Texas’ maternal care ‘deserts’ put pregnant mothers at risk, March of Dimes study says

Factors including Texas’ lack of family planning clinics and continued refusal to accept the federal Medicaid expansion have perpetuated maternal care “deserts” that increase health risks for pregnant women, according to a new March of Dimes report.

While populous counties such as Bexar provide full access to maternal care, nearly 47% of the state’s 254 counties are considered maternal care deserts in the nonprofit’s latest analysis. Nearby Atascosa, Bandera and Wilson counties all qualify as deserts because they have no birthing hospitals or other facilities providing obstetric care, the data show.

About 4% of Texas’ total births occur in maternal care deserts, and the March of Dimes warns that hospital closures and provider shortages are hitting rural areas and people of color especially hard. The number of birthing hospitals statewide dropped by 1% from 2019 to 2020, according to the analysis, which analyzed data from 2019 through 2021.

“The fact of the matter is that the United States is already one of the most dangerous developed countries for mothers in terms premature births and maternal mortality,” said Erin Stangland, interim executive director of March of Dimes’s Central Texas Division. “We cannot afford to make those conditions worse.”

Indeed, researchers found that nearly 5% of Texas women had no birthing hospitals within a half-hour drive. Although women in Bexar County and statewide face on average face an 8-mile drive to such a facility, that distance was far longer in counties including Atascosa (34 miles), Wilson (28 miles) and Kendall (22 miles).

Beyond long travel times, more than 20% of birthing mothers in Texas received no or inadequate prenatal care, according to the March of Dimes. That’s higher than the U.S. rate of just under 15%.

Health advocates won a victory during Texas’ most recent legislative session, when lawmakers voted to extend postpartum Medicaid coverage from 60 days to 12 months. Even so, Texas remains one of just 10 states that have refused to participate in the federal Medicaid expansion and it has the nation’s highest percentage of uninsured residents, according to Census data.

Additionally, the March of Dimes’ analysis found that Texas women face a “very high” vulnerability to adverse outcomes due to an absence of reproductive healthcare services.

There are just 2.8 Title X clinics — or sites which provide free, confidential contraception to anyone regardless of age, income or immigration status — per 100,000 women in Texas, the study notes. That compares to 5.3 per 100,000 across the country. On average, people in Texas’ maternal care deserts, travel 3.2 times farther to reach their closest Title X clinic than those in full-access counties.

Because its most recent data dates back to 2021, the new March of Dimes analysis doesn’t reflect the reality of the Supreme Court’s Dobbs v. Jackson Women’s Health Organization ruling, which allowed states including Texas to ban abortion access. The organization hopes to release additional data examining the impact of that monumental decision, Stangland said.

In a recent Kaiser Family Foundation survey, a majority of OB-GYN professionals said they expect the Supreme Court’s ruling to increase pregnancy-related mortality and increase racial inequalities in maternal health.

“We know the Dobbs ruling will have ripple effects across the nation,” March of Dimes’ Stangland added.

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This article appears in Jul 26 – Aug 8, 2023.