Texans like to boast that their state is oversized on everything from job creation to cowboy hats, but its latest big news is nothing to be proud of. According to a just-released report from the journal Obstetrics and Gynecology, maternal mortality doubled in the state from 2011 to 2014. Unbelievably, Texas now has the highest rate of maternal mortality in the developed world. The United States as a whole is pretty shameful on that score, to be sure, with a rate that places it between Qatar and Bahrain. Moreover, the national rate has been rising in recent years—California is the only state that has managed to significantly lower maternal mortality. Even so, Texas is way out of line. What gives?
Opinion writers have been quick to point the finger at the state’s assault on birth control and abortion. In 2013, Texas passed stringent regulations that forced half of the state’s abortion clinics to close. Previously, in 2011, Texas had pursued its jihad against abortion by slashing its family-planning budget (which includes care for pregnant and postpartum women) by two-thirds in order to defund Planned Parenthood, despite the fact that its network of clinics was the single largest provider of reproductive-health care for low-income women. At least 53 clinics—many of them not affiliated with Planned Parenthood—closed; others scaled back their hours and services. What remained of the family-planning budget went to general-purpose community clinics and other health-care providers who struggled to fill the gap. As a result, fewer women were able to access long-acting contraception, and more women had unplanned or unwanted pregnancies—including women already in poor health, for whom pregnancy was not advisable. More women couldn’t obtain an abortion, lacked an entry point into prenatal care, or started that care later.
It’s certainly ironic that Texas legislators claimed to be closing clinics to protect women’s health while ignoring the real public-health crisis of mounting maternal mortality. But the full story is more complex—and even sadder. “The closure of abortion clinics isn’t related to this reported increase in maternal mortality, which predated it by two years,” said Daniel Grossman, a professor of reproductive sciences at the University of California, San Francisco, when we discussed the issue. He’s also the director of Advancing New Standards in Reproductive Health and an investigator for the Texas Policy Evaluation Project. “The family-planning cuts may have been a contributing factor,” Grossman continued—a second study, released in July by the Texas Maternal Mortality and Morbidity Task Force and Department of State Health Services, suggests that they were—“but there had to be something else going on.” One is the opioid epidemic: Overdosing is the second-biggest cause of maternal mortality in Texas. Another is racism: In Texas, the maternal-mortality rate for white women is in step with their pregnancy rate; for Hispanic women, it’s actually lower. But black women are 11.4 percent of all pregnant women in the state and a whopping 29 percent of those who die.
Before I started working on this column, I pictured maternal mortality as death during pregnancy or childbirth. In fact, the statistics include every form of death except non-pregnancy-related cancer and accidents for up to a year after the pregnancy’s end. (This would include deaths from abortion, but despite the concerns of Texas politicians, there seem to have been none of these.) Most Texas women who died post-pregnancy didn’t do so in the delivery room, but six weeks or more after childbirth. The three top causes: cardiac events, drug overdoses, and hypertension.