- Today on Austin InSight, maternal health.

Having a baby is riskier in Texas than most other states, especially for Black women.

We're asking why.

- And does the state's strict abortion ban put women's health at risk?

Austin InSight starts right now.

- [Announcer] Support for Austin InSight comes from Sally and James Gavin, and also from Suerte, Este and Bar Toti restaurants, bringing Austin together around culinary excellence to celebrate creativity, conservation, and culture in central Texas.

(bright music) (bright music) (bright music) - Hi, and thanks for joining us.

I'm Laura Laughead.

- And I'm Danielle Banda.

Well, having a baby is one of the most significant events in any woman's life.

Data shows that in Texas, the risk of death or the maternal mortality rate is higher than in most other states.

- And that rate is much higher for Black women compared to white women.

The reasons and potential solutions for this are complex.

Our News and Public Affairs Director, Ed Bryson, has more in this report.

- See, I remember you.

- Yes.

(baby babbling) - Okay, don't pull her hair.

- [Ed] For Jordan Hostler Rowe, the birth of her daughter Micah, now seven months old, was a lifelong dream come true, but a dream with underlying fear.

- Throughout my life, I knew I wanted to be a mom.

I wasn't aware of all of the issues that Black women specifically face in my earlier adult years but I distinctly remember hearing about Serena Williams when she gave birth to her first child, and how she had to really advocate for herself and make sure that she was taken care of, and that she could have easily died and people weren't believing her and were minimizing what she was describing.

And that felt terrifying to me.

- Say hi.

- [Ed] Her care team includes certified midwife Denise Washington, who is on the front lines of maternal healthcare in Texas.

- What else do you see?

- Pregnancy, childbirth is pre-programmed in every woman.

That is how we were designed.

Of course, they didn't give us the instruction manual.

(laughs) - [Ed] Texas ranks near the bottom among US states in maternal mortality according to research from the Commonwealth Fund, and the Texas Department of State Health Services reports that Black women are 2 1/2 times more likely to die than white women during or soon after a pregnancy.

Data from 2019 and 2020 shows deaths increasing for Black women, up to 39 per 100,000 births, while the death rate declined for white women.

Advocates like birth justice activist Serita Fotanesi, who is 18 weeks pregnant, birth workers like doula Ebony Williams, and physician leaders like Dr. Clara Ortique, Chair of the Texas Maternal Mortality and Morbidity Review Committee, all point to the same underlying cause of the higher risk of death for Black women.

- The short answer is racism, right?

And long systemic racism and discrediting and not believing Black women.

You know, Texas Crown Jewel Beyonce has even talked about her incredibly traumatic and trying times during pregnancy, and if Beyonce is struggling, what are the rest of us supposed to be doing, right?

- We've identified that it is mostly due to systemic, right?

Systemic racism, systemic policies that have been put into place that Black women or Black birthing families have more of a disadvantage, too.

- It's the institutional racism and prejudice that exist not only in our education system, but also in our legal system.

Every system that was created in this country has some historic marginalization of Black people.

- [Ed] So what is systemic racism?

Some question that it even exists at all.

It's not being in the Ku Klux Klan or calling someone a slur.

That's overt racism.

It's easy to see.

Systemic racism can be subtle, less discernible, especially if you are not on the receiving end of it.

That's according to sociologists, historians, and researchers and the women we talked to.

It's about being uniquely disadvantaged.

Doctors and nurses aren't shouting the N-word at pregnant Black women, but in the maternal care system in Texas, their risk of death is far higher than that of white women.

- If you have over decades not allowed access to healthcare, not allowed access to safe environments, not allowed access to areas that are not food deserts, not allowed access to areas where, as I said, it's safe to exercise, different schools based on tax-based need, you are forced to live in an area where your schools are not as good, then over time, a people becomes negatively impacted.

- [Ed] In 1998, Washington was homeless, a teenager, and pregnant.

She safely gave birth in a hospital, but without family and community support.

That frightening, lonely experience led her to a career as a birth worker, and she says, to firsthand encounters with systemic racism.

