Maternal Health in Texas
The maternal mortality rate in the state of Texas has been compared to that of a "third world" nation.[1] Maternal deaths have been on the steady rise in Texas since 2010, increasing from 18.6 deaths per 100,000 live births to more than 30 deaths per 100,000 live births in 2014.[2] This rate is higher than any other state in the US, as well as countries such as Japan, with 5 deaths[3], and France, with 8 deaths[3]. Countries with comparable maternal mortality rates to Texas include Mexico, with 38 deaths; Turkey, with 16 deaths; and Chile, with 32 deaths.[3] In one study, the leading cause of maternal death in Texas was found to be heart-related complications, accounting for 20.6% of 189 studied maternal deaths. The second leading cause was overdoses, responsible for a shocking 11.5% of those 189 deaths. The quality of the maternal healthcare system in Texas, the context in which these deaths occur, has numerous socioeconomic and political determinants, ranging from the diverse demography to recent budget changes.
History of Maternal Health in Texas
In 1854, Texas, following a US-wide trend, outlawed abortion[4] as more women began seeking abortions to limit family size. The American Medical Association rallied against this trend[4], aware that the risks of mortality from septicemia and infection were higher for women undergoing abortion[5]. Doctors also opposed abortion as they became scientifically aware that the fetus developed an identity before expectant mothers were aware of the life within them[6], thus indicating that abortion implied the termination of human life. Americans were also concerned that married women obtaining abortions would further reduce the already diminishing population of white, middle-class Protestants.[7]
Texas outlawed abortion in 1854 but made an exception for mothers who required an abortion to survive.[8] Penalties for assisting with an abortion were harsh: consensual abortions resulted in two to five years in the penitentiary for the abortionist, and a possible murder conviction if the woman died during the abortion.[9] The law was clarified in 1907 to define abortion as the termination of a fetus at any stage of gestation, including before the mother realized the fetus's existence.[10]
Annotated Bibliography
Anderson, J. L., Waller, D. K., Canfield, M. A., Shaw, G. M., Watkins, M. L., & Werler, M. M. (2005). Maternal obesity, gestational diabetes, and central nervous system birth defects. Epidemiology, 16(1), 87-92.
Anderson’s explanation of maternal obesity and diabetes and their contribution to maternal and child mortality is key to understanding maternal mortality in Texas. Anderson argues that Texas’s extremely diverse and impoverished population contributes greatly to the behavioral conditions observed in the population. Anderson proposes ways to target these behaviors to reduce maternal death and argues for the urgency of implementing measures to mitigate maternal mortality.
Broussard, C. S., Rasmussen, S. A., Reefhuis, J., Friedman, J. M., Jann, M. W., Riehle-Colarusso, T., ... & Study, N. B. D. P. (2011). Maternal treatment with opioid analgesics and risk for birth defects. American journal of obstetrics and gynecology, 204(4), 314-e1.
Opioid abuse is a major factor contributing to maternal and child mortality in Texas. Broussard discusses opioid abuse in Texas and argues against their use in treating postpartum patients. Broussard’s analysis of drug abuse is useful in discussing the determinants of maternal death and the significant role of opioids compared to policy, services, and funding cuts in mortality rates.
DeNavas-Walt, C., Proctor, B. D., & Smith, J. C. (2004). Income, poverty, and health insurance coverage in the United States: 2006. Current Population Reports: Consumer Income. US Department of Commerce, Economics and Statistics Administration, US Census Bureau, 1.
De-Navas Walt covers the high rate of uninsured citizens in Texas and provides an in-depth analysis of Medicaid programs in relation to maternal health. While De-Navas Walt discusses insurance coverage across the US, emphasis is placed on Texas due to its impoverished regions and high maternal mortality rates. The paper is particularly helpful in its discussion of Texas’s adoption of ACA legislation and its impact on providers and the population. Because insurance is often the first step in accessing maternal health services, De-Navas Walt’s analysis of ACA legislation in Texas is particularly helpful in understanding the maternal healthcare system there.
Frost JJ, U.S. Women’s Use of Sexual and Reproductive Health Services: Trends, Sources of Care and Factors Associated with Use, 1995–2010, New York: Guttmacher Institute, 2013.
While De-Navas Walt explains Texas’s adoption of ACA legislation and provision of health insurance coverage, Frost explains how women have used these insurance policies. Frost focuses on immigrant women, African-American women, teenagers, and those below the poverty line, for whom insurance policies seem more restrictive. Even for those above the poverty line, Frost argues that insurance policies are exclusive and often affect the distribution of services.
Gibbs, C. E., & Locke, W. E. (1976). Maternal deaths in Texas 1969 to 1973: A report of 501 consecutive maternal deaths from the Texas Medical Association's Committee on Maternal Health. American journal of obstetrics and gynecology, 126(6), 687-692.
Gibbs and Locke discuss the determinants and effects of 501 maternal deaths in Texas over four years. This includes a discussion of insurance policies and healthcare services in Texas, views on family planning and abortion, and the health and case-specific deviations of the patients. Using Gibbs and Locke’s comprehensive discussion of the factors contributing to the high maternal mortality rate in the 1960s, I plan to provide a brief overview of maternal healthcare services, policies, and mortality in the 1960s. This will aid readers in comparing the services and policies offered today to those of the late 1900s.
Johnson, A. (1989). Abortion, Personhood, and Privacy in Texas. Tex. L. Rev., 68, 1521.
