Childbirth is Killing Texas Mothers: Why My MPH is Needed at Home

Everything is bigger in Texas. The land mass, the food proportions, and even the odds that a mother will die while delivering her child.

If Texas were considered a country, it would rank 83rd globally in maternal mortality, trailing behind countries such as Bosnia and Iran. It’s even more alarming that research has yet to find an answer to this Texas-sized problem.

From 2000-2009, Texas’s maternal mortality showed a steady increase, rising from 17.4 maternal deaths per 100,000 live births to 18.6. Then, from 2010-2012, the rate more than doubled to nearly 40 deaths per live births. Though rates lowered slightly in 2014, they are still alarmingly high.

While definitive sources to the problem have yet to be found, lack of healthcare coverage is a likely culprit. Texas has the highest percentage of uninsured individuals who make too much for Medicaid enrollment and too little to qualify for Affordable Care Act premiums. As a result, almost 400,000 women have less access to affordable care for conditions like heart disease and drug dependence, two of the biggest drivers of maternal mortality in the state.

I am a Texan, born and raised in Dallas County. By some stroke of fortune, I’ve been given the opportunity to study at one of the best public health institutions in the nation, situated in a city with one of the largest public health agencies in the world. I have the opportunity to watch what happens when substantive resources are combined with political will to tackle public health problems—a dream for a girl who’s state cut funding for family planning clinics by two-thirds in 2011.

Taking a practical step to learn more about New York’s efforts, I joined Mailman’s Office of Career Services on a tour of the New York City Department of Mental Hygiene a few months ago. During my visit, I listened to specialists in a variety of fields, including reproductive health, and was given tangible steps to get involved in their efforts as both an intern and as a career path.

After our visit, my determination to return home was shaken. It would be so easy to work on the health issues that interest me here. Representatives at the health department worked to incorporate health equity in their programs. Money and resources were being directed toward addressing maternal health, rather than funneled away to other channels. Conversely, the attitudes in Texas toward reproductive healthcare are largely fueled by regressive, quasi-religious rhetoric and misogyny.

Recently, U.S. District Judge Sam Sparks had to step in and prevent Texas from cutting Medicaid funding to Planned Parenthood, a move that would have severely affected women of color and lower income women–women who already suffer from higher rates of maternal mortality. And rather than addressing the harm done by the healthcare budget cuts of 2011, the Republican-led Texas legislature has no intention of expanding Medicaid nor defending Medicaid funds from potential cuts, despite the fact that over half of Texan pregnancies are funded by the program.

Outside of Texas, however, childbirth deaths are becoming a national problem. Running counter to global trends, the United States is among only 13 countries world-wide that have experienced an increase in maternal child mortality from 1990-2015. This puts us in a cohort of healthcare-strapped countries such as North Korea and Venezuela.

Despite the power of the Department of Health and Mental Hygiene, New York state has relatively dismal maternal mortality rates as well, ranking 47th nationwide. However, New York, unlike Texas, doesn’t let political and social obstinacy towards addressing unacceptable maternal mortality rates get in its way. The Lone Star State on the other hand, always more eager to lead than follow, tops the list of states in maternal mortality. In fact, it has one of the highest maternal mortality rates in the developed world.

As a public health professional, it seems so much easier to protect women’s health in New York City, rather than engage in an exhausting battle back home. And the cultural pull of NYC goes far beyond entertainment and location. Here, a women’s reproductive healthcare needs are being addressed, not stymied and ignored. However, the very things that make Texas so problematic speak to why I am needed there most.

Chelsea Wynn is a Texas-native, first year Sociomedical Sciences student pursuing a certificate in Infectious Disease. She is interested in building a public health career that integrates cultural context and evidence-based research for the creation of equity-centered interventions.

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