- I've gone to the hospital as a student midwife with my preceptor with a white client, and the energy is completely different.

They wanna cater to this woman.

"Do you need anything?

Are you okay?

Are you feeling uncomfortable?"

Like they are hands and knees catering to this woman.

But when I come in with my Black doula clients, the energy is trying to hurry up and get in and get out.

"Oh, they're fine.

They don't need... Just get the epidural and lay down.

You'll be okay."

And that is, to see it and have to live with it and deal with it and know that it's still around, it's just crazy to me.

I hate to say that.

I hate to think I'm being treated differently or my client is being treated differently because I am Black, but I know it's true.

- [Ed] Say that there's no single solution to making birth safer for Black women, but these experts say doula and midwife care fills gaps in the traditional care system.

- Midwifery is not set up in the traditional medical way.

So, and even with just having a doula, it's not traditional Western medicine, so it is culturally-based medicine from Africa, from the Indigenous people of this country.

(people chattering) - A doula is a support person during the perinatal period, so prenatal, birth, and postpartum.

We are not medical practitioners.

However, we're there to provide emotional, physical, resource support.

We're not that medical authoritative figure, so we tend to be able to be a friend, someone that they trust that they're able to open up to and be vulnerable with.

So we're able to, a lot of times, build that relationship with our clients that most times they're not able to build with their provider.

- [Ed] In March, a coalition of advocates organized by Giving Austin Labor Support, or GALS, met before visiting lawmakers at the state capitol.

They want Texas to allow doulas to earn more reimbursement for Medicaid so that more women at risk can get needed support.

But even women with resources and good health insurance worry.

- I am tremendously grateful for my care team at Texas Children's, both my OB and the maternal/fetal medicine team, and also as great and wonderful as they are, it's still really terrifying to be pregnant right now in Texas.

(care provider chattering) - [Care Provider] Who are these people?

- [Jordan] I felt more excitement, more joy.

- [Ed] Meanwhile, Micah was fortunate to come into this world safely and surrounded by the type of care and support that her mother chose, something any mother would want.

- I really wanted the energy of the room to feel calm, to feel welcoming, and to feel focused on her, and I had that.

She's really, really, really great.

(baby laughing) Yeah, okay.

Yeah.

Oh!

I'm getting so strong.

- [Care Provider] So yeah, like scoot now.

I can scoot backwards on my tummy.

- Ed, that was a great story, and little Micah over here was just so cute and so well behaved, I might add.

So Ed, joining us to discuss more, can you tell us what is being done now to combat this problem?

- Well, Laura, the state took a significant positive step forward very recently.

Last year, maternal care coverage through Medicaid was extended to a full 12 months, and previously, this coverage only lasted for 60 days.

So that's a big step that experts and healthcare advocates believe will have an impact on these data around maternal mortality, because nearly half of all births in Texas are covered by Medicaid.

- And how does that differ from the Medicaid expansion under the Affordable Care Act?

It is a different matter, Danielle.

It's a good point to make.

Texas is one of only 10 states that has not expanded Medicaid under the ACA, which is also known as Obamacare, and women's health experts say that's a big part of the reason that Texas ranks very low in comparisons to other states when it comes to overall healthcare quality for women.

And so we rank closer to relatively poor states, like Mississippi, versus say, Massachusetts or Wisconsin.

And another part of that, another consequence of that is that this means that perhaps billions of dollars in healthcare services have not been administered to people in Texas who might have qualified if we had chosen to expand Medicaid.

- Thank you, Ed.

(upbeat music) (upbeat music) (upbeat music) (upbeat music) - According to Media Reports, a contributing factor in maternal mortality is law regarding abortion ban in Texas, but the state government committee that reviews maternal deaths currently is not able to look into abortion related deaths.

Now, the Texas Maternal Mortality and Morbidity Review Committee has 23 members, mostly physicians and a few other experts.

Their job is to review maternal deaths, determine the causes, and recommend solutions.

