The United States is currently one of only thirteen countries in the world where maternal mortality is worse now than it was fifteen years ago. As with other health issues, significant racial disparities underlie maternal health outcomes. According to the CDC, Black women are three to four times more likely to die from pregnancy-related complications than white women-and the disparity persists across socioeconomic and education levels.
Though national trends point to worsening maternal health outcomes overall, the risk of death from pregnancy and child birth varies greatly by state, suggesting that this risk is not natural or inevitable, and that state-by-state policies are implicated. Georgia represents one U.S. state that fairs particularly poorly: as of 2017, it ranked 48th in the nation in terms of maternal mortality, with Black women most affected.
In early 2017, the GHJP clinical students began an examination of existing public health and policy research that points to state-level decisions, including policies, funding, and institutional factors, implicated in the critical state of maternal health in Georgia. This undertaking was conceptualized in collaboration with Black Mamas Matter Alliance (BMMA), a Black women-led cross-sectoral alliance, which centers Black mamas to advocate, drive research, build power, and shift culture for Black maternal health, rights, and justice, and the Center for Reproductive Rights, a US-based global reproductive rights NGO.
The initial analysis and recommendations by students were reviewed and revised in light of collaborating partners' and other expert reviewers' input, more recent public health research, and the exploding national conversation on this issue. The final results from the project have been published in a 2018 report titled "When the State Fails: Maternal Mortality and Racial Disparity in Georgia." Read the press release, the complete 77-page report, and a 21-page Executive Summary.
The report examines interlocking state-level systems and policy failures contributing to racial disparities in maternal mortality in Georgia. It offers policy and advocacy recommendations related to improving access to and quality of maternal healthcare, insurance access and pricing, funding by public and private entities, accountability around data analysis and use in the case of maternal mortality review committees, and the potentially positive role for outreach with religious communities. The analysis and recommendations pay particular attention to underlying inequities and barriers to care that fall along lines of gender, race, and class.
By focusing on state-level systems under the influence of policy makers, the report aims to call attention to existing research and new areas for research to better understand and guide structural changes that can ameliorate the burdens of maternal death, particularly on Black women and others disproportionately vulnerable in the crisis.