According to a new study in the journal Obstetrics and Gynecology, Texas’ maternal mortality rate had doubled over a two-year period. More troublingly, while Texas showed the sharpest increase of maternal deaths, the study found that the overall maternal mortality rate within the United States has increased from 2000 to 2014. “There is a need to redouble efforts to prevent maternal deaths and improve maternity care for the 4 million U.S. women giving birth each year,” the study’s authors note, adding that the maternal death rate in the United States is higher than in other industrialized countries.

While the overall numbers are concerning, Texas’s are particularly troubling, in part because researchers were unable to pinpoint exactly why the state’s maternal mortality rate doubled in such a short timeframe. While some states saw a slight increase of their maternal mortality numbers because of more accurate data collection and digitization of death certificates, this was not the case with Texas. Via the study:

The Texas data are puzzling in that they show a modest increase in maternal mortality from 2000 to 2010 (slope 0.12) followed by a doubling within a 2- year period in the reported maternal mortality rate.

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There were some changes in the provision of women’s health services in Texas from 2011 to 2015, including the closing of several women’s health clinics. Still, in the absence of war, natural disaster, or severe economic upheaval, the doubling of a mortality rate within a 2-year period in a state with almost 400,000 annual births seems unlikely. A future study will examine Texas data by race–ethnicity and detailed causes of death to better understand this unusual finding.

Austin’s KUT notes that in 2011, Texas cut funding to numerous prenatal programs, particularly those aimed at providing care for low-income women. Those funding cuts, however, might explain the rise of unplanned pregnancies in the state, but do not account for the sharp rise in maternal mortality rates.

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Meanwhile, the state’s legislature has decided that $1.6 million of the funds from its Healthy Texas Women program are best spent at an anti-abortion “crisis pregnancy clinic.” Please note that the director of that clinic once said that fetal tissue disposal was a public health crisis that could contaminate Texas’ water supply with HIV.