Texas will soon have four new maternal health research centers that will pilot innovative solutions to the state's maternal mortality and morbidity crisis.
The U.S. Health and Human Services Department is funding 16 centers nationwide. Texas' four new centers will be at The University of Texas Rio Grande Valley, The University of Texas at Arlington, Texas Southern University and Texas A&M University.
Texas persistently struggles with maternal mortality and morbidity, and the rates are only expected to increase under its near-total abortion ban. In 2013, when Texas first started tracking deaths and severe illness or injury from pregnancy and childbirth, Black women were twice as likely as white women and four times as likely as Hispanic women to die from pregnancy-related causes.
A decade later, despite more research, tracking and political attention on the issue, these disparities persist.
"I think, as a public health researcher, there comes a time where you have enough data and you have to start thinking, what can we do about it?," said Dr. Candace Robledo, a professor at UTRGV School of Medicine, who received one of these grants. "That's where Texas is now."
Over the next five years, each of these research centers will launch a program to address the specific needs of pregnant and parenting people in their local communities. Teams of researchers will look at how these interventions impact maternal mortality and morbidity and whether they can be scaled statewide.
All 16 of the new research centers nationwide are located at "minority-serving institutions," universities that enroll a high proportion of students of color.
"That's really crucial, because we mentor a lot of students who come from various different backgrounds," said Kyrah Brown, an assistant professor in the College of Nursing and Health Innovation at UT-Arlington. "This really creates the opportunity to engage them in research, especially if it’s research that involves populations that look like them."
Expanding the mental health workforce
Mental and behavioral health issues are a leading cause of maternal mortality in Texas. But with a high uninsured population and nowhere near enough mental health care providers, the Rio Grande Valley has struggled to serve new moms in crisis.
Through its $2.3 million grant, UT-RGV will train promotoras, or community health workers, to assess women who may be dealing with mental health issues and help connect them to the proper resources.
"A promotora can walk into a room and instantly has trust, so we're leveraging that relationship, particularly for those that may not trust the medical establishment," said Robledo.
Rather than requiring a new mom struggling with mental or behavioral health issues to make yet another doctor's appointment, promotoras can meet them at home or in a community setting, she said. Robledo hopes this program will be a model to expand the mental health workforce for everyone, not just women who are pregnant and parenting.
"How do we best design a framework that can be replicated elsewhere to train promotoras to provide this low-level, integrated behavioral health in community settings?" Robledo said. "This is the question we get to answer over the next five years."
A new research center
Texas Southern University will use the $2.4 million grant funding to create a new holistic research center focused on maternal health and community engagement. To do so, it will partner with the Texas Medical Center and Harris County.
Among other new initiatives, the center will launch an innovative program that partners pregnant women and new moms with pharmacists who can call them at home to help them stay on track with their medications.
"We've done this with oncology and it's been very successful with cancer care, so why wouldn't we take that best practice and apply it to maternal care?" said Omonike Olaleye, senior associate vice president for research and innovation at Texas Southern.
Olaleye's team will also launch several community-led pilot projects to address maternal health disparities in the greater Houston area. Olaleye said she hopes Harris County becomes a model for improving maternal health in diverse communities with a wide array of needs.
"A lot of the severe morbidity is caused by lack of access, which is hard for me to comprehend ... It’s really sad to be next to the largest medical center in the world and continue to see these poor outcomes in our mothers," Olaleye said. "But I truly believe this is a turning point for us."
Examining the impact of policy changes
Researchers at the UT-Arlington will use their $2.25 million grant to look at why so many Black women suffer serious cardiovascular complications during and after childbirth — and what can be done about it.
Brown plans to create a policy simulator, a data dashboard that can show how different solutions might drive down maternal morbidity from cardiovascular complications in North Texas. As part of the research, they will interview community leaders, elected officials, health care workers and people who have experienced complicated pregnancies, and then offer "learning labs" to teach the community how to use the data to advocate for better outcomes.
"We've been working on [maternal health] for years, but it hasn't been quite enough yet," Brown said. "We haven't had that paradigm shift yet. My hope is that, especially with having so many different stakeholders involved in this, it will help be a catalyst for bringing those pieces together."
More in-home support for new moms
Texas A&M will use its $2.28 million grant to launch a program where community health workers, nurses and doulas will help new moms at home for the first year after they give birth. The initial program will target high-risk women in the Golden Crescent, a seven-county region that includes Corpus Christi.
The program is loosely modeled on the Nurse-Family Partnership, a well-regarded national program where nurses visit new moms at home to offer health care and parenting support. Texas has several Nurse-Family Partnership programs scattered across the state, but with a nursing shortage and vast maternity care deserts, it's been difficult for these programs to cover the whole state.
Instead of registered nurses, A&M's proposal would connect new moms with what they're calling "champions" — community health workers, doulas or lay health care providers — who can offer some of the same support and connect moms to additional services as needed.
"They're meeting families where they’re at, literally, because you’re in their home," said Robin Page, the primary investigator on the grant, who works as a nursing professor at Texas A&M. "You’re taking in so much more than just seeing the patient in a clinic setting. You’re able to see the whole family, their environment and the challenges that they’re struggling with that we can help them address."
Page and her team are partnering with Texas A&M-Corpus Christi to study how this alternative workforce model might expand the reach of home visiting programs, and she hopes to collaborate with the other three research centers in Texas.
"In a big state like Texas, we have a lot of gaps," she said. "We need to see how we can strengthen each other’s efforts, instead of working in silos."