Johnson’s text provides a detailed overview of Texas’s views on abortion and family planning since the early 1800s. While the explanations are brief, they consider the political climate, economy, and medical advancements, among other factors. Most importantly, this text helps understand the history of Texas’s controversial policies and debates on maternal healthcare services. Johnson’s comprehensive discussion of economic and political factors affecting maternal healthcare complements that of Gibbs and Locke, which focuses on the scientific and hospital-related factors.
Potter, J. E., Hopkins, K., Aiken, A. R., Hubert, C., Stevenson, A. J., White, K., & Grossman, D. (2014). Unmet demand for highly effective postpartum contraception in Texas. Contraception, 90(5), 488-495.
Potter discusses factors affecting the poor state of contraception in Texas, from lack of access, funding, and adequacy to the shutdown of Planned Parenthood Clinics. He also discusses trends in abortion and unintended pregnancies and correlates these to the lack of services. Similar to De-Navas Walt, Potter focuses on minority populations for whom access to contraception has been particularly limited. Potter’s data and analysis will be useful in explaining contraceptive services and barriers to these services in Texas.
MacKay AP, Berg CJ, Duran C, Chang J, Rosenberg H. An assessment of pregnancy-related mortality in the United States. Pediatrics Perinatal Epidemiology (2005); 19:206–14.
McKay’s assessment of maternal mortality is useful in understanding Texas’s maternal mortality ratings in comparison with other states. McKay’s study focuses on pregnancy-related mortality but also places this in the context of maternal mortality across the US. McKay analyzes deviations in trends of pregnancy-related mortality, including those in Texas. A discussion of family planning services, unintended pregnancies, and demographics helps to understand how these factors are intertwined in determining pregnancy-related mortality.
MacDorman, Marian, Eugene Declercq, Howard Cabral, and Christine Morton. "Recent Increases in the U.S. Maternal Mortality Rate." Obstetrics & Gynecology 128.3 (2016). – maternal death statistics.
MacDorman’s study is a primary indicator of maternal mortality in the US and Texas. MacDorman provides an in-depth analysis of the factors contributing to maternal mortality and the trends in mortality in the US. Like McKay, MacDorman analyzes trends in Texas separately, explaining how several factors, from funding cuts to diverse demographics, have skewed mortality rates in Texas. MacDorman’s study is most helpful in its clear depiction of trends, statistics, and determinants of mortality in Texas.
Santelli, J., Ott, M. A., Lyon, M., Rogers, J., Summers, D., & Schleifer, R. (2006). Abstinence and abstinence-only education: a review of US policies and programs. Journal of Adolescent Health, 38(1), 72-81.
Santelli discusses the forms of sex education provided in the US since the 1900s. Texas adopted the abstinence-only sex education program in the 1990s, which does not require sex education but, if taught, emphasizes abstinence. Santelli discusses the pros and cons of this system and the Personal Responsibility Education Program, another way the state has received funding for contraception and sex education. Considering all factors affecting sex education, Santelli draws conclusions about the efficacy of sex education in the US.
Stevenson, A. J., Flores-Vazquez, I. M., Allgeyer, R. L., Schenkkan, P., & Potter, J. E. (2016). Effect of Removal of Planned Parenthood from the Texas Women’s Health Program. New England Journal of Medicine, 374(9), 853-860.
Studies have correlated cuts in federal funding for family planning and abortion in Texas to a higher rate of maternal mortality, and the media has widely reported on this topic. Stevenson discusses Texas’s loss of federal funding due to a refusal to integrate Planned Parenthood Services into the Women’s Health Program, the resulting state-funded initiative, and reallocation of budget to family planning services. He shows that there is no direct correlation between maternal death and funding cuts, but that the latter has affected healthcare services and may lead to poorer maternal health, increasing maternal mortality in the long run.
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- ↑ Redden, Molly (2016-08-20). "Texas has highest maternal mortality rate in developed world, study finds". The Guardian. ISSN 0261-3077. Retrieved 2016-10-07.
- ↑ "Recent Increases in the U.S. Maternal Mortality Rate". Obstetrics & Gynecology. 128.3.
- ↑ 3.0 3.1 3.2 "Maternal mortality ratio (modeled estimate, per 100,000 live births) | Data". data.worldbank.org. Retrieved 2016-10-07.
- ↑ 4.0 4.1 Gammel, Hans (1898). Laws of Texas, 1822 - 1897. Austin, TX: Gammel Book Company. p. 556 – via JSTOR. Search this book on
- ↑ Smith, Barbara (1980). Narrative Theories, Narrative Versions. The University of Chicago Press. pp. 213–236 – via JSTOR. Search this book on
- ↑ Mohr, James (1978). Abortion in America. Oxford University Press. p. 4 – via Google Books. Search this book on
- ↑ Mohr, James (1978). Abortion in America. Oxford University Press. pp. 166–167, 180 – via Google Books. Search this book on
- ↑ Gammel, Hans (1898). The Laws of Texas 1822 - 1897. Austin, TX: Gammel Book Company. p. 556 – via JSTOR. Search this book on
- ↑ Gammel, Hans (1898). The Laws of Texas. Austin, TX: Gammel Book Company. p. 553 – via JSTOR. Search this book on
- ↑ Texas, Medical Association (Louisville, KT). Transactions of the Texas State. pp. 119–120 – via Google Books. Check date values in:
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