PolitiFact: Texas ‘leading’ the nation in maternal mortality

A Democrat credited Texas’ Republican governor for highlighting maternal mortality and then made a claim about the state leading nationally in a disturbing way.

State Rep. Shawn Thierry, D-Houston, noted in a press release circulated the day after Gov. Greg Abbott set the agenda for the special legislative session starting July 18 that Abbott authorized maternal mortality as a potential topic after Thierry and Sen. Lois Kolkhorst, R-Brenham, had urged him to do so.

Thierry said: “It was clear that a special session was going to happen and we now know that our Texas mothers are dying during childbirth at the highest rates in the nation. This time around, we cannot afford for party politics to stand in the way of resolving this crisis.”

Abbott included “extending maternal mortality task force” in his session call, he said, to allow lawmakers to maintain the state’s advisory Maternal Mortality and Morbidity Task Force into 2023. The group, created by the 2013 Legislature, is otherwise abolished as of September 2019.

We wondered if Texas mothers are more often dying in connection with childbirth than mothers in other states.

That’s been reported previously, including in a June 4 Associated Press news story stating researchers last year found the Texas rate “not only the highest in the U.S., but one of the highest in the developed world.”

According to a study in the medical journal Obstetrics and Gynecology, Texas in 2014 had the developed world’s highest maternal mortality rate at 35.8 deaths per 100,000 births. The journal is the official publication of the American College of Obstetricians and Gynecologists.

A methodological wrinkle was necessary, the authors wrote, to make sure the mortality rates estimated for each state reflected needed improvements in measurement. That is, the study adjusted each state’s tally of maternal deaths to account for whether the state’s death certificate already included a revealing question devised nationally in 2003 based on providing checkboxes on death certificates to measure whether women had been pregnant at up to a year before death. Adding the question, the study says, drove up reported maternal mortality rates.

Broadly, the study relied on a definition of “maternal mortality” typically used for international maternal mortality comparisons. The definition, attributed to the World Health Organization: “The death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.” The study says, though, the WHO also defines late maternal deaths: “The death of a woman from direct or indirect obstetric causes more than 42 days but less than 1 year after termination of pregnancy.”

So, did Texas have the nation’s highest maternal mortality?

The state had a yet-to-be explained spike in rates in 2011-12, the study says, giving it by far the highest rate in the country.

Previously, adjusted maternal mortality rates for Texas showed a modest increase from 2000 to 2010, the study says, from a rate of 17.7 per 100,000 live births to 18.6. “However, after 2010, the reported maternal mortality rate for Texas doubled within a 2-year period to levels not seen in other U.S. states,” the report says. A figure in the study shows the Texas rate reaching 35.8 deaths per 100,000 live births by 2014.

The report calls the two-year doubling for Texas through 2011-12 “puzzling.” The authors continue: “Texas cause-of-death data, as with data for most states, are coded at the National Center for Health Statistics, and this doubling in the rate was not found for other states. Communications with vital statistics personnel in Texas and at the National Center for Health Statistics did not identify any data processing or coding changes that would account for this rapid increase.”

The report continues: “There were some changes in the provision of women’s health services in Texas from 2011 to 2015, including the closing of several women’s health clinics. Still, in the absence of war, natural disaster, or severe economic upheaval, the doubling of a mortality rate within a 2-year period in a state with almost 400,000 annual births seems unlikely. A future study will examine Texas data by race-ethnicity and detailed causes of death to better understand this unusual finding.”

Among 48 other states, the estimated mortality rate in 2000 was 18.8; the rate escalated slowly to 23.8 in 2014, the report says.

We noted that Thierry’s statement referred only to childbirth, and not to the larger time period covered by the maternal mortality definition. We asked Dr. Lisa Hollier, American College of Obstetricians and Gynecologists president-elect and the chair of the 15-person Texas task force focused on maternal mortality, about that.

Hollier, an obstetrics and gynecology professor at Baylor College of Medicine in Houston and a maternal-fetal medicine specialist, said, “As I considered this question, I believe that the proportion of all maternal deaths that occur literally ‘in childbirth’ would be largely equivalent across states. Given the high rates of maternal mortality in Texas relative to other states, I believe this would mean that deaths ‘in childbirth’ would also be high in Texas relative to other states.”

Our ruling:

Thierry said Texas mothers “are dying during childbirth at the highest rates in the nation.”

In 2011 and 2012, according to a 2016 study, Texas had by far the nation’s highest maternal mortality rate. A clarification missing from Thierry’s statement: That national analysis took into account deaths not just at childbirth but during pregnancy and up to 42 days after delivery.

We rate this claim Mostly True.

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