The committee operates with limitations, like the prohibition on investigating abortion related-deaths.

- And the committee recently decided not to review maternal deaths in the two years following the Supreme Court decision that triggered the total abortion ban taking effect in Texas.

National Media outlet ProPublica has reported that at least three women in Texas have died because some Texas doctors are reportedly avoiding a previously common treatment for miscarriages.

Physicians told reporters that the abortion ban is dangerous for women and for doctors, who face up to 99 years in prison for providing care that could be viewed as an illegal abortion.

We asked the committee chair about this.

- [Interviewer] Is the abortion ban in Texas, is that law in your opinion, based on your experience and knowledge, contributing to maternal mortality in Texas?

- I'm going to not answer that question.

- It's important to note that Dr. Ortique supports reforms that would allow the committee to review abortion-related deaths, but her silence on this question is one of many perhaps unintended consequences of the strict, and some physicians say, unclear abortion ban in Texas.

I spoke with some local OBGYNs about how this ban has changed care delivery.

- Okay, take a deep breath for me.

- [Laura] That's Dr. John Thoppil, the founder of River Place OBGYN.

The Air Force veteran is also the former President of the Texas Association of Obstetricians and Gynecologists.

- We're scared to even talk in the privacy of this room.

Used to be a sanctum, right?

It was between the patient and us.

- [Laura] For him, this office has become a battleground in what he describes as an attack on women's health, and OBGYNs are caught in the crossfire.

- Even if you do everything right, doesn't mean that somebody won't come for you.

- What Dr. Thoppil is talking about is SB 8, the Texas Heartbeat Act passed in 2021.

Here's a quick refresher.

SB 8 is also known as the bounty hunter or vigilante law.

It bans abortion after the detection of cardiac activity.

But here's the thing.

It incentivizes private citizens to sue people suspected of performing an abortion after six weeks, or anyone who helped, from a loved one to an Uber driver.

They could be awarded $10,000 if they win.

But Texas has multiple abortion bans in place.

In 2022, after the overturning of Roe versus Wade, a Texas trigger law criminalized providing an abortion after fertilization, with no exception for rape or incest, just a slim exception for the life of the mother.

Physicians found in violation could lose their license, face a penalty of $100,000, or face up to life in prison.

It's these laws, Thoppil says, are placing stress on already burnt-out OBGYNs in Texas.

Some of them are retiring early or considering moving, and now there's a recruitment shortage.

- Now for the first time, we're struggling in getting the candidates from outside of the state to look at moving here.

- [Laura] That inspired him and his colleague, Dr. Rachel Shepherd, to join over 100 OBGYNs across the state in signing an open letter condemning the ban.

- Recently, I've felt a lot of fear from my patients.

These laws are not supported by every day OBGYNs.

- [Laura] A recent survey of Texas OBGYNs shows nearly a third found the law confusing and that confusion, experts say, can kill women.

- How do you decide when it's legal to intervene?

If you know that they have a 50% risk of dying, when is it appropriate to make an intervention?

- There are several cases of Texas women who have died as a result of complications with their pregnancy, be it a miscarriage or other health condition.

They were not able to get the healthcare that they need because the language of the law is unclear.

- [Laura] Dr. Kari White and her research team study the impact of abortion and contraception policies.

- I think this is a really bleak time for maternal healthcare in Texas.

The research is very clear that restrictions on abortion care, particularly those that prohibit the provision of care in nearly all circumstances, puts women's healthcare at risk.

- [Laura] In 2023, the Texas Supreme Court ruled that physicians don't need to wait until a patient is near death or has irreversible bodily damage, while the Texas Medical Board has since issued some guidance for doctors in emergency situations.

- You shouldn't have to fear for your life having a baby.

That makes no sense.

- [Laura] But from doctors to doulas, the law is still unclear.

- Some of the things that are used for abortion are also used for other medical issues.

It's tragic that we have people who are not medical making these decisions.

- [Laura] Today, thousands of pregnant Texans are still traveling out of state for abortions.

