10 Things You Need to Know About Georgia's Maternal Mortality Crisis
Between 2000-2014, most countries saw significant drops in maternal mortality, which is the rate at which people die from pregnancy and childbirth. But in the U.S., maternal mortality increased by 26.6%. About 700 birthing people die of pregnancy or birth-related causes every year.
Although media coverage of these deaths often cites birth by older mothers and demographic trends, these deaths are not inevitable—and they’re not the fault of less healthy birthing people. Nations with similar health trends to our own don’t have anything close to our maternal mortality rate. A person giving birth in the U.S. is about five times as likely to die as one giving birth in Britain.
No single factor can explain all of these deaths, though one theme recurs: at every stage of pregnancy, birth, and the postpartum period, our contempt for birthing people and our lack of concern for women undermines their health. The maternal mortality rate neatly encapsulates how little we as a society care for mothers.
Until 2003, death certificates did not even contain a checkbox for pregnancy-related deaths. Even with the addition of this checkbox, protocols for identifying and tracking maternal deaths are weak or nonexistent. There is no official nationwide count of maternal deaths. This compels questions about why we are so uninvested in ending maternal deaths. Why is there so little outrage? Why have mainstream feminist movements not led the charge on this issue? Have we collectively decided that mothers just don’t matter?
Maternal mortality is just one piece of the puzzle. A collapsing maternity care system has left many birthing people with long-term injuries, untreated health issues, or buried under an avalanche of medical debt. Here’s what you need to know about our collapsing maternity care system.
The united states is the most dangerous place in the industrialized world in which to give birth
The United States is the most dangerous wealthy nation in which to give birth. And while other countries have seen maternal mortality plummet to nearly zero, our maternal death toll continues to rise. We rank 46th overall for maternal mortality. Countries with many more challenges and far less wealth—including Saudi Arabia, South Korea, Qatar, and Estonia—are safer places to give birth.
In Finland, just 3 mothers die for every 100,000 who give birth. To put this into perspective, the death rate for minor dental procedures is about 6 per 100,000, so it’s actually safer to give birth in Finland and other developed nations than it is to have a root canal. It’s virtually unheard of for a person to die giving birth. In the U.S., 14 out of every 100,000 birthing people die. For Black women, the figure is an astonishing 44 per 100,000.
Georgia is the most dangerous state in the United States in which to give birth
Georgia’s maternal mortality rate is more than three times the national maternal mortality rate. We rank dead last in the nation, at more than 46 deaths per 100,000. For Black women, the figure is even higher—66 per 100,000. What’s more, our maternal death toll has steadily risen thanks to a public health system that has done nothing to stem the tide, and a government that has refused to intervene. Hospitals in Georgia are not required to adopt initiatives to curb maternal mortality. They don’t even have to publicly report their data. Medicaid expansion is consistently linked to a lower maternal death rate, but Georgia’s then-governor refused to expand the program, leaving women to die. Our new governor, Brian Kemp, explicitly campaigned on a platform of not expanding Medicare.
Black women die at four times the rate of white women—and racism is a primary culprit
Nationally, Black women die at 3-4 times the rate of white women. In Georgia, the Black maternal mortality epidemic is even worse, with 66.6 out of 100,000 Black women dying. To put this into context, this is a maternal mortality rate that is higher than that of more than 100 countries. Ecuador, Vietnam, Iraq, and Palestine all have lower maternal mortality rates.
Many people mistakenly believe that worse outcomes are due to differences between black and white women, or that black women are less healthy. This is untrue. Many Black women who die enter pregnancy completely healthy. Even wealthy, highly educated Black women die at much higher rates than white women.
Racism is a key culprit here. A 2012 analysis found that Black women’s experiences of racism were directly correlated with pregnancy outcomes. Other studies support the notion that doctors unconsciously apply racist stereotypes to their Black patients. A review of Black people who sought emergency treatment for a broken bone and who reported similar levels of pain found that 74% of white patients, but just 57% of black patients, received painkillers. Twenty-one percent of Black women say they were exposed to racism when treated for childbirth complications. People of color are less likely to be tested for common issues such as high blood pressure. Research consistently shows that doctors believe inaccurate racist stereotypes about black people, such as that they feel less pain.
After birth, racism continues to be a problem. Hospitals are more likely to discourage black women from breastfeeding, and more likely to offer their babies formula.
Stories of black women who die during or after birth clarify the extent to which we undervalue black lives. Women often must beg for care. Serena Williams had to coach her doctors on how to treat her, after her doctors initially denied signs of a dangerous blood clot. Kira Johnson was told she “wasn’t a priority,” and bled to death internally as she and her husband begged for care. Lashonda Hazard pleaded for treatment for intense abdominal pain while pregnant. She texted a friend, “I’m literally dying.” Both she and her baby died the next day, after receiving no medical treatment.
Medical neglect and inadequate systems of care play a key role in the crisis
Stories about the maternal death epidemic often blame women for their own deaths. They talk about older mothers, overweight women, or unhealthy lifestyles. Yet according to a Report from the Maternal Mortality Review Committees, provider and institutional factors are the culprit in at least 57% of maternal deaths. This may actually underestimate the extent to which inadequate medical care plays a role, since doctors are often reluctant to scrutinize other doctors, and patients’ charts may leave out egregious medical errors. Hospitals almost never admit to playing a role in patient deaths.
