As rural Central Texas faces deepening maternal health care gaps, St. David’s Foundation is investing $4.6 million in community-based organizations to expand culturally-responsive care and improve outcomes for underserved women, especially women of color.
Texas has one of the highest maternal mortality rates in the country, with particularly severe disparities for Black women, and sharp rises in recent years. In Texas, as of 2022, the maternal mortality rate was 28.2 per 100,000 live births, with rural women facing higher risks.
In a 2022 report, the Texas Maternal Mortality and Morbidity Review Committee determined there was at least some chance for preventability in 90% of pregnancy-related deaths.
The St. David’s grantees are largely focused on rural communities in Central Texas, particularly in counties surrounding the Austin and San Antonio metro areas, where access to consistent maternal care remains limited despite geographic proximity to major medical centers.
“Our bigger goal is to create real capacity in the region, particularly in these outlying counties, for how these services can serve vulnerable women, and ultimately, how we can build a movement that creates more awareness around inequitable birth outcomes and informs our broader system of care about how to improve care and support for women of color,” said Andrew Levack, senior program officer with St. David’s Foundation.
In Hays County at the CommuniCare Health Centers’ Kyle clinic, this funding will expand a “Motherhood Project” centered on group prenatal care. The model brings pregnant women into shared medical visits that combine clinical care with education and peer support. The program is designed to improve maternal and birth outcomes by increasing access to culturally-informed care.
“We’re focusing this particular grant on Black and Hispanic women because we feel they are higher risk populations, so we’re providing interactive learning, community support, and education. What we’ve found is that patients tend to feel like they can trust what they’re learning more,” said Mari Cortez, chief marketing and advancement officer at CommuniCare. “The model of care is designed to improve health outcomes and reduce preterm birth, improve patient satisfaction, and increase breastfeeding rates. It’s really because they feel more comfortable with people who are similar to them.”
These placed-based programs bring services directly to patients, rather than expecting them to travel long distances for support.
“Often there is a perception that these communities are close in proximity to cities like San Antonio [and Austin], so they can go there and are fine,” said Jake Reyna-Casanova, the grants and patient advocacy manager at CommuniCare. “But then in reality, we see day in and day out where that’s technically not the case. There are a lot of health disparities within this community.”
Those disparities are compounded by longstanding workforce shortages in women’s health, particularly in rural areas where providers often remain inaccessible to patients.
Although Hays County doesn’t fall into the Daily Yonder’s typical definition of rural, which comes from the Office of Management and Budget, 30% of the county is classified as rural by the Census, another categorization system.
“Recruiting and retaining providers has always been a challenge, but women’s health providers especially, because of the high need in that area. If someone goes into labor, they don’t want to commute hours, that’s for sure,” Cortez said. “They want access close to home, so we have provided that access.”
The Kyle clinic’s “Motherhood Project” builds on a group prenatal care model already used at other CommuniCare clinics in the region, where it has been linked to improved outcomes, including higher breastfeeding rates, better prenatal appointment attendance, and lower rates of low birth weight.
“We have a good grasp of how it works and what is needed,” Reyna-Casanova said. “Now it’s just a matter of bringing it to Kyle.”
Levack said these programs will not only expand services, but strengthen how care is delivered by integrating clinical systems with community-based support.
“We’re really excited to see opportunities to make clinical models that are more culturally responsive and more geared to women of color in these rural and outlying areas, ways to combine clinical midwifery practices with community-based organizations, and ways to bring care to those in rural areas,” Levack said. “[In the grant proposals], we saw much more holistic programs that dealt with wraparound support for pregnant and parenting women, looking at issues that are particularly challenging in rural areas, including social supports, counseling, mental health support, transportation, and childcare.”
The Bastrop Birthing Center, a fellow grantee, plans to use the funding to expand a different model of care aimed at closing gaps across the full spectrum of maternal health services.
Though the Office of Management and Budget (OMB) classifies Bastrop County as metropolitan, more than 70% of its residents live in rural areas according to the Census definition of rural. The county is also a designated maternity care low-access area, where limited providers and birthing facilities often require women to travel an average of 30.5 miles for delivery care, even as it experiences higher-than-average birth rates and a 10% preterm birth rate.
The Bastrop Birthing Center is building out prenatal, delivery, and postpartum supports, including transportation, counseling, and ongoing care for new mothers.
“When I first opened the birthing center, there was only one OBGYN out here,” said Ellie Tisdale, who is a midwife and founded the Bastrop Birthing Center in 2018. “Not only was the maternity care in the area just inaccessible, there were also unnecessary interventions happening.”
Inside the Bastrop Birthing Center in Bastrop, Texas. (Photo courtesy of Ellie Tisdale)
Tisdale said many people in her community were waiting four months or more to get an OBGYN appointment and that despite Bastrop’s proximity to Austin, the service gaps persist.
“I hear all the time about women who deliver on the side of the road,” Tisdale said. “We’re far enough away from emergency services that it’s difficult to access care when needed.”
With support from the St. David’s Foundation, The Bastrop Birthing Center is working to bridge those rural inequities.
“We know that Texas has one of the highest maternal mortality rates in all of America, and so culturally responsive is taking care of the women who are here and the women who need it most,” Tisdale said. “I think that this funding is going to help the large demographic of people who can’t afford services or don’t have access to services. We hope to help fill in all of those gaps.”
The post A Multimillion-Dollar Investment in Texas’s Maternal Health Care appeared first on The Daily Yonder.
