Lawmakers in Texas largely failed to take any significant action to address the state's skyrocketing rate of pregnancy-related deaths just months after researchers found it to be the highest in not only the US, but the developed world.
Legislators introduced proposals to address the issue after a University of Maryland-led study found that the state's maternal mortality rate doubled between 2010 and 2012. But several key measures didn't even make it to a vote, falling victim to Republican infighting over other issues.
"We had a chance to move the needle and we really failed to do so," said state Sen. Lois Kolkhorst, a Republican from the town of Brenham. "Certainly, as we develop in medicine, we can do better to take care of women in today's society versus past societies. I'm very disappointed."
Because this year's session has ended, lawmakers will have to wait until they reconvene in 2019 to address the issue.
Kolkhorst introduced a measure with wide support that would have extended the life of Texas' maternal mortality task force to 2023 from its current 2019 end date, allowing the committee of doctors and behavioural specialists to analyse more closely the specific causes of pregnancy-related deaths.
The task force formed in 2013 to study and combat what state lawmakers already perceived as a rising maternal mortality rate. Then last summer, the University of Maryland study found that Texas had the highest maternal mortality rate in the U.S. The study also found that the U.S. rate was higher than all other Organization for Economic Cooperation and Development countries reporting maternal mortality data, except for Mexico. That study offered no explanation for the reason.
Further research would help. "Is it hemorrhaging, is it post-partum depression, is it aftercare?" said Kolkhorst. "Are there things we could do pre-birth that would help with post-birth?"
The extension of the task force is "vital for us to be able to understand the causes and preventive measures" of so many Texas mothers' fatalities, said Lisa Hollier, the task force's chairwoman.
"The detailed case reviews we are doing are essential to understanding the actual causes of death," said Hollier, explaining that even though her committee has found that cardiac problems are a leading cause of pregnancy-related deaths, that alone "doesn't lead to specific information for appropriate intervention programs."
State Rep. Shawn Thierry sought to look into one particularly disturbing trend that the Texas task force had found: Black women make up 11% of births, but 28% of death. Thierry, a Democrat from Houston, wanted to compare the risk of black women in different income brackets.
But Thierry's bill — which was backed by the Texas Medical Association and American Heart Association — died along with a parade of other proposals after tea party-backed lawmakers, protesting a lack of movement of their own pet issues, used a House procedural maneuver to kill every bill on a legislative calendar that wasn't supposed to generate debate.
"We haven't done enough," Thierry said.
Abortion-rights supporters have put at least some blame on strict state requirements for abortion clinics that prompted closures, though supporters of such laws say they protect women.
"When you do things like making access to abortions almost impossible, the impact that's going to have on our states most vulnerable population is worse and worse," said Marsha Jones, executive director of the Afiya Center, a reproductive justice organization founded by and for black women in Texas.
Other failed proposals that could have helped with the problem would have extended Medicaid coverage to low-income adults and to mothers for longer post-partum periods, said Adriana Kohler, a senior health policy associate for Texans Care for Children. Still, Kohler praised lawmakers for passing some measures, including one that will require Texas to post guidelines online for reporting pregnancy-related deaths and another that will allow mothers to be screened for post-partum depression for a year after childbirth.
But Hollier said those small measures may do nothing to stop a continuing catastrophe.
"I am concerned that we had the opportunity for some improvements and that opportunity may have passed us by."