The election results are in, but the journey to hold Texas officials accountable is just beginning. Advocates are increasingly optimistic that the incoming elected officials will finally empower the state’s maternal mortality committee to investigate deaths related to abortion.
Recent legislative actions and state laws have severely limited the Texas Maternal Mortality and Morbidity Review Committee, restricting the data it can analyze and preventing it from sharing its findings with federal agencies. “It was a review committee — it felt like — in name only,” remarked state Rep. Lauren Ashley Simmons, a Democrat from Houston and member of the House Public Health Committee. With Democrats now in control of the governorship, lieutenant governorship, and the state House, Simmons believes the committee will gain the authority it needs to fulfill its mandate.
One of the primary changes advocates are pushing for is the timely release of the committee’s biennial maternal mortality report, which was due on September 1. This year, however, the Department of State Health Services (DSHS) decided to postpone the report’s publication until December 1 in order to refine its findings and recommendations.
Women’s health advocates suspect that this delay was a strategic move to avoid revealing potentially troubling data that could connect the state’s near-total abortion ban to a rise in maternal deaths, particularly ahead of the midterm elections. The eagerly anticipated report will provide insights into cases from 2021 to 2024, marking the first comprehensive examination of maternal mortality and morbidity since the abortion ban took effect in 2022.
State Rep. Donna Howard, an Austin Democrat and former author of a law aimed at expediting the committee’s review process, has been in communication with DSHS Interim Commissioner Imelda Garcia, who confirmed a meeting to discuss the report scheduled for Monday. Howard is hopeful that the report will be available as early as this week.
On Monday, DSHS reiterated that the report is set to be released by December 1, but they did not specify an exact date.
Beyond the timely release of the report, maternal health advocate Nakeenya Wilson, a former committee member, holds high hopes for the committee’s future. “We have a Democratic leadership that typically supports full reproductive rights,” Wilson stated, referring to the newly elected Democrats. “This leadership is also notably female.” If Houston Rep. Senfronia Thompson assumes the House speakership in January, along with Lt. Gov.-elect Vikki Goodwin and Gov.-elect Gina Hinojosa, it would mark the first time Texas has had female leadership in its top three positions.
While a repeal of the abortion ban appears unlikely, Democrats have indicated a willingness to adopt a more lenient approach to its interpretation and enforcement. Attorney General-elect Nathan Johnson has already expressed that he will refrain from pursuing legal action against out-of-state doctors providing abortion pills.
Democrats also have the opportunity to enhance the maternal mortality committee’s capacity to assess the abortion ban’s adverse effects and to appoint more allies to the committee.
Established in 2013 to review maternal deaths and near-fatal incidents, the committee has faced significant challenges in recent years. The original legislation governing its formation prohibits the review of abortion-related deaths, and Republican lawmakers have resisted efforts to widen its scope. Advocates from both sides of the abortion debate have called for the committee to assess these cases, albeit for divergent reasons.
While anti-abortion advocates seek to investigate fatalities resulting from abortions, reproductive rights supporters are equally interested in understanding how the ban may have forced women into unsafe, unregulated procedures.
Wilson noted that the committee currently examines cases of women who died because they were denied an abortion, and this year’s report is expected to be the first to illustrate the ban’s impact on this specific group.
If the committee’s scope is broadened to encompass deaths resulting from abortions, anti-abortion advocates predict it will highlight the associated risks of the procedure and reinforce the necessity for an abortion ban. John Seago, president of Texas Right to Life, stated that such an expansion would enable the committee to investigate both medically induced abortions and those performed out of state. Although previous Republican proposals aimed to limit reviews to voluntary abortions, Seago’s organization supports examining both voluntary and medically necessary procedures.
Amy O’Donnell, executive director of Texas Alliance for Life, echoed this sentiment, advocating for the removal of restrictions that prevent the examination of deaths linked to abortions. “We cannot have that full picture without knowing what the abortion-related death numbers are,” she commented.
The committee has also faced scrutiny for adding a prominent anti-abortion advocate to its ranks and for not adequately addressing Black maternal health outcomes. According to the committee’s last report, Black women in Texas are approximately 2.5 times more likely to die from pregnancy and childbirth complications than their white counterparts.
On the first day of filing for the upcoming legislative session, Democrats introduced new legislation related to the committee. State Rep. Charlene Ward Johnson, D-Houston, submitted a bill requesting a separate study on Black maternal health, similar to one she proposed in the previous session that passed the House but stalled in the Senate.
Critics have previously condemned the committee for moving from data from 2021 to 2024, effectively skipping over the years 2022 and 2023—critical periods following the U.S. Supreme Court’s ruling in Dobbs v. Jackson and Texas’ implementation of its current abortion ban. Advocates and lawmakers are now hopeful that the committee will extend its reviews to include the omitted years.
However, Dr. Carla Ortique, the committee’s chair, cautioned that the feasibility of such a retrospective review depends on available resources, which are currently limited. The committee is entirely volunteer-run at present. “We’re already reviewing two years at a time. I think it would be extremely difficult to try to review four years during that time frame,” Ortique explained, noting that this would necessitate the hiring of at least three full-time employees.
While some necessary reforms will require legislative action, others could be implemented without such measures, including the retrospective review of 2022 and 2023 data, as well as changes in committee membership.
In 2023, lawmakers modified the committee’s structure as defined by state law, replacing the community advocate position held by Wilson with two community member slots, both of which are currently occupied by medical professionals. This shift has left the committee without any grassroots advocates.
As governor, Hinojosa will have the authority to appoint the DSHS commissioner, who will subsequently select committee members from a pool of applicants. “I absolutely want to see people who understand that abortion is not just a social culture war issue, but a medical procedure,” Simmons stated, referencing a bill she previously introduced that sought to add two positions for doulas to the committee, which ultimately did not advance out of committee.
Despite the renewed focus on maximizing the committee’s potential, concerns lingered just weeks ago about its very existence. With DSHS up for a Sunset review, both Ortique and Wilson expressed fears that the committee could be disbanded entirely. However, last week’s Sunset Staff Report indicated a “continuing need” for the committee and recommended that the state enhance its data-sharing capabilities with both internal and external public health partners. A final decision will be made by the Sunset Advisory Commission in 2027.
In 2024, Texas withdrew from the national Maternal Mortality Review Information Application, overseen by the Centers for Disease Control and Prevention, which previously supported maternal death tracking in Texas and nationwide.
Data on maternal mortality, both from Texas and other states, is crucial for informing maternal healthcare practices. Dr. Kimberly Pilkinton, president of the Texas Association of Obstetricians and Gynecologists, pointed out that previous data analyses have led to significant improvements in maternal mental health treatment and the management of postpartum hemorrhage. Nationally aggregated data can provide insights that state-level data alone may not reveal. “Maternal morbidity and mortality crosses party lines,” Pilkinton emphasized. “One preventable maternal death is worth every bit of resource put into it.”
