Texas’ Black maternal mortality crisis is ‘completely preventable’

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HOUSTON — When Tonjanic Hill learned she was 14 weeks pregnant in 2017, she was overjoyed. Despite her history of uterine fibroids, she never lost her belief that one day she would have a child.

But just five weeks after confirming her pregnancy, and the day after announcing at a gender reveal party that she was having a girl, she apparently couldn’t stop urinating. She didn’t realize her amniotic fluid was leaking. Then came her excruciating pain.

“I ended up going to the emergency room,” said Hill, now 35. “That’s where I had the most traumatic and terrifying experience ever.”

An ultrasound revealed that she had the following symptoms: Lost 90% of amniotic fluid. But over the angry protests of Hill’s nurses, Hill said, her doctor insisted that she be discharged from the hospital and see her gynecologist the next day. Her doctor brushed off her concerns, she said. The next morning, her gynecologist rushed her back to the hospital. However, she lost her baby Tabitha Winnie Denkins.

black women are unlikely They have a harder time carrying a pregnancy to term than women from other racial groups. In Harris County, where Houston is located, if you become pregnant, Infants are about twice as likely to die As in other racial groups, before the first birthday. Black fetal and infant deaths are A series of systematic failures That contributes to disproportionately high maternal mortality rates among blacks.

“This is a public health crisis that affects Black mothers and their babies and is completely preventable.” barbie robinsonHe became executive director of the Harris County Department of Public Health in March 2021. “When you look at the demographic breakdown of who is being disproportionately affected by lack of access, we are in a situation where we expect these dire consequences.”

In fact, according to the federal government, Harris County ranks third in so-called excess deaths of black infants, behind Chicago’s Cook County and Detroit’s Wayne County. Management of health resources and services. These three counties are also among the most populous in the United States. account of They account for 7% of all black births and 9% of excess black infant deaths in the country, said HRSA senior scientist Ashley Hirai. These counties have the highest number of black births; more deaths will occur This wouldn’t happen if black infants had the same chance of reaching their first birthday as white infants.

Genetic reason unknown The fact is that black infants have higher mortality rates than white infants. Such deaths are often referred to as “deaths of disparity” because they are more likely to result from systemic racial disparities. Regardless of economic status or educational background, the stress of experiencing persistent systemic racism negatively impacts the health of Black women and their babies. According to research Published in Women’s Health Issues.

Such miscarriages and deaths can occur even in communities that appear to have vast medical resources. For example, Harris County has two public hospitals; texas medical center According to March of Dimes, the world’s largest medical complex with more than 54 medical institutions and 21 hospitals, the death rate for black infants from 2014 to 2019 was 11.1 deaths per 1,000 live births. In contrast, the mortality rate for white infants was 4.7.

Harris County is rich in providers. I don’t feel safe Pregnant Black patients can find timely and appropriate care. culturally competent — Care that acknowledges the person’s traditions, beliefs, and values ​​during treatment.

Research shows that regardless of income or insurance status, health care providers often get fired Black women’s questions and concerns; Minimize physical complaints, unable to provide proper care. In contrast, a Florida study of 1.8 million hospital births over 23 years found a disparity in mortality rates for black and white newborns. It became half When a black doctor cared for a black baby.

In 2013, Houston native Kay Matthews had a successful catering business when she lost her daughter, whom she named Troya, at eight months and three weeks pregnant.

Matthews had been feeling unwell for several days, feeling weak and tired, but doctors said there was no need to worry. Not long after, she realized something was terribly wrong. She passed out after calling 911 and when she woke up, she was in the emergency room.

None of the medical staff would talk to her, she said. She had no idea what was going on. No one answered my questions and I started having panic attacks.

“It felt like I was watching myself lose everything,” she recalls. She said her nurse seemed irritated by her questions and behavior, so she was given a sedative. She said, “When she woke up, the baby was gone.”

Matthews said one staff member said that even though she was a financially stable business owner and he had a well-paying job as a truck driver, she and her partner could afford to pay the bills. I remember hinting that there wasn’t one.

She said hospital staff showed minimal sympathy after Troya’s death. They seemed to ignore her grief, she said. It was the first time she could remember that she felt like she was being treated cruelly because she was black.

“There was just no respect, no respect, no compassion,” said Matthews, who went on to found the organization. Shades of Blue Projecta Houston nonprofit focused on improving maternal mental health for primarily Black patients.

To address Harris County’s high mortality rates, Robinson established the Maternal and Child Health Office and launched a home visiting pilot program to connect prenatal and postnatal patients with resources such as housing assistance, medical care, and social services. . Limited access to healthy diets and recreational activities are barriers to healthy pregnancy outcomes. According to research, Relationship between eviction and infant mortality rate.

For Hill, not having insurance was also a contributing factor. Hill said she only visited the community health center once during her pregnancy before she miscarried. Since she was a college student, she worked multiple jobs, and she did not have health insurance provided by her employer. She has not yet been approved for Medicaid, the state’s federal program for people with low incomes and disabilities.

Texas has the highest uninsured rate in the nation, with nearly 5 million Texans. 20% under 65 years old — There is a lack of coverage, said senior researcher Anne Dunkelberg. all texas, a nonprofit research and advocacy organization focused on equity in public policy. Census data shows that the percentage of non-Hispanic black Texans is slightly better at 17% of the state’s total, but still higher than the 12% percentage of non-Hispanic white Texans. Medical experts are concerned that more people will lose insurance coverage. Pandemic measures against the new coronavirus infection (Covid-19) have ended For Medicaid.

Without full insurance, pregnant people may avoid medical treatment and skip important early pregnancy visits, she said. Fatima LalaniHouston Medical Director hope clinic.

in texas Mothers have the lowest percentage According to the state’s 2021 Healthy Texas Maternal and Child Data Book, more people nationwide received early prenatal care in 2020, with non-Hispanic black mothers and infants receiving more early pregnancy care than other races and ethnicities. were less likely to receive care.baby Born without prenatal care They were three times more likely to have a low birth weight baby and five times more likely to die than those whose mothers were in care.

If Ms Hill’s miscarriage reflected a system failure, the birth of her twins two years later shows how the right support can change outcomes.

Hill had been covered by Medicaid since the beginning of her second pregnancy, so she saw a high-risk pregnancy specialist.So-called early diagnosis incompetent cervix, Hill was consistently examined, monitored, and treated. She was also forced to bed rest throughout her pregnancy.

She had an emergency C-section at 34 weeks and both babies spent two weeks in the neonatal intensive care unit. Today, her premature twins turned 3 years old.

“I believe God and high-risk doctors saved the twins,” she said.

KFF Health NewsFormerly known as Kaiser Health News (KHN), we are a national newsroom producing in-depth journalism on health issues and one of our core operating programs on health issues. KFF — An independent source for health policy research, polling, and journalism.

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