Texas has long struggled with maternal health outcomes, but new data underscores a devastating reality for Black women, particularly in Houston’s backyard.
Racial disparities in maternal and infant health outcomes are well-documented. Harris County stands out as a particularly stark example, with high rates of maternal and infant mortality and maternal morbidity that often surpass both Texas and national averages.
This is striking given the county’s diverse population of nearly 5 million residents, including a significant Black demographic. Dr. Ericka Brown, A local health authority at Harris County Public Health, says the crisis is rooted in longstanding inequities.
“The disparities we see in Harris County and across Texas reflect longstanding gaps in access, quality, continuity of care, and systemic inequities,” Brown said. “Black women are more likely to experience barriers to timely diagnosis and treatment, less likely to have their concerns taken seriously, and more likely to deliver in under-resourced settings.”
Brown said even in a region home to the Texas Medical Center, access remains uneven. Chronic conditions such as hypertension and cardiovascular disease, often shaped by inequities in preventive care, housing, and economic opportunity, further increase risk. She said that when those factors collide with gaps in care coordination, preventable complications become preventable deaths.
“Black women are more likely to experience barriers to timely diagnosis and treatment, less likely to have their concerns taken seriously, and more likely to deliver in
Dr. Ericka Brown
under-resourced settings.”
According to the 2024 Maternity Care Deserts Report from the March of Dimes, women living in counties without adequate maternity care face higher rates of preterm birth, low birthweight, and maternal complications. In emergencies such as hemorrhage, preeclampsia, or sepsis, longer travel times can mean the difference between life and death.
Importantly, many maternal deaths occur after delivery, often within the first year postpartum. In care deserts, follow-up appointments, mental health services, and cardiovascular monitoring are harder to access.
LaToyia Dennis knows that reality firsthand.
The maternal health advocate and founder of A Chance to Learn nearly died twice during her pregnancy journey. She miscarried five times. During one loss, doctors told her she arrived at the hospital just minutes before it would have been too late.
Later, when she became pregnant again, a hospital incorrectly told her she had miscarried and needed a dilation and curettage.
“Because I was exhausted, I would have walked across the street and aborted my baby,” Dennis said. “An ultrasound later revealed my baby was alive.”
Dennis was eventually diagnosed with gestational diabetes and preeclampsia and delivered two months early. Days after returning home, her body began seizing and releasing fluid. Her blood pressure soared. She survived, but years later, a physician told her that what she experienced is often fatal.
“She said, ‘I have never met anybody who has made it,’” Dennis recalled. “When your body starts releasing fluid, your organs are shutting down, and you are dying.”
Now, Dennis travels the country advocating for maternal health equity. She said one of the most persistent barriers Black women face is not being heard.
“It is as if we can tolerate this enormous amount of pain,” Dennis said. “You’re okay. It’s going to pass. And lo and behold, you’re in preterm labor at 20 weeks.”
She also points to social determinants of health, such as food deserts, transportation barriers, and economic instability, that place women of color at greater risk. Cultural competency in health care remains inconsistent, particularly around conditions like gestational diabetes and preeclampsia, which can have lingering effects beyond delivery.
“Many systemic changes and interventions are being implemented to address the Black maternal mortality crisis. This includes public health initiatives that promote awareness of the crisis and actions that must be taken, including culturally and timely access to care,” Brown said. “Policy reforms are in place, which aim to provide access to better care and health care services being covered under insurance.”
During the 2023 legislative session, Texas passed HB 12, extending postpartum Medicaid and CHIP coverage for eligible women, ensuring vital postpartum care services. This extension benefits enrolled participants by providing access to regular checkups, mental health care, and treatment for special health needs and preexisting conditions.
For women navigating pregnancy now, Dennis urges preparation and persistence. Have someone in the room. Ask questions until you understand. If a provider dismisses concerns, find another.
Brown shares key advice for women to protect themselves during pregnancy:
• Women should discuss reproductive health with their primary care provider/OBGYN before pregnancy to identify risks and underlying conditions.
• After a positive pregnancy test, it is crucial to schedule an appointment for confirmatory testing/ultrasound, although many providers may not see patients until 8-10 weeks.
• Women should advocate for themselves during the early weeks of pregnancy, describing symptoms to help develop an early care plan.
• The Maternal Health Bill of Rights (MHBoR) was created to provide expectant mothers and families with guidelines outlining their rights to quality care during pregnancy and childbirth.
• Access to the MHBoR is available online at the provided link: https://mhbor.harriscountytx.gov/
