Texas maternal death rate drops to pre-pandemic levels as mental health becomes the leading cause

The rate of women dying from pregnancy or childbirth has dropped to pre-pandemic levels, as mental health issues become the leading cause of deaths and Black mothers continue to die at higher rates than others, according to a highly anticipated report from Texas’ maternal mortality committee released Friday.

The biennial report, which state officials were supposed to release Sept. 1 but delayed until after the midterm elections, offers the first comprehensive look at maternal mortality rates since the state banned nearly all abortions in 2021.

The most recent report studies deaths that occurred in 2021 and in 2024, skipping 2022 and 2023 reviews of individual cases. In 2024, the maternal mortality ratio — the number of maternal deaths per 100,000 births in Texas — was 20.5, a decrease from 23.5 in 2021 (which excludes COVID-related deaths), and slightly above what rates were in 2019, according to the report.

More than three-quarters of deaths were found to be preventable in both 2021 and 2024, although it represented a slight decrease from 80% from the committee’s previous report in 2024.

Pregnancy-related mortality rates among Black women was the highest among all racial and ethnic groups and 2.4 times higher than non-Hispanic white women.

Severe maternal morbidity rates, which cause short- and long-term health effects on women, increased from 80.4 to 83.5, and also affects women at drastically different rates based on race and ethnicity. Black women in 2024 experienced severe maternal morbidity at a rate of 146.2 per 100,000 births, more than double that of white women in the same time frame.

For deaths that researchers determined were related to pregnancy, infection was the leading cause of death in 2021 and mental health in 2024.

The contributing circumstances to pregnancy-related deaths also shifted significantly from 2021 to 2024, including a quadrupling in the number of cases where violence like suicide or homicide was a factor, from 5% to 19%. While obesity as a contributor halved from 63% to 29%, every other major factor nearly doubled, including chronic health conditions, mental disorders and substance abuse.

More than half of the pregnancy-related deaths in both 2021 and 2024 were women who were on Medicaid, but decreased slightly from 57% to 53%. In both years, 22% of deaths were women who paid out of pocket for medical care.

The committee’s report omits 2022 and 2023 from individual case reviews, which could have provided additional information on deaths that have occurred after the near-total ban on abortion. The report makes no mention of abortion or the changes to state law.

The Texas Department of State Health Services, which oversees the Texas Maternal Mortality and Morbidity Review Committee, rejected the notion that the abortion ban was the reason those years were skipped.

“The committee was completing 2021 reviews and decided to move next to 2024 (the most recent full year available at the time) so the data wouldn’t continue to get farther and farther behind,” said Chris Van Deusen, a DSHS spokesperson, on Friday. “The committee made the decision with no dissent at the commissioner’s request and encouraged by the chair.”

Agency officials also denied the election was a factor for the report’s delay this year and pointed to a state law passed in 2025 that gave agencies more leeway to submit reports to the governor.

Women’s health advocates complained the delay was politically motivated and gave lawmakers less runway to craft bills based on the report ahead of the upcoming Texas legislative session which begins in January. Bill filing began on Monday.

However, as a result of Texas’ historic power shift that puts Republicans in the minority party, more help may be coming to the maternal mortality committee. Democrats already filed legislation related to the committee on Monday. State Rep. Charlene Ward Johnson, D-Houston, filed a bill calling for a separate study on Black maternal health in the state, similar to a bill she proposed in the 2025 session. That bill passed the House but not the Senate.

Most of the report’s 11 recommendations on improving maternal health outcomes in Texas were the same as the 2024 report, however new recommendations include prioritizing access to “critical resources” including clinical trials and improving education and healthcare coordination for those with chronic or high-risk medical conditions.

Recommendations carried over and updated from last year’s report include engaging Black communities to address healthcare disparities and improving access to mental health services. For those services, the report included an added note to increase education and behavioral health treatment for women who experience pregnancy loss and women with substance abuse disorders.