Jane's Due Process is a nonprofit that helps teens access reproductive care, including abortions, and the group has received funding from the Austin City Council.

- And so we know that when our state leaders fail us, it's going to be those Austin leaders that step up and show the rest of the state how we should be taking care of our community.

- [Laura] Dr. Thoppil says lawmakers should listen to doctors and their patients before another woman has to die.

- I do believe there's a lot of good people who just don't have a fundamental understanding of the unintended consequences of what they've done.

- Now, there are positive signs that these concerns are being heard.

Our conservative state government leaders are expressing support for changing the abortion law.

In a February interview, governor Greg Abbott said, quote, "I look forward to seeing what type of clarity may come forth in proposed legislation.

Everybody on every side needs to understand that protecting the life of the mother is of paramount importance," end quote.

- Lieutenant Governor Dan Patrick has weighed in, saying, quote, "I do think we need to clarify any language so that doctors are not in fear of being penalized if they think the life of the mother is at risk," end quote.

Now, several bills have been filed in the legislature, including a proposal from state representative Donna Howard of Austin that would amend the law to include clear exceptions.

Representative Howard joins us now.

Thank you so much for being here.

- Thanks for having me.

- Absolutely.

Well, with some momentum in favor of changing the law, how likely is it that such a bill will pass?

- I'm feel, I'm very hopeful.

I mean, we have state leadership saying that this is something that they believe we need to do to clarify the law because we all understand that women have died and that women have suffered some extreme chronic conditions, even infertility, and that's not what we want, none of us, and so I think that we are all coming together to make sure that the language is clear, to work with the doctors to ensure that they do not feel like the language is threatening them from practicing medicine, evidence-based medicine, and the bottom line is we all want to save the lives of Texas moms.

- Absolutely.

Well, what do you think the latest is on your bill, and what's your point of view on the new proposals announced last week?

The Life of the Mother Bill proposed by Senator Brian Hughes from Quitman, and representative Charlie Garrin from Fort Worth?

- Well, I'm thrilled that they have done this.

I think that that bodes well for something passing, and I am a a joint author on Chairman Garren's bill.

We have two Republicans, including, as you said, Senator Hughes, who actually wrote legislation prohibiting abortion.

So to have him step up and take a leadership role here in clarifying this language, I think is a strong statement.

And again, I think we're all on the same page here, that whatever we need to do to ensure that Texas women get the care they need when they have complications of pregnancies that they desperately want, that we want to all take the necessary steps to ensure they get the evidence-based medical care that they need.

- Sure.

Now what do you hope will be the impact of amending the current law?

Will it undo what some people refer to as unintended consequences of this policy?

What can you tell us?

- Well, I guess I wanna clarify first that this is not a choice bill.

This has nothing to do with allowing what currently exists as prohibited abortions.

That is not a part of this bill.

It is not a choice bill.

It is strictly a medical clarification bill for medical emergencies.

So what it will do is it will allow doctors to not be threatened by the possibility of losing their license, hundreds of thousands of dollars in fines, and actually going to prison for life.

- Well, representative Howard, thank you so much for taking the time to speak with us today.

We really appreciate it.

- Thank you.

- The credit for bringing to light concerns about the Texas abortion ban goes to the investigative reporting team at ProPublica, a national nonprofit media outlet.

Joining us now is Kavitha Surana, national reporter for ProPublica.

Kavitha, thank you so much for being here.

- Thanks for having me.

- So first, let's talk about your newest reporting about increased maternal deaths following the abortion ban.

How significant is this increase, and what would you say is causing it?

- ProPublica purchased hospital discharge data to try to get a window into what are the outcomes for women who are facing pregnancy complications in their second trimester, and what we found is that sepsis rates for women who are hospitalized for a pregnancy loss in their second trimester rose more than 50% after Texas outlawed abortion.

And now to explain a little more about sepsis, it's a life-threatening condition that's a reaction to an infection and it can move really quickly and have serious long-term effects.

It can lead to loss of organs, loss of fertility, and even death.

