 births, according to data from the United Nations.

A pair of recent studies found that pregnant people are dying in Texas at a higher rate than the rest of the country.

Researchers at the Maryland Population Research Center found that in 48 states the maternal mortality rate, the number of maternal deaths per 100,000 births, increased by 26.6 percent over a four-year period: from 18.8 in 2000 to 23.8 in 2014. The study, published in Obstetrics and Gynecology, separated out maternal mortality data for California and Texas, because the trends in those states were “markedly different” than the rest of the country.

While California’s maternal mortality rate decreased from 2003 to 2014, there was a “modest increase” in the maternal mortality rate in Texas from 2000 to 2010. However, the study found that after 2010, the “reported maternal mortality rate for Texas doubled within a two-year period to levels not seen in other U.S. states.”

Texas’ Maternal Mortality and Morbidity Task Force and the Department of State Health Services issued a joint report in July after the task force investigated 189 pregnancy-related deaths in 2011 and 2012. 

The task force analyzed pregnancy-related deaths, while the data in the Obstetrics and Gynecology study uses maternal death as a metric. A maternal death occurs during pregnancy or within 42 days of the pregnancy’s end. Pregnancy-related death, as defined by the Centers for Disease Control and Prevention, is a broader category that includes deaths within one year of a pregnancy’s end.

The findings of both studies have sparked debate about the underlying cause of the state’s increase in maternal mortality. Texas lawmakers, meanwhile, slashed the state’s family planning budget by $73.6 million during the 2011 legislative session, leading to a 77 percent reduction in the number of clients served by family planning providers contracted by the state.

‘When Problems Are Chronic, They Can Be Easier to Ignore’

While the cause of Texas’ spike in maternal mortality rates is unclear, what is beyond dispute is that one community is disproportionately affected. 

The task force report found that Black women “bear the greatest risk for maternal death.” During the two-year period examined by the task force, 11.4 percent of births in Texas were by Black women, while Black women accounted for 28.8 percent of maternal deaths.

Dr. Lisa Hollier, chair of Texas’ Maternal Mortality and Morbidity Task Force, told ProPublica in 2016 that the disproportionate rate of maternal death among Black women in Texas is “incredibly important and not widely recognized.”

The response from policymakers since these findings were made public has been anemic.

An assortment of issues have taken center stage during the 2017 legislative session, but the state’s maternal mortality rate has not been a priority for the GOP-majority legislature. None of the state’s elected leaders have named maternal mortality among the issues they have prioritized for this year’s legislative session.

The virulently anti-choice Texas Gov. Greg Abbott (R) did not mention maternal mortality in January during his State of the State address. Maternal mortality rates were not listed among Lt. Gov. Dan Patrick’s (R) legislative priorities, or mentioned by House Speaker Joe Straus (R) during his opening remarks to the legislature. 

John Wittman, spokesperson for the governor, said in a statement to the Texas Tribune that Abbott “is committed to reducing the maternal mortality rate. Our office is actively engaged with the Legislature on this issue and the Governor looks forward to seeing legislation on his desk that addresses this alarming problem.”

Hollier told the Texas Tribune it will be difficult to convince lawmakers to make maternal mortality a priority during the legislative session. “We need to work hard to make sure that this issue is not forgotten,” Hollier said. “The problem has been here for a while, and I think sometimes when problems are chronic, they can be easier to ignore.”

Rep. Shawn Thierry (D-Houston) told Rewire that she was “shocked” by the high rates of maternal mortality among Black women. The reports prompted her to take legislative action.

“If we know the cause, then we can treat it,” Thierry said. 

Thierry filed legislation this month to require the state to investigate the underlying causes of the rising rates of pregnancy-related death among Black people in Texas.

HB 2403 would direct the task force to conduct a study evaluating the causes of maternal mortality and morbidity in the state’s Black population. The study would be required to assess the health issues that disproportionately affect Black people, including cardiac health conditions, eclampsia, hypertensive disorders, obesity, and stress-related health conditions.

The legislation would require the task force to develop policy recommendations to reduce the incidence of pregnancy-related deaths and severe maternal morbidity; improve patient outreach and education; and enhance health-care provider training.

Lack of data was a significant obstacle for the task force.

“Data challenges particularly on the death certificate, combined with a lack of staffing resources for redaction and abstraction of maternal mortality cases, complicates and slows the work of the task force review teams,” noted the report.

‘We Save a Family and We Save a Community’

Marsha Jones, executive director of the Afiya Center, a nonprofit reproductive justice organization based in Dallas, told Rewire that she was “alarmed” by the high rates of maternal mortality among Black people. Jones views the increase in maternal deaths as a consequence of the cuts to “basic and minimal services that women need” by the Republican-dominated Texas legislature. 

“This is because Black women continued to be ignored in these conversations,” Jones said. “Our legislators are so concerned with controlling women’s reproductive rights that they refuse to acknowledge the harm that they are doing to this state’s most marginalized women.”

Dallas County, which includes the Dallas metropolitan area, reported 14 maternal deaths in 2014, according to data from the Texas health department. Only Harris County, which encompasses the Houston metropolitan area, reported more maternal deaths that year: 21.

The Maternal Mortality and Morbidity Task Force report made recommendations to “reduce the incidence of pregnancy-related deaths and severe maternal morbidity,” and Thierry’s bill would require recommendations that target Black people.

Jones said those recommendations won’t be effective if the state does not increase its outreach efforts and create partnerships with the organizations and advocates working with marginalized communities. “There’s got to be an intentional effort in funding these community-based organizations who’re working one-on-one with people on the ground,” said Jones, whose organization is predominately funded by foundations, private donors, and fundraising.

Thierry said lawmakers should not view the increase in maternal mortality among Black women as an issue that only has an impact on the Black community. “This is not something where they should feel like this is an African-American woman’s issue and it won’t affect me,” Thierry added. “Everyone is going to be effected.”

“We’re all connected, and I don’t want them to see this as though that’s not their problem,” Thierry continued. “If we save the life of a mother, essentially we save a family and we save a community. We improve the overall state of Texas.”