Texas’ maternal mortality committee questions recent changes after anti-abortion doctor’s appointment

The chair of Texas’ maternal mortality review committee expressed concerns Tuesday with recent changes to the body, including the Legislature’s elimination of the community advocate position and the Department of State Health Services commissioner’s recent appointment of an anti-abortion doctor to the committee.

Dr. Ingrid Skop, a San Antonio OB/GYN who was appointed to the committee last month, is vice president and medical director at the Charlotte Lozier Institute, the research arm of the political advocacy group Susan B. Anthony Pro-Life America. She is prominent among a small group of anti-abortion doctors who frequently testify at Congress and state legislatures and are trotted out as expert witnesses in court cases.

Dr. Carla Ortique, the Houston OB/GYN who chairs the committee, said Tuesday other committee members have told her they’re worried it might seem like the rest of the committee shares Skop’s views. She noted Skop’s appointment prompted national news coverage and concerns about potential bias in the committee’s recommendations.

Ortique reiterated that the committee’s focus will continue to be the way Texas and the nation are failing pregnant women — particularly Black women — and that their work relies on science, medical evidence and public health standards in investigating maternal deaths.

“We will continue to strive for standardization of the review process and application of a public health equity lens to guide our deliberations,” Ortique said. She noted the committee is intentionally racially, ethnically, culturally and economically diverse, and while they never discuss politics during the review process, “I believe it's safe to assume that our committee members are likewise not politically nor ideologically homogeneous.”

Skop was appointed in May as part of a slate of new positions created by the Legislature last session. The committee originally had 15 members, including a position for a community advocate. That role was most recently filled by Nakeenya Wilson, a grassroots maternal health worker and Black woman who herself experienced a difficult childbirth.

In expanding the committee to 23 members, the Legislature eliminated the community advocate role and replaced it with two positions for community members who have experience in a health care field, undermining the grassroots nature of the original position. One of the new community member positions is meant to represent pregnant women in the state’s urban areas and the other rural regions.

Wilson, who is based in the Austin area, applied for the new position but was not appointed. Instead, the urban role went to Dr. Meenakshi Awasthi, a pediatric emergency medicine fellow at the University of Texas Health Science Center in Houston, and the rural position went to Skop, who practices in San Antonio, the state’s second-largest city.

At Tuesday’s meeting, the first without Wilson, Ortique and other members applauded Wilson’s work on the committee and raised concerns about what this shift means for the group’s future.

“As I sat and listened to the roll call today, it was abundantly apparent that greater than 90% of our members now hold doctoral-level degrees,” Ortique said. “This is a cause for concern.”

Maternal mortality review committees across the country have long recognized the importance of having community members at the table for these discussions, Ortique said.

“it is rarely possible for those who sit in positions of privilege to truly be the voice of at-risk communities,” she said. “We can and should at all times be voices that support and attempt to foster positive change. We can be trusted allies. However, we cannot truly be their voice.”

Ortique encouraged committee members to continue to find ways to hear from and center the experiences of Black women, uninsured women and others with limited access to maternal health care. Dr. Carey Eppes, a maternal-fetal medicine specialist at Texas Children’s Hospital who serves on the committee, thanked Wilson for her work and willingness to share her experiences with the committee and other maternal health initiatives in Texas.

“Her contributions have been invaluable and I have learned a lot from working with her,” she said.

Ortique reminded committee members that the Legislature makes decisions about the committee’s makeup and the Department of State Health Services commissioner decides who to appoint to the body.

“Regardless of personal belief and opinion, we must respect the importance of upholding the integrity of the process and accept the commissioner’s right and authority to make appointments that they deem to be best,” she said.

Ortique also raised concerns about the future of Texas’ use of a federal maternal death data system.

Texas, like almost every other state, currently relies on the Centers for Disease Control’s Maternal Mortality Review Information Application system to track maternal deaths. But last year, the Legislature appropriated almost $6 million to create a state-level program that would allow Texas to cut itself out of the federal program.

At Tuesday’s meeting, Ortique spoke about attending a CDC conference in Atlanta and highlighted all the important input that comes from cross-state collaboration. Participating in the national system allows Texas to “efficiently and effectively” review cases and contribute to the national conversation about maternal deaths, Ortique said.

The committee believes a state that represents more than 10% of the births in the country should continue to participate in the MMRIA system, Ortique said, even if that means running federal and state data systems simultaneously. But she acknowledged that was not what the legislation intended, and it is not clear whether Texas will be able to remain in the national system.

Despite all the national attention on Skop’s appointment, only one person spoke during the public comment period Tuesday. Dinah Waranch, a midwife and frequent attendee of these meetings, expressed her frustration with what she characterized as the committee’s timidity.

“It seems the committee is both imprisoned by its insider perspective and at the mercy of cruel political forces,” she said. “Partisanship, the politics of abortion and institutional rigidity are anathema to bringing the changes that must happen to save lives.”

“You have more power than you admit to,” she said to the committee members. “And I’d like you to take charge of your own power.”

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