After watching the local health care system and community organizations battle Tarrant County’s high infant and maternal mortality rates for over 10 years, Fort Worth Mayor Mattie Parker decided a “catalytic effort” was needed.
“Our hypothesis at the time was that we had every resource and every great provider that can tackle this challenge in Tarrant County and Fort Worth, but we were missing something to connect the dots and really make a difference for health outcomes for mothers and babies,” Parker said. “And luckily, that proved true.”
This spurred the creation of the Tarrant County Maternal & Infant Health Coalition. Since it was launched in 2022, the coalition’s efforts have included distributing iron pills to expectant mothers, seeking feedback from those who previously gave birth in the county, and creating a system to connect mothers with resources they need beyond their doctor’s office.
The coalition is made up of the county health department, universities, nonprofits, and local hospitals and medical practices. The group aims to improve infant and maternal mortality rates for Tarrant County, with hopes for an even wider impact in the future.
A 2024 report said Tarrant County’s maternal mortality rate for Black women is the second highest in Texas. Tarrant County’s 2022 infant mortality rate was 6.08 for every 1,000 live births, the fourth-highest rate among similarly large Texas counties.
Dr. Stuart Flynn, dean of the Anne Burnett Marion School of Medicine at Texas Christian University, facilitates meetings for the coalition and is the liaison between Tarrant and Dallas counties. Flynn brought Dallas County’s UT Southwestern Medical Center and Parkland Health aboard the coalition.
“Amazingly enough — and I love this as an outcome, because I’ve been here nine years and I was kind of told this would never happen — we’re now working in tremendous collaboration,” Flynn said.
Severe complication, simple solution
As part of the coalition, iron pills are distributed to expectant mothers in Dallas and Tarrant counties free of cost, beginning from the mother’s first prenatal appointment and continuing throughout her pregnancy. The pills help prevent hemorrhages that require blood transfusions, a severe complication for birthing mothers, Flynn said.
“What the iron does is it makes you less anemic, and therefore when you have a hemorrhage during birth, you may not get to that critical point where then you have to be transfused,” Flynn said.
The iron distribution has seen significant positive results, Flynn said, and he hopes the improvements from the North Texas region will lead to the U.S. Preventive Services Task Force adopting a recommendation.
“Right now, they’re saying they think it has merit,” Flynn said. “They don’t have enough data to make it a full recommendation. We anticipate in the next two to three years, showing them that, in fact, we have decreased the percent of transfusions by 30-plus percent.”
Seeking feedback
The coalition also enlisted researchers at the University of Michigan to interview mothers who had given birth in Tarrant County.
A problem some interviewees raised, Flynn said, was that their care teams did not reflect their identities. For example, Black mothers did not have Black caregivers, and Spanish-speaking mothers did not have Spanish-speaking caregivers.
“That has nothing to do with giving iron. That has everything to do with trying to assure that our health care teams look more like our patients than less,” Flynn said.
Black babies are much less likely to die when their medical providers are also Black, a 2020 study showed. Black mothers also report feeling more comfortable with doctors who look like them, according to another study.
Closing the loop
Another main effort by the coalition was creating a “closed loop referral system” to ensure mothers actually reach the resources to which they are referred.
Hospitals were referring mothers to outside resources that could help them, but in the end, the mothers and those resources never connected, Parker said.
In order to solve this problem, the coalition used an app called Parent Pass. With the app, mothers can connect with “navigators” through the Help Me Grow system who will assist them in getting what they need, such as food, mental health care or child care.
“It’s someone that’s well trained, and now we have an overabundance of people that are now trained as navigators to help connect moms to those services, which has been incredibly helpful,” Parker said.
Increasing communication
United Way of Tarrant County also plays a part in the coalition through its maternal health program, created in 2022 to tackle the high maternal mortality rate.
The program’s initiatives include providing doula services free of cost and helping hospitals put a care system called TeamBirth into effect, said Adam Powell, president and CEO of United Way of Tarrant County.
The TeamBirth model helps increase communication between mothers and those caring for them, and between the care team members themselves. A “shared planning” whiteboard is used to keep track of the plan to ensure everyone is on the same page.
“Having had a baby myself, I can see firsthand how helpful that would have been, especially in the labor and delivery room, to make sure that your needs and your voice was heard no matter what the situation was,” Parker said.
Looking to the future, Parker believes Tarrant County can become a nationwide leader.
The creation of the coalition allowed the North Texas region to apply for a $45 million grant from the Advanced Research Projects Agency for Health to support care for mothers and their babies in the area, she said.
“A new mother and a new baby is the most fragile thing in your community, and how you treat those individuals, those women and their infants, is a reflection on who you are as a city,” Parker said. “Twenty years from now, because of this coalition’s hard work and foundation — especially if we’re able to secure this grant — I think we’re well on our way to be an example for the country.”
McKinnon Rice is a reporting fellow for the Fort Worth Report. Contact her at mckinnon.rice@fortworthreport.org.
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