Maternal mortality rates in the U.S. continue to far exceed those in other high-income nations, despite a decline since the end of the COVID-19 pandemic, according to a new international report from the Commonwealth Fund.
More than 80% of maternal deaths in the U.S. are likely preventable, according to the report, the latest study highlighting a health crisis that continues to impact North Texas families.
The study warns that a deepening shortage of maternity health providers, particularly midwives, may exacerbate the crisis.
In North Texas, to combat the worsening health outcomes of moms and babies, Parkland Health and Dallas County have each been awarded the first $1 million in a five-year grant through the federal government’s Healthy Start program.
Dallas County’s 2019 infant mortality rate of about 6.2 deaths per 1,000 live births outpaced the state’s average of 5.5 deaths per 1,000 live births, according to the 2022 Dallas County Community Health Needs Assessment.
Healthy Start is a federal program that supports moms and babies before, during and after pregnancy through grants to organizations working at the community level.
The program aims to improve the well-being of expecting mothers and those who have just given birth, addressing needs in communities with infant mortality rates that are 1.5 times the national average or greater.
Healthy Start also targets disparities in health outcomes that have resulted in higher mortality rates for Black and Indigenous women and infants of color. Black women in the U.S. experience far higher rates of maternal deaths than other racial or ethnic groups in the country.
Social infrastructure
The $6 million in Healthy Start funding headed to Texas is one of the largest federal awards of any state, said Carole Johnson, administrator of the Health Resources and Services Administration housed in the U.S. Department of Health and Human Services.
“We have to fix it,” Johnson said. “It can’t be the case that our maternal mortality and infant mortality rates are what they are. And in Texas, as in many other places, the disparities are pretty significant for Black women, regardless of income or education level.”
Nationwide, Black women die at a rate of two to three times the rate of white women from maternal mortality causes, Johnson said.
“We need to tackle this in a holistic way because moms deserve the best from us,” Johnson said.
Johnson said the community’s social infrastructure is just as important as the level of health care the mothers and children receive. That means things like safe, affordable housing and reliable transportation to help moms get to prenatal visits.
Healthy Start programs tailor services to community needs by supporting culturally responsive health care services, food assistance, emergency supplies, transportation to care, housing navigation and other critical social supports.
The program coordinates appointments, screens for depression and provides childbirth and breastfeeding classes.
Unlike more restrictive federal grants, the Healthy Start program can help fund families’ most critical needs, Johnson said.
Moms in the program get help enrolling in health insurance and coordinating their care before and after pregnancy.
The program also links parents with services, including support for access to housing, transportation, or food, which are key factors in the health of parents and children. The program can best meet those needs by examining what policy wonks often call the “social determinants of health,” Johnson said.
Federal data shows that Healthy Start participants, compared to nonparticipants, are more likely to start care for their pregnancies earlier and have more prenatal care visits, which are key indicators for better maternal health outcomes.
The most recent program evaluation data from 2022 shows 95% of Healthy Start child participants had a regular source of medical care. In contrast, the national average is 70% of children.
Parkland’s program
Parkland’s community-based Healthy Start program has been active since 1994 with a focus on reducing infant mortality. The program focuses on improving health outcomes before, during and after a person’s pregnancy.
Niccole McKinley, operations administrator of Parkland Health’s Women and Infants Specialty Health Division, manages the financial arm of the Healthy Start project and federally funded grants.
Parkland’s program — which is required by the federal government to enroll about 700 women, children and fathers — focuses on a population of people in Dallas County who have the highest risk for infant mortality.
While the program has historically served core ZIP codes, primarily in the southern sector, the new five-year grant cycle will serve 33 ZIP codes in Dallas County.
More than 1,100 women, children and fathers were in the program last year, McKinley said.
Thousands of families have found support from Parkland’s program in the past 30 years of its involvement in the community. McKinley said it has saved lives.
In the last five-year grant cycle that began in 2019, McKinley said the program had at least three years with no infant death for women enrolled in the program. In 2023, the program recorded just one death, McKinley said.
“Getting them into prenatal care early, or at all, prior to delivery is an important piece,” McKinley said.
Other keys to the program to boost success for mothers: stabilizing housing, child care and employment following a child’s birth.
Dallas County expansion
Dallas County, which is receiving the federal award for the first time, will be starting its Healthy Start program from scratch, said Sandra Lozano, public health director of Dallas County Health & Human Services.
While Parkland Health and Dallas County collaborate, Lozano said each program serves distinct ZIP codes. The county’s program works on a referral system with hospitals, doctor’s offices and community centers to spread the word to families in three ZIP codes: 75149, 75150 and 75217.
Dallas County’s expansion into areas like Mesquite and parts of southern Dallas will focus heavily on improving low birth weights in those communities, Lozano said.
The county’s program will mirror Parkland’s program that provides case management home visits to moms. Participants will also receive educational resources, car seat safety tips and other prenatal and postnatal support, Lozano said.
“It’s a huge accomplishment for Dallas County to win this grant and work with Parkland,” Lozano said. “We are very excited that this dream for Dallas County residents is coming true.”
