Combating Severe Obstetric Complications
Prioritizing Outcomes for Texas Mothers
- Related Services:
- Coalition Building
- , Procurement
The Problem
More babies are born in Texas than in 48 other states, second only to California. Every one of these children is a gift to their families and our communities, but maternal health complications place women and their unborn or newborn babies at high risk. Unfortunately, Texas has one of the highest rates of these complications. Of the twenty-one national indicators, DSHS reports discuss the most common in Texas. Moreover, DSHS reports that 80% of pregnancy-related maternal deaths are preventable. Viewing this statewide challenge in a single metroplex sheds additional light on the topic: in Dallas and Tarrant counties, one in twenty-five women suffer from a severe obstetric complication (SOC), such as blood loss requiring transfusion, kidney or heart failure, dangerously high blood pressure, or fluid in their lungs. To combat SOCs, five organizations established the Maternal Health Accelerator (MHA): The Burnett School of Medicine at TCU, UT Southwestern, PCCI, MHMR of Tarrant County, and The Child Poverty Action Lab (CPAL). The MHA’s goal is to reduce SOCs by more than 20% locally in 3 years, and has formed a coalition of over 120 organizations to do so. To launch the work, MHA secured $23.5 million in philanthropic funding and applied for $15 million in federal funding available through ARPA-H’s HEROES initiative.
Our Approach
Because MHA’s work closely aligned with lawmakers’ goals for improved maternal health outcomes, we introduced MHA’s unique approach to Texas legislators in summer 2024. We clearly communicated that, unlike most programs, philanthropic and federal funding would only be provided if MHA lowered SOCs. This flipped the conversation about funding on its head; most programs fund inputs, such as goods or services offered. MHA offered a unique opportunity to fund verified outcomes. We helped communicate that MHA proposed to achieve this goal through four evidence-based interventions:
- Distribute iron. Local evidence showed that handing expectant mothers a bottle of prenatal iron supplements, rather than merely recommending it, reduced postpartum transfusion risk by one-third.
- Standardize training. Local evidence found that simulating postpartum hemorrhage across doctors, nurses, and departments in a physiologically safe and standard way significantly reduced average blood loss.
- Postpartum monitoring. Local evidence showed that dangerously high blood pressure is a leading cause of postpartum rehospitalization, and MHA proposed to discharge at-risk patients with blood pressure cuffs, as well as ensure virtual and home-based visits.
- Wraparound care. State evidence showed that non-medical drivers of health are contribute to SOCs. MHA proposed to combat these drivers through leading care navigation and by providing census-block data to public health practitioners.
These interventions became possible due to tremendous support and leadership in DFW. As Mayor Mattie Parker, a leading champion of MHA, stated: “I believe the way we care for mothers and children in Fort Worth is a true measure of our city’s success… When I first convened the Maternal & Infant Health Coalition in 2022, Fort Worth and Tarrant County already had exceptional medical providers and resources – but we lacked the coordination needed to truly improve outcomes for mothers and babies. This project and its funding will enhance that collaboration and create real impact in our region for years to come.”
Breakthrough Solutions
Through direct conversations with policymakers, we introduced MHA’s proposal and demonstrated clear alignment with the state’s goals. We identified aligned legislative champions and drafted a budget rider to fund any maternal health outcomes program in Texas doing this good work. Sen. Royce West, Rep. Toni Rose, and Mayor Parker championed the policy and continually advocated for the new idea. Our team expertly navigated the rider through the appropriations process, providing prompt answers to equip champions for success. From filing to reports, decision documents to amendments, our team supported lawmakers and staff every step of the way. Our previous experience in the Article II subcommittees allowed us to successfully anticipate each step and resulted in new state funding for maternal health outcomes programs. In fall 2025, federal funding was awarded to MHA and then cut. Regardless, with philanthropic support, MHA launched and iron supplement distribution began in April 2025.
Jan. 2026 Update: The 6-month rolling average SOC rate for Dallas and Tarrant Counties is down over 10% from its baseline. The decrease is being driven by a declining rate of transfusions.