State-level reforms, as well as improvements in healthcare practices and institutional attitudes, are necessary in order to improve maternal mortality rates in black women in the state of Georgia, according to research discussed at the American Public Health Association 2018 Annual Meeting and Expo, held November 10-14 in San Diego, California.

National maternal mortality statistics in the United States are worse now than 15 years ago, and analysis has demonstrated that black women are 3 to 4 times more likely to experience fatal complications related to pregnancy compared with white women. These mortality statistics vary significantly between states, highlighting the effect of state-level policies and funding for obstetrical care. Researchers found that with regard to maternal mortality, the state of Georgia was ranked 48th in the nation in 2017; they therefore  focused on “state-level systems under the influence of policymakers to suggest that structural reforms will be central to ameliorating the burdens of maternal death, particularly on black women and others that are disproportionately vulnerable.”

Using the framework of the human rights obligations of a state to its residents and in an effort to identify and eliminate the causes for disproportionate pregnancy-related risks, the researchers evaluated the state-legislated policies and practices currently in place. They developed their results through desk research and collaborative conversations with the Center for Reproductive Rights and the Black Mamas Matter Alliance.

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Investigators identified delays and insufficiencies in distributed information, poor distribution of healthcare options and services, suboptimal healthcare practices from local to state levels, and inappropriate attitudes regarding obstetrical care for black women in Georgia as barriers to quality medical care. In addition, Georgia’s insurance policies were found to provide inadequate and inconsistent coverage for maternal healthcare, compounded by the state’s poor funding practices for healthcare programs. Further, Georgia’s maternal mortality review committee was found to be subpar in its ability to and success in conducting meaningful inquiry and intervention into cases of maternal death; although researchers noted that the state does meet the minimum national requirements for competency on this issue.

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Citing the potential nation- and world-wide application of these findings, the study investigators concluded with a call for “researchers, activists, organizations, and others in the reproductive justice movement to advocate for better access to and better quality of care, better insurance access and pricing, greater funding for maternal health, and better data accountability in Georgia and across the United States.”

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Thomas K, Gusman N. When the state fails: maternal mortality and racial disparity in Georgia. Presented at: American Public Health Association 2018 Annual Meeting and Expo; November 10-14, 2018; San Diego, CA. Abstract 3129.0.