A new national report by the March of Dimes gave Texas a grade of D for its number of preterm births compared with other states and says Texas also is below the national average in prenatal care – both indicators of maternal health in the state.
In 2020, 10.8% of Texas births were preterm, down slightly from 11% in 2019, the March of Dimes report says. However, Texas’ percentage of preterm births has stayed in a narrow range between about 10.2% and 11% since 2010, and the rate continues to affect Black women and children disproportionately.
Texas’ D grade was just below the national grade of C-minus that March of Dimes gave the U.S. The 2020 U.S. preterm birth rate of 10.1% barely changed from 10.2% in 2019. Since 2010, the national rate also has stayed in a narrow range, between 9.6% and 10.2%.
About 20% of Texas women – compared with 14.9% nationally – either begin receiving prenatal care in the fifth month of pregnancy or later, or attend less than 50% of the appropriate number of visits for the infant’s gestational age, the report also says.
Texas has taken strides to address issues tied to maternal and infant health in recent years, says Houston obstetrician-gynecologist Lisa Hollier, MD, chair of the Texas Maternal Mortality and Morbidity Review Committee (MMMRC).
However, serious disparities remain, and many of them are tied to social factors, she says.
For instance, the preterm birth rate among Black women in Texas is 41% higher than the rate among all other women, the March of Dimes data show. In 2017-19, 14% of live births to Black women were preterm, compared with 10.8% for Hispanics, 10.5% for Native Americans-Alaska Natives, 9.7% for whites, and 9% for Asian-Pacific Islanders.
“We have so many gaps and so many opportunities here in Texas, and if we look at this with an equity lens – what are the things we need to be doing to enhance equity – I think addressing the social factors is just so incredibly important,” Dr. Hollier said.
Dr. Hollier praised the March of Dimes report for including a social vulnerability index, which compares the impact of social determinants of health by county (see map on page 14 of the report).
“Socially vulnerable populations are at greater risk of experiencing poor health outcomes during a public health emergency,” the report said. “The same factors used in the index also contribute to poor maternal and infant health outcomes, including poor access to maternity care.”
The index measures differences among counties using 15 social factors, grouped into four areas: socioeconomic status, household composition and disability, minority status and language, and housing type and transportation. Each aspect of the index uses physical or social factors that help estimate where poor health outcomes may be more prevalent.
“Probably 80% or 90% of our health outcomes are determined by social factors, including food, housing, transportation, education – the context in which we live our lives,” Dr. Hollier said.
The report faulted Texas policymakers for not adopting Medicaid expansion or passing legislation to cover care by doulas – trained companions who provide physical, emotional, and educational support to new mothers. TMA backs Medicaid expansion and in the 2021 legislative session supported House Bill 2685, which – had it passed – would have created a pilot program to provide Medicaid coverage for doula services.
The report did credit Texas for setting up the MMMRC and creating a perinatal quality collaborative that works to improve maternal and infant health care. It also credited the Lone Star State for allowing midwives to practice. Two types of midwives practice in Texas – certified nurse midwives and direct entry, also known as lay midwives. TMA strongly supports use of the former as members of the care team because of their extensive education and training. However, TMA continues to call for greater education, oversight, and accountability regarding direct-entry practitioners.
The report also pointed out Texas lawmakers passed House Bill 133, a TMA-backed measure that provides women enrolled in pregnancy-related Medicaid with six months’ postpartum coverage, an increase from the previous two months.
Although the law took effect Sept. 1, Texas still needs to obtain a federal Medicaid waiver to enact the change. But if the federal budget reconciliation bill – also known as the Build Back Better Act – passes, it will supersede the state law and redefine Medicaid postpartum coverage as a full 12 months in every state.
The MMMRC recommends 12 months of postpartum coverage, a proposal TMA strongly supports. However, Texas’ six-month extension is extremely welcome and will save lives, Dr. Hollier says.
“As the public health emergency [from COVID-19] winds down and women are transitioned off Medicaid, I really hope that [HB 133] is in place, and we’re able to provide comprehensive Medicaid coverage for women at least six months postpartum.”