The United States is failing mothers. Over the past few decades, maternal mortality has been on the rise. Between 1987 and 2016, the number of deaths per live birth has more than doubled in the United States . With an estimated 26.4 deaths per 100,000 live births, the United States now has the worst maternal mortality rate in the developed world . At 37.2 maternal deaths per 100,000, Georgia fares even worse. Georgia consistently ranks highest in maternal death and these outcomes only continue to worsen .
The CDC defines pregnancy-related deaths as those that occur while a woman is pregnant “or within 1 year of the end of a pregnancy…from any cause related to or aggravated by the pregnancy or its management .” According to a Yale policy report, Georgia’s poor maternal outcomes can be partially attributed to systemic issues surrounding healthcare quality and access, health insurance coverage, and maternal mortality data .
Poor healthcare access in rural counties is one cause of many healthcare challenges faced in the state, including maternal mortality. For women in these areas, receiving the specialized care they need is an uphill battle. 79 counties in the state have no OB-GYNs and 80% of pregnant women in rural areas must travel to deliver .
Maternal health outcomes are also significantly worse for black women. Nationally, black women are 3 to 4 times more likely to die from a pregnancy-related condition and black women in Georgia experience the worst maternal outcomes in the United States . One major cause of this is bias within the healthcare system. Black women frequently report feeling discriminated against or unheard in medical settings, prompting some to avoid prenatal care entirely . Women who do pursue care can face challenges in receiving quality care.
Georgia has one of the highest rates of uninsured individuals in the nation, with a disproportionately high number of uninsured people identifying as Hispanic or Black . Georgia’s decision against Medicaid expansion has also limited women’s abilities to get health insurance, be covered earlier on in their pregnancy, and receive the recommended length of coverage postpartum.
Finally, the state has failed to thoroughly collect and investigate information on maternal mortality. Although Georgia has established a maternal mortality review committee, the committee’s data has wide gaps, questionable accuracy, and limited reports . For a death to be classified as maternal mortality, a coroner checks a box on a death certificate asking whether or not the individual was pregnant within the past year. However, mistakes are often made in filling out death certificates, so much so that some officials suspect our current figures on maternal mortality are undercounted .
Maternal mortality is a serious problem, but through effective policy change, it is one we can minimize. The CDC notes that 60% of pregnancy-related deaths are preventable. In January of 2019, the Georgia House Study Committee on Maternal Mortality published a report chock-full of policy recommendations for the state that can reduce these preventable deaths. These include, amongst other structural and logistical recommendations, expanding Medicaid coverage for pregnant women from 60 days postpartum to one year, requiring postmortem exams following maternal deaths, developing healthcare models for prenatal care, and increasing the number of medical professionals in rural areas . The committee also recognizes the need for better data on maternal mortality with consideration for the racial and social factors that determine maternal outcomes and informational campaigns across the state.This report highlights the extensive nature of the work required to address Georgia’s maternal mortality problem. Nevertheless, these recommendations provide viable policy solutions that are a crucial first step in resolving this issue. One piece of proposed legislation in the 2020 assembly, the “Georgia Dignity in Pregnancy and Childbirth Act”, could help address some of Georgia’s shortcomings. This legislation would require perinatal centers to implement implicit bias programs. It also outlines more detailed requirements regarding the collection of data on maternal outcomes .
If Georgia wants to address its maternal mortality problem, systemic changes must occur sooner rather than later. It is evident that there are a multitude of actions that can address this epidemic. Ultimately, our failings in protecting mothers are a reflection of our deeper failings to protect women’s health across the state and country .
Written by: Ayah Abdelwahab