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Black maternal mortality rates are highest among all races and accessibility to contraception and abortion are shown to be critical in reducing instances of death. As Zurawski v. Texas finds Texas law overly restrictive for pregnancies deemed life-threatening, the ruling offers hope in the greater effort to curb the rising maternal mortality rate across demographics.

Late on Friday, August 4, 2023, a judge ruled that individuals experiencing complications during pregnancy are exempt from the state’s restrictive abortion laws after several Texans, including two doctors, sued to clarify the laws.

While the Office of the Attorney General has pressed the state to dismiss the lawsuits, claiming plaintiffs have no grounds to sue, Texas Attorney General Ken Paxton is currently suspended as he awaits a state Senate trial following his impeachment.

The ruling, as it provides the option for abortion for any life-threatening pregnancy, has the potential to alleviate maternal death in the Black community. Pregnancy in the Black population has been historically fraught with consistently higher mortality rates as pregnancy-related death is three times more likely compared to white counterparts

While higher rates of medical neglect in the health sector for Black people is to blame for a significant portion of these deaths, other factors consistently put Black pregnancy under greater risk of complication. Likewise, over 90% of maternal deaths in the US in 2019 were found to be preventable.

In Texas, the maternal mortality rate outpaces the nation’s averages at 18.5 deaths per 100,000 live births. There have been efforts in the state government to address this through extension of medicaid coverage for the first year after childbirth, though plans of full expansion of benefits including these changes have yet to be realized by the state. 

Even having a smaller proportion of Black live births than the nation as a whole, Black maternal death in Texas still accounts for the same proportion relative to state metrics. While around one in three maternal deaths are attributed to Black mothers, they only comprise 11% of all live births in Texas while making up 14% of all live births in the country. Despite the Black proportion of the population being around 20% smaller in Texas than the rest of the nation, the group is equally overrepresented in maternal mortality statistics.

Aside from being more susceptible to complications during childbirth that lead to death both during childbirth and postpartum, Black Americans are also more susceptible to preeclampsia, eclampsia, embolism, and cardiomyopathy. For these conditions, early diagnosis through testing is critical to ensure survival. Despite popularized rhetoric saying the opposite is true, it is a fact that termination of a pregnancy is sometimes necessary to save the mother’s life, and thus may be recommended going forward post-Zurawski.

Disparities between Black and white maternal death are highlighted among causes such as preeclampsia/eclampsia and cardiomyopathy (a type of heart failure). Black women are five times more likely to die from these conditions, according to 2016-2017 data. Additionally, Black women were also found to be twice as likely to die of hemorrhage or embolism. Source: AJPH

As factors like education and higher income improve chances of survival among Black women, access to abortion recommended by a physician granted by Zurawski v. Texas will most likely benefit women of higher incomes that can afford standard care. However, maternal death is still higher across the board for Black people compared to white counterparts. 

Studies of the last decade have consistently shown that educated and wealthier Black women still were more likely to die than non-educated or poor whites, respectively. A study conducted in New York City found that college-educated Black women were more than twice as likely to suffer severe complications compared to white women with a high school diploma. Likewise, in California, Black mothers of the highest incomes were still more likely to suffer complications than white women of the lowest incomes

While Black maternal death has been on a consistent rise, Texas saw a particularly significant increase of over 35% in the maternal mortality rate from 2019 to 2021. Throughout the last ten years, the Texas legislature has carried out several concerted efforts to tighten regulation or restriction on abortion. As it has been previously indicated that tighter abortion laws could result in higher maternal mortality rates, the spike observed in 2021 coincides with the effective ban of abortion beyond 22 weeks enforced in 2019.

While the verdict of Zurawski v. Texas could potentially alleviate rising maternal death along with numbers returning to pre-pandemic levels, the full effect of Texas’ abortion ban has remained to be seen as data from 2022 is still being assessed by researchers. As 2023 has brought continued efforts to restrict abortion access, such as when a federal judge in Texas unsuccessfully attempted to block the FDA approval of the abortion pill (mifepristone) in March, maternal health remains at risk as well. 

As contraceptive and abortion access remain linked to better overall community health and less instances of maternal death, any strictures in place have the potential to endanger lives, especially those of Black mothers.