Maternal Mortality in Texas and Minority Women
By Larissa Estes

A chance encounter with the Texas State Epidemiologist in 2008 encouraged my pursuit to conduct public health research affecting minority women. During a short walk, he asked me what I wanted study for my dissertation. At the time, I was not sure about my dissertation topic but I knew it would involve women and minority health disparities. The State Epidemiologist rattled off several statistics combining my two interests. One statistic stood out, “In Texas, black women are more likely to die from pregnancy related causes compared to white women.”

Maternal mortality is often used as a measure of health and well being of women across the globe. In industrialized countries with lower levels of poverty, more accessible health care systems, and programs in place to support pregnant women, one can argue that the maternal mortality ratios (MMRatios) should be the lowest possible. This is particularly true for the U.S.A., which spent $2.2 trillion on health care expenses in 2007. According to the World Health Organization (WHO), the MMRatio for the U.S. was 11.0 deaths per 100,000 live births in 2005. In 2005, the Centers for Disease Control and Prevention (CDC) cited the MMRatio as 15.1 deaths per 100,000 live births. Despite the discrepancy between the WHO and CDC, the U.S. MMRatios for 2005 are higher than the MMRatios for Bosnia and Herzegovina (3.0 deaths per 100,000 live births), Canada (6.0 deaths per 100,000 live births) or the United Kingdom (8.0 deaths per 100,000) for the same time period . During 2005, 60 maternal deaths were reported in Texas resulting in an MMRatio of 15.5 deaths per 100,000 live births, higher than either the CDC or WHO MMRatios of 15.1 deaths per 100,000 live births and 11.0 deaths per 100,000 live births, respectively. There is rising concern regarding maternal mortality in the U.S. particularly after Amnesty International released its 2010 report “Deadly Delivery: The Maternal Health Care Crisis in the USA.” This report describes minority women often encounter barriers (e.g. discrimination, socioeconomic status, uninsured/underinsured, transportation, etc.) that prevent them from receiving quality maternal care.

Disparities across race/ethnicity have persisted in the U.S.A. despite overall declines during the 20th century in maternal mortality. The persistent racial disparity in maternal deaths cannot be overlooked or ignored. Black women are approximately three times more likely to die from pregnancy related causes, no matter the surveillance method1. Using Pregnancy Mortality Surveillance System data, researchers at the CDC found that pregnancy-related death was consistently higher among black women when compared to white women for all factors evaluated by race. As women aged, the difference in risk increased. Black women over 35 years were at greater risk than white women of the same age group. Higher levels of education and marital status did not make a difference in the increased risk experienced by Black women7. Black women are also less likely to receive early and/or quality prenatal and obstetric care. Even when researchers adjust for medical (access to care, quality of care) and socio-economic factors (education), the magnitude of risk remained11.

In Texas, the racial disparity is also evident. Black women are three times more likely to die from pregnancy related causes of death than white women. Enhanced surveillance efforts have the potential to confirm or refute the racial/ethnic disparity and more accurately determine the extent of the disparity. It is unclear if current estimates and differences are accurate. A better understanding of the racial/ethnic disparity can help providers and policymakers develop programs and policies to address maternal mortality among the most vulnerable populations.

Implementing changes to surveillance efforts and a maternal mortality review committee has the potential to enhance interpretation of the available data in Texas. These changes could provide a more complete picture of the systemic reasons for maternal deaths and how future deaths can be prevented. Maternal mortality review committees can also enhance available data and has the potential to improve public health planning and women’s and maternal and child health program and policy development.

The implications of this study are widespread. This study has the potential to influence policymakers at the Texas State Department of Health Services and Texas Legislature. The demonstration of need through enhanced surveillance could influence policy decisions. A model for a state maternal mortality review committee could take the knowledge learned from the enhanced surveillance and transform the information into programmatic efforts to evaluate the circumstances surrounding a maternal death. Results from committee review could influence policy decisions made on how to address maternal mortality, women’s health and maternal and child health in Texas. It is my goal to better describe the risk experienced by black women in Texas and encourage further public research on how to improve the health and well being of pregnant black women.

Larissa J. Estes, MPH is a native of Portland, Oregon. She received her B.S. in Athletic Training from Duquesne University (Pittsburgh, PA) and M.P.H. in Family and Child Health from The University of Arizona College of Public Health (Tucson, AZ) in 2003 and 2005, respectively. She served as the Vince L. Hutchins Fellow in the U.S. Department of Health and Human Services, Health Resources and Services Administration, Office of Women’s Health from 2005 – 2007. Estes is currently a Dr.P.H. candidate in Management, Policy and Community Health at the University of Texas Health Science Center – Houston School of Public Health. She is a graduate research assistant for the University of Texas Institute for Health Policy and is an independent public health consultant. Estes is an active member of Alpha Kappa Alpha Sorority, Inc and the Ivy League Educational & Charities Foundation (Houston, TX).