New York: While the maternal mortality rates are declining worldwide, the situation for women in the United States is a glaring exception.
And in Texas, where clinics serving women have shuttered and their health interests have been battled all the way up to the US Supreme Court, the rate of pregnancy-related deaths more than doubled over the course of two years.
These are some of the findings in a new study (PDF) in the September issue of Obstetrics & Gynecology.The authors set out to analyze maternal mortality trends in part because the United States government has not published official data on this subject since 2007, they said, calling that fact an "international embarrassment."
One of the eight United Nations Millennium Development Goals sought a 75% reduction in pregnancy-related deaths from 1990 to 2015. Just as the world turned its attention to this matter with marked success, the United States stopped offering data and began moving backward.
Funding challenges and a tangled mess of inconsistent measurements may have been to blame for the lack of information, the authors said.
The United States performs worse than any other developed nation when it comes to maternal death, according to State of the World's Mothers 2015, the most recent comprehensive report compiled by Save the Children, a 90-year old global organization advocating for kids' needs.
In the United States, a woman faces a one in 1,800 chance of dying from a pregnancy-related cause during her reproductive years, that report says. She's 10 times more likely to die this way than a woman living in Poland, Austria or Belarus.
Pregnancy-related deaths are still rare in the United States, certainly in comparison with less-developed nations. But the estimated rate of maternal mortality in 48 states and Washington grew by about 27% between 2000 and 2014, said the authors of the newer study.
The two most populous states, California and Texas, had enough data to allow for more analysis. Research showed that California succeeded in decreasing numbers, the researchers said, but Texas death rates climbed like no other state in the nation.
The trouble with Texas
From 2006 through 2010, numbers from the National Center for Health Statistics show that the rate of maternal deaths in Texas wavered little. There were as few as 69 deaths in 2009 and as many as 82 in 2008.
But from 2010 to 2012, those numbers shot up from 72 deaths to 148. In 2013, deaths fell slightly to 140, and there were 135 in 2014, the last year analyzed by the study's researchers.
Advocates for reproductive rights -- including the right to legal and safe abortions -- were quick to seize upon the news with their analysis about the trend in Texas.
The uptick is no coincidence, they say. In this same window of time, Texas politicians voted to defund Planned Parenthood and slashed family planning dollars, reducing access to more than abortions.
Other services provided by Planned Parenthood, which often caters to underserved communities, include breast and cervical cancer screenings, contraceptive counseling, STD testing and treatment, and multiple forms of preventive women's care.
"For many of our patients, Planned Parenthood and other family planning clinics are their gateway to the health care system," said Sarah Wheat, chief external affairs officer for Planned Parenthood of Greater Texas, in a written statement.
"Women have been left out in the cold, without being able to obtain regular healthcare screenings, or birth control to space their pregnancies, and delays in their initial pregnancy test and prenatal referral -- all of which are harmful to women's health."
She and other activists say these developments are among a string of examples of Texas leadership putting politics above all else.
The passage of Texas' House Bill 2 in 2013 placed so many restrictions on abortion clinics that half of them closed, creating an abortion desert for those seeking the procedure. That law was struck down by the nation's highest court in late June.
Soon after, though, came a rule that will require the burial or cremation of all fetal remains in Texas -- adding a new emotional and financial burden for women, including those who miscarry.
And this month, Texas announced plans to distribute $18 million in the form of 31 grants to support low-income women's health care, including gynecological exams, birth control and cancer screenings.
The second-highest award of $1.6 million went to the Heidi Group, which critics claim is an anti-abortion group with no experience offering medical services.
"It's time to stop these political attacks before even more women pay the price with their health and lives," Wheat said.
Identifying the cause
Pegging the spike of Texas maternal deaths in 2011-12 on politics and the closure of clinics isn't fair, said Carrie Williams, a spokeswoman for the Texas Department of State Health Services.
"There is no evidence of that," she said by email. "That reduction [in clinics] wouldn't have taken effect till September 2011 and it would have taken months to be reflected in the type of data we are talking about here.
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She said that the concern about the uptick in deaths is one the department shares and that it's "a complex problem that requires looking closely at a number of factors," including obesity, chronic disease and tobacco use. For that reason, she said, a task force has been set up to examine what transpired and offer recommendations.
Marian MacDorman, the lead author of the recent study that highlighted the Texas numbers, said the goal in the research was simply to identify trends and not answer why Texas numbers jumped.
Even so, the maternal and child health research professor at University of Maryland gives weight to the idea that the closure of women's health clinics in recent years played a role.
"It's certainly a theory," she said. "And I don't have a lot of other theories at the moment."
Bigger than one state
The Texas numbers may be the most striking. But the maternal mortality trend is a national problem, the new study's authors make clear. And this point is driven home by the analysis of others.
Of 183 countries and territories studied from 1990 to 2013, only 17 saw maternal mortality rate percentage increases, the World Health Organization report "Trends in Maternal Mortality: 1990 to 2013" showed. In the United States, the maternal mortality rate grew by 136% over those 23 years, more than any other country studied.
All of this echoes what the authors of the new US study mean when they say it's time to "redouble efforts to prevent maternal deaths and improve maternity care for the 4 million U.S. women giving birth each year."
