Texas' 2024 Maternal Death Rate Returned Near Pre-Pandemic Levels, a New State Review Finds
A Nov. 13 DSHS and maternal-mortality committee report puts Texas' 2024 maternal death rate at 20.5 per 100,000 live births, near the pre-2020 range, and finds mental health conditions were the leading cause of pregnancy-related deaths among reviewed 2024 cases.
The Texas Maternal Mortality and Morbidity Review Committee and the Department of State Health Services say the state's maternal death rate has fallen back near the range recorded before 2020, while mental health conditions became the leading underlying cause of pregnancy-related deaths in the most recent year the committee reviewed. Their 2026 joint biennial report, required by state law and due to the governor and legislative leaders by Dec. 1 of each even-numbered year, reviews 2021 and 2024 cases. The PDF's creation metadata is dated Nov. 13, 2026. The committee completed case reviews of the 2021 and 2024 cohorts for this report; for 2022 and 2023, DSHS continued to calculate maternal mortality ratios, with that data on Texas Health Data, but the committee did not complete individual case reviews in this report. Sunset staff also reviewed DSHS and this committee in a November staff summary, as we reported in Sunset Staff Say DSHS Is Well Run but Hampered by Its Dependence on HHSC.
Two different official measures should not be mixed. DSHS's enhanced maternal mortality ratio, the number of maternal deaths per 100,000 live births, fluctuated between 17.0 and 20.7 from 2013 through 2019, then rose to 27.7 in 2020 and 39.1 in 2021, "due in part to COVID-19 related deaths." If those COVID-19 maternal deaths are excluded, the agency says the ratios would be 24.2 in 2020 and 23.5 in 2021. By 2024, the ratio was 20.5, "a similar rate as before 2020." Separately, the pregnancy-related mortality ratio, which counts deaths the committee judged to be caused by pregnancy or aggravated by it, was 30.0 per 100,000 live births in 2021 and 20.7 in 2024.
Pregnancy-related death, as the report defines it, is the death of a woman during pregnancy or within one year after pregnancy ends, from a pregnancy complication, a chain of events started by pregnancy, or the aggravation of a condition by pregnancy. Pregnancy-associated death is any death in that same period, regardless of cause. Beginning with the 2021 cohort, DSHS and the committee used representative sampling so reviews could catch up. Of 158 sampled pregnancy-associated deaths in 2021, the committee judged 60 (38 percent) pregnancy-related, 67 not related, and 31 undetermined. Of 127 sampled cases in 2024, it judged 59 (46 percent) pregnancy-related, 45 not related, and 23 undetermined.
The committee found at least some chance of preventability in 77 percent of the 60 pregnancy-related deaths in 2021 (46 cases) and 76 percent of the 59 in 2024 (45 cases). That "preventable" finding is the committee's judgment, using a Centers for Disease Control and Prevention definition, not a court finding.
Causes shifted sharply between the two review years. In 2021, infections were the leading underlying cause, accounting for 55 percent of pregnancy-related deaths (33 of 60). COVID-19 was the top condition in 91 percent of those infection deaths. Hemorrhage accounted for 13 percent, and non-cerebral thrombotic embolism and mental health conditions for 7 percent each. The report's 2021 mental-health count is four cases, which is also the figure used in later findings. In 2024, mental health conditions were the most frequently observed underlying cause, 20 percent (12 of 59), followed by hemorrhage (15 percent), hypertensive disorders of pregnancy (14 percent), embolism (12 percent), and infection (10 percent). Among the 12 mental-health deaths in 2024, depressive disorder was the top underlying condition (nine cases), followed by substance-use disorder (two) and bipolar disorder (one). The committee judged all four of the 2021 mental-health deaths and 92 percent of the 2024 mental-health deaths potentially preventable. Most of those deaths occurred 43 days to one year after pregnancy ended, and most occurred outside hospitals, unlike deaths from hemorrhage, hypertension, embolism, and infection, which in 2024 were found in hospitals in every reviewed case.
Disparities persisted. In 2024, the pregnancy-related mortality ratio for non-Hispanic Black women was 47.7 per 100,000 live births, about 2.4 times the 20.1 rate for non-Hispanic White women, compared with 16.6 for Hispanic women and 11.9 for non-Hispanic women of other races. In 2021 the Black rate was 55.7, roughly 2.1 times the White rate. In both years the ratio was also highest among women 40 or older and women with a high-school education or less. Hypertensive disorders of pregnancy were the leading cause among non-Hispanic Black women in 2024; mental health conditions led among non-Hispanic White and Hispanic women. Severe maternal morbidity, a DSHS measure of serious labor-and-delivery complications, rose from 80.4 cases per 100,000 delivery hospitalizations in 2023 to 83.9 in 2024, and was 146.2 among non-Hispanic Black women.
Other circumstances also changed. Violent pregnancy-related deaths, defined as suicide or homicide, were 5 percent of the 2021 related deaths (three cases) and 19 percent in 2024 (11 cases). In all pregnancy-related homicides in those two years, the report says, the perpetrator was the decedent's partner. Obesity was identified as contributing or probably contributing in 63 percent of 2021 related deaths and 29 percent in 2024. Mental disorders other than substance-use disorder, substance-use disorder itself, and nicotine or tobacco each rose from 8 percent, 8 percent, and 3 percent in 2021 to 19 percent in 2024. Medicaid paid for 57 percent of the 2021 related deaths and 53 percent in 2024, the most common payer. In 2024, the committee also flagged delays in receiving medical treatment, lack of access to care, repeated urgent or emergency visits, and treatment that appeared inconsistent with best practices as common barriers.
Among 600 linked pregnancy-associated deaths from 2020 through 2023, a broader DSHS analysis found that accidental drug poisoning, cardiac events, COVID-19, homicide, a mixed "other" category, and suicide together accounted for 78 percent of deaths, and that 61 percent occurred between 61 days and one year after delivery.
The committee recommends better access to care through the first year after pregnancy, integrated mental and behavioral health services for women of reproductive age, including those with substance-use disorders, work on health disparities, and stronger responses to violence and intimate-partner violence. Those are recommendations to state leaders, not a new statute. The figures should be read as published, including the limits of a sampled review and the years not individually re-examined here. "A bruised reed shall he not break, and the smoking flax shall he not quench" (Matthew 12:20). The work of counting these deaths is for the sake of the next mother who can still be helped.