So experts said that seeing this rise so dramatically really speaks to how the effects of the ban is not a case of just one or two doctors making the wrong call, but really a basic change in how doctors are treating and interacting with pregnant patients in many places across the state.

- And to hear that, that's a rather stunning statistic, and we'll talk more about how that played out in real time in a woman's case.

But first I wanna ask you, what does your reporting reveal about the state's response to the impact of this abortion ban on maternal care, like you just said?

How vigorously or not have state officials looked into this?

- Well, we decided to do this reporting after realizing that no one was systematically looking into the effects of this ban with any urgency.

In Texas, the state has a maternal mortality review committee and that would be the best organization equipped to review these kinds of deaths, but they are barred from reviewing any cases that include abortion procedures, even if it's during a miscarriage.

And they have decided to skip reviewing cases from 2022 and 2023 deaths, the years after the state banned abortion, saying that they wanna get a more contemporary view.

- And you talked to us about how you were able to find some of these specific cases of maternal deaths, but per your reporting now, do you expect to find more deaths and uncover more deaths like these?

- Well, I will say we've only looked at a small slice of autopsy records in Texas and also in other states.

This is really shoe leather work that takes a lot of work to get those records, and even autopsies are only a small slice of maternal deaths that have happened in the state.

So we are continuing this work.

We're continuing to request these records and review them with experts and try to find out more, not only in Texas, but also in other states that have outlawed abortion.

- Well, that is definitely reporting that we will stay tuned for.

Well, Kavitha, thank you so much to yourself and to the team at ProPublica for shedding light on this issue through your shoe leather investigative journalism.

- Thanks for having me.

(bright music) - As part of our mission here at Austin Insight, we highlight voices in our community, speaking out on issues that matter in an occasional commentary segment that we call Op/Ed.

- Local physician at Crystal Berry-Roberts is in studio now to comment with her opinion on the topic of Black maternal mortality.

(keys clicking) - Hi, I'm Dr.

Crystal Berry-Roberts.

As a Black obstetrician gynecologist in Texas, I hear the fears of Black women firsthand.

They are afraid they will die during childbirth at a rate two to three times greater than that of white women.

Black women here also face the reality that lifesaving abortion healthcare is delayed or withheld from them at a higher rate.

They bleed out, they die from preventable infection, while the Texas healthcare system watches.

Dying should not be on the mind of any mother to be.

No family should be faced with a wife or daughter missing from family photos with their baby or not being there to hold that little bundle of joy.

Joy for these families is replaced with grief and pain.

Access to quality maternal healthcare, free from implicit bias, is not the standard of care here.

Texas continues to fail Black women.

So what if no one is coming to save you?

I say to you, show up for yourself.

Rally your supporters to be there for your prenatal care visits, in the labor room with you, and on postpartum.

Instead of turning to birth plans that show up on your social media feeds, focus on building a trusting relationship with your provider.

You need to feel empowered to communicate your fears and desires.

You deserve to be heard and valued.

That kind of a birth plan may help save your life.

(keys clicking) - We welcome your responses to the opinion segment, and you can send us an email at myopinion@klru.org.

We'll share your comments online and on occasion on air here on Austin InSight.

And that's all we have for today's show, but be sure to tune in again next week Thursday at 7:00 PM, and don't forget, you can always watch each episode on your PBS app.

We'll say goodbye today with a look at a very unique sunset, one that you've never seen before from the surface of Earth's moon.

- This video is from Firefly Aerospace, a local company based in Cedar Park with about 700 employees.

They recently completed a 14-day mission on the moon.

They are the first commercial company to land a spacecraft on the moon.

That is really, really cool.

Congratulations to them all.

Goodbye, and we'll see you next time.

(bright music) (bright music) (bright music) - [Announcer] Support for Austin InSight comes from Sally and James Gavin, and also from Suerte, Este, and Bar Toti restaurants, bringing Austin together around culinary excellence to celebrate creativity, conservation, and culture in central Texas.

(cheerful music)