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The fight to end Texas’ high maternal mortality rate

Texas made headlines in 2016 after a study claimed the state had the worst maternal mortality rate in the developed world. The study's numbers turned out to be inflated, but Texas still has one of the most concerning maternal mortality rates in the U.S., particularly among black mothers, who die during childbirth at twice the rate white mothers do. Special Correspondent Kirsty Johansen reports.

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  • Hari Sreenivasan:

    If you're an American woman, your chances of dying from pregnancy-related causes are higher than someone who lives in Sweden, Poland or Libya.

    In an historic move this past December, President Trump allocated $50 million in funding to decrease maternal mortality over the next five years. Texas inadvertently became an emblem on the health crisis when it mistakenly overstated the number of maternal deaths in their state. But the error drew attention to the number of African-American women who still had higher maternal death rates than other populations.

    NewsHour Weekend Special Correspondent Kirsty Johansen traveled to Texas to meet the woman who helped put this issue in the spotlight and is fighting for change across the country.

  • Kirsty Johansen:

    Mornings in the Thierry household are like those in many other American homes. Shawn Thierry, a single mother – is getting her daughter Klaire ready for school, and has a jam-packed day herself. Thierry tries not to take any of their time together for granted, remembering sage words from her grandmother.

  • Rep. Shawn Thierry:

    She would always say, I remember when I was a little girl, "Well, when a woman has a baby, that's the closest she's ever gonna get to death." But that was true back in the—as they say, the old days. Women died in childbirth. And so I find it just boggling that in 2019, we're still having this conversation.

  • Kirsty Johansen:

    Texas has one of the most concerning maternal mortality rates in the country, estimated at 14.6 per 100,000 live births. For black women, it's even worse: 27.8 per 100,000. Shawn Thierry almost became one of the state's statistics herself while giving birth in 2012 to Klaire.

  • Rep. Shawn Thierry:

    I started to tell the doctors in the room, "Something's not right. I asked them to put me under. To give me full anesthesia. Thinking that if somehow, I wasn't conscious and awake of the level pain that I was in, that maybe I could survive. And they said–"Well, the doctor's not even in the room. He– he has to make that order." And I just screamed, "Go get him."

  • Kirsty Johansen:

    Thierry doesn't remember much else other than waking up and finding out she had given birth. She says her doctor never explained what had happened.

  • Rep. Shawn Thierry:

    Later, I found out, a couple of nurses came in, and they said that I had what's called a high-block epidural. And that can be an adverse reaction when I believe—it's put too high in your spine. And the medicine goes to your heart, instead of down to your legs. So it was paralyzing my heart.

  • Kirsty Johansen:

    Thierry believes her nurses and doctors didn't take her pain level seriously. She says a University of Virginia report may hold the key as to why.

  • Rep. Shawn Thierry:

    They surveyed medical students who actually believed that African Americans have thicker skin. They reveal that they thought that African Americans had a higher pain threshold. And so findings are coming out that– blacks are less likely to receive pain medication in the E.R.

  • Kirsty Johansen:

    As a black woman in Texas, Thierry knows all too well how big the problem is. She's a Texas House Representative—her district includes three of the zip codes with the highest maternal mortality rates. Driven by her personal ordeal, she's pushing the state to study maternal mortality, an issue that Doctor Carla Ortique says has become a crisis.

  • Dr. Carla Ortique:

    At least 50% to 80% of deliv—of these deaths are preventable.

  • Kirsty Johansen:

    Ortique is vice chair of the Texas Maternal Mortality and Morbidity Task Force, which was established in 2013 to study the state's maternal mortality rate.

  • Dr. Carla Ortique:

    We know that for every maternal death there are approximately 100 severe maternal morbidities. In other words, bad things that happen, near misses, near death instances. And so—it's really important that we recognize that the mortality is just that. It's the tip of the iceberg.

  • Kirsty Johansen:

    Ortique says 55% of women who give birth in Texas are covered by Medicaid. Most lose that coverage 42 days after delivery.

  • Dr. Carla Ortique:

    And so it's likely not a coincidence that you see a higher incidence of death after that 42 day mark.

  • Kirsty Johansen:

    Texas has the largest uninsured rate in the country, in part because in 2012 the state legislature rejected billions of dollars in federal aid to expand Medicaid under the Affordable Care Act. Doctor Ortique says that decision coupled with poverty, obesity and increases in opiate abuse has served only to further marginalize those in need.

  • Cheryl Perkins:

    She was always experimenting with hair…

  • Kirsty Johansen:

    Cheryl Perkins's daughter Cassaundra, had insurance when she gave birth to twins, Camille and Catreyal—now 4 years old. She already had an older daughter Journii who is now six. But even with insurance doctors missed early signs of trouble.

  • Cheryl Perkins:

    She had went to the ER 22 times with—with no resolution. Which—that never should have happened. Because, you know—it would seem like the doctors would say, "Why is this person coming back here? We're doin'—we're not doin' something."

  • Kirsty Johansen:

    Cassaundra was eventually diagnosed with an infection. And her labor was induced just 6 months into her pregnancy. Her twins weighed only 2 pounds each. She died a week and a half later after her liver failed. Her mother is now raising 3 young children alone. Catreyal meanwhile has been diagnosed with cerebral palsy, and needs 24/7 assistance.

  • Cheryl Perkins:

    That's, like—that is so hard.

  • Kirsty Johansen:

    Three years after Cassaundra's death, Dr. Ortique's task force found that the rate of racial disparity had not changed. Mortality among black women was more than double that of white women. But though the state has since developed a better method that focuses on tracking numbers, it stil does not include women who die outside the 42 day Medicaid cut-off. Shawn Thierry has also proposed a maternal mortality and morbidity data registry bill, which would require collecting health data at the time a pregnant woman is admitted for delivery, through 364 days postpartum. Under the bill, data would be collected on a daily basis and would include the most high-risk conditions, such as hemorrhaging and pregnancy-induced hypertension. One of the reasons Thierry wants to introduce the data registry is so broader statistics can reinforce the severity of maternal deaths and set a new standard for states across the US. Thierry is also trying to pass two more bills. One would extend Medicaid coverage for eligible women up to one year after they deliver or experience a miscarriage. The other would require cultural competency training for medical professionals to remove bias in treatment of African-American women – something the task force recommended. Physicians like Dr. Carla Ortique say that's fine, but only as long as it's voluntary.

  • Dr. Carla Ortique:

    While I did say I absolutely support having training—I'm not—I can't say that I totally support mandates.

  • Kirsty Johansen:

    Meanwhile, the state has already made some changes to address maternal health issues. Texas Children's Hospital women's pavilion has its own intensive care ward within the labor and delivery unit, the first of its kind in the country. And the Texas Department of State Health Services' introduced maternal safety bundles which detail treatment policies, safety equipment, training programs and internal reviews that every hospital should have. So far 85% of birthing facilities in the state have rolled out the program.

  • Kirsty Johansen:

    You're putting three bills forward. What happens if they don't pass?

  • Rep. Shawn Thierry:

    I'll be very disappointed. That's the first thing that's going to happen. But I'm– then, after that, I'll have to wait two more years.

  • Kirsty Johansen:

    In fact, this month her data registry bill was passed by the Texas House, but her two other bills were not granted a committee hearing. But she vows to keep up the fight even if she has to wait for the next biennial legislative session.

  • Kirsty Johansen:

    Can Texas wait two more years?

  • Rep. Shawn Thierry:

    Uh, one of the things I said in the very beginning is the time is now. We can't wait, because we have a list of names of women that have lost their lives behind this.

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