Physicians can do a lot to improve maternal health – one of the Texas Medical Association’s top priorities – by personally contacting their state legislators, a physician leader from TMA’s Women Physicians Section said Tuesday.
Lawmakers this session are considering several bills addressing maternal health that, among other things, promote 12 months comprehensive postpartum coverage, medical homes and improve standardized practices for delivering children, said Carla Ortique, MD, vice-chair of the Texas Maternal Mortality and Morbidity Review Committee and an obstetrician-gynecologist at the Texas Children’s Hospital Pavilion for Women in Houston. She spoke at the virtual event, Maternal Health Equity in Texas: How Can We Get There?
The state review committee’s top recommendation for improving maternal health is extending post-partum Medicaid coverage for women from 60 days to 12 months, Dr. Ortique said. That measure also is part of TMA’s multi-pronged approach to address Texas’ high uninsured rate in this session of the Texas Legislature. The new COVID-19 relief bill, American Rescue Act Plan – which is awaiting President Joseph Biden’s signature – includes a provision allowing states to pursue this option more easily.
“If each [physician] can contact your representative, your senator, to let them know that you support [improved coverage] and would be willing to testify on First Tuesdays and other times, I think that would help a lot,” Dr. Ortique said.
According to the Texas Health and Human Services Commission (HHSC), 53% of Texas births are covered by Medicaid.
Dr. Ortique’s call for greater activism on maternal health among physicians came amid a larger discussion of equity in the treatment of Texas mothers. She pointed out that while maternal illness and death affect all races and ethnic groups, they are especially prevalent among non-Hispanic black women.
“Black women consistently [experience] three to four times greater risk of pregnancy-related death when compared to white women,” she said.
This disparity exists even when controlling for multiple variables, including age, socioeconomic status, education level, and the presence of co-morbidities like obesity and hypertension, Dr. Ortique said. Black mothers who are college educated fare worse than women of all other races who never finish high school.
These are just a few of the findings from the state review committee’s latest report on maternal mortality dated September 2020. The panel also set up a subcommittee chaired by Dr. Ortique to, in part, develop strategies and recommendations to end racial disparities in maternal health.
That work parallels national efforts to incorporate health equity into maternal mortality reviews. She also participated in a national workgroup convened by the Centers for Disease Control and Prevention to examine, in part, how discrimination affects maternal death and illness.
The role of race
Dr. Ortique encouraged physicians to learn about race and discuss its impact on health care.
“Having working knowledge of the definitions and comfort with discussing the historic and current existence [of different types of racism] in our institutions and communities are important first steps in addressing the impact that they have on health outcomes,” she said.
Racism plays a role in other pregnancy-related problems, Dr. Ortique said. For instance, black newborns die at a rate three times that of white babies. She cited a 2020 study that found the death rate for black newborns was halved when they were cared for by black physicians. This may be because of racial bias and the fact that Black physicians better understand the social risk factors and disadvantages facing Black infants, the report said.
“But Blacks are consistently 13% to 15% of the population and [make up] only 4% to 6% of the medical doctors, so it’s just not feasible that there’s going to be concordance [between black patients and physicians],” Dr. Ortique said.
Texas’ health disparities do not just affect patients, she added, pointing to a January 2021 report that found Texas’ health disparities cost the state $2.7 billion annually in excess medical care and $5 billion annually in lost productivity.
Hundreds of complex factors cause maternal death and illness, but the review committee found that 89% of pregnancy-related deaths in 2013 could have been avoided by some reasonable change by the patient, family, community, health care professional, or others, Dr. Ortique said.
Individually, physicians can combat maternal mortality and illness in many ways, including by being culturally aware, supporting diversity in the health care workforce, pushing back against bias and racism, and being more attuned to the needs of patients.
She urged organized medicine and her colleagues to take proactive steps to promote a more just, patient-centered, and equitable health care system in order to improve health equity.
“I hope you’ll recognize that this is a public health emergency, and that it’s been created by the persistent systemic presence of racism in our country,” she said.