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Report: In almost half of Texas counties, pregnant people can’t access health care


Pregnant people in almost half of the counties in Texas don’t have adequate access to health care. That’s according to a new report by the March of Dimes, which measures maternity care in the United States.

More than 46% of Texas counties are defined as maternity care deserts, which means those counties have no maternity care centers or obstetricians. People seeking care had to travel an average of 30 miles to find a doctor in a maternity care desert, with some traveling up to 70 miles to find the nearest birthing hospital.

Lisa Adams, executive director for March of Dimes in Dallas-Fort Worth, said of the issues highlighted in the report, distance stood out to her as one of the biggest.

“We have a lot of areas within Texas that are just really hard to reach,” she said. “What are we doing to implement increased access to care—ways to reach them that might not be traditional methods of going to a clinic?”

In Texas, about 20% of pregnant people receive inadequate or no prenatal care, according to the report. That’s higher than the national rate, which is close to 15%.

Access to maternal health care has far-reaching impacts for pregnant people and their infants.

A 2019 brief from the Centers for Medicare and Medicaid Services reported a lack of access to maternal health care leads to “premature birth, low-birth weight, maternal mortality, severe maternal morbidity, and increased risk of postpartum depression.”

“This is a need we need to address immediately in order to improve some of these statistics for moms and babies,” Adams said. “This is an urgent health care crisis for Texas, and in order to increase care and the overall well-being, we need to start talking about this now.”

Beyond the health outcomes, traveling far distances to find care is a financial strain on families, and, according to the report, can increase “prenatal stress and anxiety.”


Maternity care outcomes in Texas

Dr. Carla Ortique is an OBGYN in Houston who serves on the Texas Medical Association’s Council on Science and Public Health. She’s also the chair of the state’s Maternal Mortality and Morbidity Review Committee, which releases reports on outcomes for pregnant people in Texas.

“It’s not as straightforward as saying, ‘Oh, if you have insurance, you have access,’” Ortique said. “There are all of the factors that impact your ability to achieve the best health possible.”

A 2020 study out of Louisiana compared rates of maternal mortality in counties across the state, and found the “risk of death during pregnancy and up to 1 year postpartum” was significantly higher in people living in maternity care deserts.

Ortique said this is also true for Texas.

“We’ve noticed those health care deserts seem to be concentrated in the same areas that…have the highest maternal mortality,” Ortique said. “I don’t think it’s a coincidence.”

Both the March of Dimes report and Ortique suggested expanded telehealth options as one way to address health disparities for pregnant people.

“The pandemic taught us a lot,” she said. “It taught us that you can still take care of people, you can provide care without being in person. Prenatal care can largely be accomplished by telehealth. You can certainly do a lot with the technology that is available, and I think [people] who are in rural areas need to be prioritized in that way.”

Overall, Ortique said prioritizing the health of new parents helps everybody.

“Maternal health outcomes are the intersection of health, gender and economic concerns,” she said. “It’s critical that we improve our outcomes there, because we’ll improve outcomes in other areas.”

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Elena Rivera