During pregnancy, doctors and midwives closely supervise pregnant people, and may see them weekly or even more frequently in the third trimester. After birth, most women receive no medical care at all. Forty-four percent of maternal deaths occur in the immediate postpartum period when women are least likely to see their providers. And 66.9% of all deaths occur after pregnancy and birth. So why are we only monitoring birthing people during pregnancy and birth?
Having a newborn is challenging. Most women will not go to the emergency room unless they know something is seriously wrong. And by then, it will be too late. Many countries have solved this problem with a simple, effective solution: home health visitors who check on birthing people in the days and weeks following birth. Many homebirth midwives already offer this service. We know it can save lives. We know women are more likely to die in the postpartum period than any other time. So why aren’t we doing anything?
Most maternal deaths are preventable
At least 60% of maternal deaths are preventable. Seventy percent of hemorrhages, the leading cause of maternal deaths, are preventable. The actual figure may be much higher. Various Maternal Mortality Review Committees have struggled to define what a preventable death is. For example, a woman who kills herself after receiving psychiatric care might not have done so if the quality of care had been better, or if she had been able to check into inpatient care without leaving her baby behind. Yet her death may be classified as unpreventable.
Most people who give birth suffer long-term complications, and these complications are not inevitable
Maternal mortality is just one piece of the puzzle. Most birthing people will not die giving birth. But almost all will experience a preventable complication. A year after giving birth, 77% of mothers have back pain. Forty-nine percent have urinary incontinence. Fifty percent have chronic pelvic pain.
Another study found that 24% had pelvic pain after birth, and that the likelihood of pelvic pain increased with the number of obstetric interventions women received.
In another study, researchers found that 29% of women had undiagnosed tailbone fractures. They had broken bones giving birth, and their providers hadn’t bothered to notice.
Doctors often dismiss these injuries as minor, though research shows they significantly impact quality of life. In addition to the women who grimace through pain years after birth, wondering if they’re normal, 50,000 women are severely injured giving birth.
Most of these injuries are preventable, yet we do little or nothing to prevent them. In some cases, the injuries are the direct result of obstetric interventions. For example, we know that episiotomies—a cut into the vagina—increase the risk of serious pelvic health problems, including incontinence. Moreover, there are few medical indications for episiotomies. Yet doctors keep performing them at far beyond the recommended rate, and often for no clear reason at all. Worst of all, doctors continue to perform episiotomies without consent, and often over a birthing person’s objection. One survey found that 59% of birthing people who received an episiotomy did not consent to the procedure.
Research consistently shows that pelvic floor physical therapy can reduce the risk of incontinence and pain following birth. In many nations, it’s standard. In the U.S., it’s considered a luxury, and insurance almost never pays for it. We think a lifetime of pain and incontinence is a fair price to pay for giving birth.
Childbirth is a leading cause of PTSD
Childbirth can be scary and intense, but it rarely needs to be physically or psychologically traumatic. Despite this, our maternal health system provides birthing people with little support. Ninety percent of birthing people receive an unnecessary medical intervention, and at least 12% don’t consent to the intervention. Sixteen percent of birthing people have PTSD after giving birth. Sixty-six percent of these cases are due not to the difficulties inherent in childbirth, but to maltreatment during or after birth. One in three birthing people describe their births as traumatic. This makes childbirth a leading cause of PTSD.
It costs more to give birth in the U.S. than anywhere else in the world—and birth leaves many families in debt
Families in the U.S. pay more to give birth than families anywhere else in the world. Higher costs have not improved care. Indeed, they might be driving our failing maternity care system. Medicine for profit tips the balance of power in the delivery room, and incentivizes doctors and hospitals to recommend costly procedures while providing lower quality (and less time-consuming) care. A working paper by the National Bureau of Economic Research found that money likely drives doctors to perform more C-sections than can be medically justified.
Our high-cost childbirth system leaves many families struggling financially. The postpartum period is already a vulnerable time. Add in a few thousand dollars of debt, and it’s enough to push some families over the edge.
We’re not doing anything to prevent maternal mortality, even though we could
Aside from gathering incomplete data, we are collectively not doing anything to prevent maternal mortality. Indeed, many people don’t even realize it’s an issue. Numerous researchers have identified strategies to curb maternal mortality. Hospitals and systems of care have ignored them.
A leading cause of postpartum death is suicide. The research consistently shows that social factors—inadequate community support, returning to work too early, unsupportive partners, and more—are the key culprit. Yet the popular media continues to blame hormones. This prevents us from working to remedy the real causes. Moreover, we have done almost nothing to ensure access to quality postpartum mental health care. Women who feel suicidal are sent to psychiatric wards, where they are separated from their babies. That’s traumatic to women and their babies. It’s needlessly punitive, and deters women from seeking the help they need. Yet in other nations, women can seek inpatient care on units that allow them to room-in with their babies, just like they do in hospitals after giving birth. Our failure to offer something similar in the U.S. demonstrates how little we actually care about maternal health.
Maternal mortality is not inevitable
Movies and other media portray childbirth as inherently dangerous. And some people believe that a lifetime of pain is the inevitable result of giving birth. Neither is true. Other nations have much better maternal outcomes than our own. In most wealthy nations, maternal mortality is virtually unheard of, and women get the care they need to avoid chronic pain and incontinence.
This is not inevitable. Continuing to allow women to die is a choice that speaks volumes about the worth of American mothers.