Maternal Death: Health Promotion in Rosharon, Texas

The purpose of this paper is to explore higher rates of maternal deaths in Rosharon, Texas, to identify contributory factors, and to devise culturally competent, tailored health promotion interventions to combat this significant public health problem. The paper shall investigate the disproportionate effect on minorities and recommend evidence-based interventions that are consonant with Healthy People 2030's aims to minimize avoidable maternal deaths within this multicultural community. Maternal death is a public health priority of concern in the United States, with Texas experiencing particularly alarming trends. In Rosharon, Texas, where diversity exists within Brazoria County south of Houston, maternal mortality trends reflect the problematic statewide trends. This paper seeks to examine the higher maternal mortality trends in Texas with particular emphasis on Rosharon residents and formulate relevant health promotion interventions. An exploration of the reasons for maternal deaths is needed for the development of targeted interventions that reduce disparities and enhance outcomes. The relevance of the issue cannot be overemphasized, as maternal mortality is a preventable tragedy that is indicative of larger healthcare system issues disproportionately affecting specific populations (Edwards et al., 2024). The issue of maternal mortality is one of the Healthy People 2030 priorities for maternal and women's health, focusing on culturally appropriate interventions for reducing maternal mortality within Rosharon's diverse population.

Relation of Topic to Target Population

Rosharon, Texas, is characterized by a distinctive demographic landscape with sizeable Hispanic, Black, and White populations within the predominantly rural ambiance. This population is directly affected by the maternal mortality emergency, as statewide figures show staggering maternal mortality spikes that disproportionately impact minorities. Based on the Texas MMMRC and Department of State Health Services (2024), “the pregnancy-related mortality ratio (PRMR) for 2020 was 23.1 maternal deaths per 100,000 live births, up dramatically from 16.7 in 2019”. More troubling is the racial gap apparent from the figures. The PRMR for non-Hispanic Black women was 39.0 per 100,000 live births, some 2.5 times higher than for non-Hispanic White women (16.1 per 100,000 live births). Similarly, Hispanic women reported a dramatic increase from 13.4 per 100,000 live births in 2019 to 22.2 per 100,000 live births in 2020 (Texas MMMRC, 2024). According to Edwards et al. (2024), between 2019 and 2022, maternal mortality rose 56% compared to a mere 11% for the country as a whole for the same period. For Rosharon, whose ethnically diverse population, such numbers constitute a dire health problem that calls for immediate action. The target group for the health improvement intervention is women of childbearing age (15-44) of Rosharon, with priority given to Black women and Hispanic women who are most at risk.

The project aligns with the Healthy People 2030 goal MICH-04, which is reducing maternal mortality. Concepts for promoting health for the reduction of maternal mortality involve primary prevention through preconception care, secondary prevention through the early recognition of complications of pregnancy, and tertiary prevention by enhancing postpartum care. Another element is the improvement of social determinants of health, as the review committee identified economic instability, safety issues, and transportation as factors that directly relate to maternal mortality (Texas MMMRC, 2024).

Summary of Articles

The Texas Maternal Mortality and Morbidity Review Committee (2024) examined 203 pregnancy-associated deaths for the year 2020, of which 85 (42%) were determined by the committee as pregnancy-related, with 80% of them being potentially preventable. Infections (25%), followed by cardiovascular circumstances (14%), and obstetric hemorrhage (14%), caused the majority of pregnancy-related deaths. Notably, COVID-19 accounted for 67% of infection-related deaths. The report identifies persistent disparities, with non-Hispanic Black women experiencing a PRMR 2.5 times higher than non-Hispanic White women. Women with less education and those aged 40 or older faced significantly higher risks. The committee identified 595 contributing factors across preventable deaths, with issues in systems of care (33%), provider factors (31%), and facility factors (20%) being most prominent. These findings highlight the need for systemic improvements, including better coordination between emergency services and maternal healthcare providers, standardized protocols for obstetric emergencies, and improved postpartum care management.

Klibanoff (2024) stated that maternal deaths rose in Texas to record levels in 2020 and 2021, the highest levels reported since the state first started tracking the numbers back in 2013. Even removing COVID-19-related mortality, the maternal mortality rate rose from 17.2 per 100,000 live births in 2019 to 24.2 per 100,000 births in 2020. The article highlights that 80% of maternal deaths had the designation of being potentially avoidable, down from 90% of such cases as reported previously. Like the committee report, the article highlights the stark racial disparities, where Black women are 2.5 times as likely, compared with white women, to lose their lives giving birth. The article further explains how the Texas Legislature signed off on expanding coverage under Medicaid for new mothers from two postpartum months to a full 12 post-birth months, putting into action a well-established recommendation of the mortality review committee.

Edwards et al. (2024) have reported a dramatic maternal mortality increase in Texas as a consequence of restrictive reproductive health policies. Their research indicates maternal mortality rose by 56% between 2019-2022 in Texas, well above the 11% increase nationally over the same time frame. The article provides statistics by racial group: maternal mortality increased from 14.5 to 18.9 per 100,000 live births for Hispanic women, rose nearly two-fold from 20 to 39.1 for White women, and rose from 31.6 to 43.6 per 100,000 live births for Black women. The article further indicates that such restrictive policies have coincided with women being less likely to access prenatal care and more likely to have trouble getting OB-GYN appointments.

Health Promotion Discussion

Addressing maternal mortality in Rosharon requires culturally appropriate, multi-level health promotion strategies targeting this diverse community's specific needs. Based on the reviewed literature, five key approaches are recommended:

Community-Based Education Programs: Educational workshops at churches, community centers, and local festivals would increase awareness of maternal health risks and warning signs. Programs should be delivered in both English and Spanish. The Texas MMMRC (2024) recommends "engaging Black communities and addressing health disparities," which can be accomplished through partnerships with local Black churches and community organizations.

Healthcare Provider Training: Continuing education for local healthcare providers focused on leading causes of maternal mortality—infections, cardiovascular conditions, and obstetric hemorrhage—would address provider-level contributing factors. These trainings should emphasize culturally competent care and address implicit bias.

Postpartum Support Network: A community-based network is crucial, as “25% of pregnancy-related deaths occur 43 days to one year postpartum” (Texas MMMRC, 2024). This could include peer support groups, home visitation programs, and telehealth options for high-risk women.

Transportation Assistance: A volunteer-based transportation network would help pregnant and postpartum women access medical appointments, addressing rural transportation barriers and improving care continuity.

Mobile Health Clinics: Mobile clinics visiting underserved areas would increase access to prenatal and postpartum care, providing screenings, education, and referrals to comprehensive care, addressing barriers noted by Edwards et al. (2024).

Conclusion

Maternal mortality within Rosharon, Texas, is a critical public health issue that is reflective of broader statewide patterns of mounting mortality rates as well as long-standing racial disparities. An examination of recent research indicates that the majority of maternal mortality is preventable, with infections, cardiovascular issues, and obstetric hemorrhage as the primary causes. Disproportionate effects among Black women as well as Hispanic women demonstrate the need for culturally appropriate interventions that target clinical as well as social contributors to health. The health promotion strategies identified for Rosharon—community-level education, training of healthcare providers, support systems for postpartum women, transportation support, and mobile health centers—directly address issues identified in the research. By implementing evidence-based techniques that consider Rosharon's distinctive demographic and geographical features, the project seeks to decrease maternal mortality and improve outcomes for all women within the population, focusing on the most vulnerable women. These initiatives support Healthy People 2030 goals, focusing on the preventable nature of such loss of life and the capability for improvement through concerted interventions.