Racial Disparity Begins At Birth: Maternal Mortality is Killing Georgia’s Black Women
By: Teddy Perkins
Tags: Birth, Labor And Delivery, Maternal Mortality, Maternal Health, Atlanta

Photo from Atlanta Black Star

This fall in a graduate writing class, a Black woman said,“The Black body has a harder time with pregnancy and labor. That’s why more Black women and babies are dying.” The Black woman sitting next to her nodded. “It’s a biological thing. Black women are just not as good as white women at giving birth.”

They pointed to a recently released national statistic which indicates that Black women in the United States are close to four times more likely to die in birth than their white counterparts. “Black women,” the girls in my class concluded confidently, “are just not meant to be mothers.”

When faced with these statistics, the women in that writing class drew the commonly held conclusion that the problem is not systemic policy and practice — the problem is individual. The Black body, they had been conditioned to believe, is not as equipped to bear children as the white body.

Their conclusion is not uncommon. Another Black student in the same program later commented, “When doctors don’t believe your pain, you start to doubt it yourself. You start to believe that you are doing something wrong — you think that you are the problem. We’ve been made to think that something is wrong with our bodies, not with the system we are being treated in.”

Globally, the apparent racial discrepancy increases even more. Sierra Leone, a predominately Black country, is the global leader in maternal mortality, reporting over 1,360 maternal fatalities for every 100,000 births. Iceland, a predominantly white country, has the lowest reported maternal mortality rate, with only 3 maternal fatalities reported for every 100,000 births. Mothers in Sierra Leone are 453 times more likely to die in childbirth than mothers in Iceland.

The data does drastically not change when a Black woman increases in social or economic class. Beyoncé and Serena Williams are arguably two of the most prominent black leaders in American culture; both nearly died from postpartum complications following their recent labors. A 2016 study concluded that a black woman who has graduated college is still over three times more likely to die in birth than a white woman who has not finished high school.

But is that the only possible explanation of these horrifying statistics? For leaders in the Black birth community, the answer is a resounding no.

“Maternal mortality in the U.S. has worsened since the 1980s, with the U.S. — and specific states within the U.S. — standing out for their bad records,” says Ali Miller, Co-Director of Yale’s Global Health Justice Program “This state-by-state specificity raises critical flags for state policy: what are the factors that account for the vast difference between states? Why are state-level policy makers allowing these factors to continue to harm women?”

If the problem was the incompetence of the Black body, the numbers would presumably be the same across state lines. The drastic differences seen across communities, however, show that the problem is one of broken policy and systemic racism.

Across the state of Georgia — in both rural and urban areas — the numbers are staggering: Black women are six times more likely to die during birth or the postpartum period than their white counterparts — making it the state with the highest maternal mortality rate in the country. Georgia’s maternal mortality is higher than any developed country and than many developing countries.

Neel Shah, an obstetrician-gynecologist, reported to Harvard Magazine that“the common thread is that when Black women expressed concern about their symptoms, clinicians were more delayed and seemed to believe them less. (This has) forced me to think more deeply about my own approach. There is a very fine line between clinical intuition and unconscious bias.”

Labor and delivery nurse Alyssa Ledwith agrees, stating, “Black women are dying at an astronomical rate, but it is nearly impossible to get doctors or other medical professors to admit that the problem is a racial problem. Even within the medical community, it’s pretty hard to find people willing to confront their own bias and see that something needs to change not in the Black women, but in the medical community that responds to them.”

The problem, the Harvard report goes on to claim, is not one of incompetent bodies. The problem is one of medical access. A 2010 report by Amnesty International marked the racial disparity in the national crisis of maternal mortality — citing Georgia as the most dangerous state in the country for Black mothers to give birth.

For a while, it seemed that helpful policies would be instituted in response to the Amnesty International report. But since the 2010 Amnesty International report, the maternal mortality report in the state has continued to rise.

And though this problem is on the rise, 40% of the state’s labor and delivery centers actually closed in the last 20 years, further limiting access for patients in rural and underserved communities. Over half of Georgia’s 159 counties no longer have an obstetrician. Other hospitals are overrun with patients. Atlanta’s Northside Hospital now boasts the highest annual number of births of any hospital in the country — nearly 30,000 births each calendar year.

It wasn’t until 2018 that legislators began to allocate funds to amend the problem cited in the 2010 report. And it wasn’t until 2019 that the lawmakers realized their original allocation of $100,000 would not even begin to address the statewide scope of the problem.

In September 2019, Georgia legislation approved a $2 million budget to provide educational grants to labor and delivery units in hospitals that work with underserved communities in an attempt to help raise awareness to the known contributing factors of Black maternal mortality. But legislators recognize that many factors are not understood. Part of that money will also be allocated to collect research to help lawmakers make data-driven solutions as they consider the scope and magnitude of this problem.

In the meantime, while lawmakers wait for data to guide their decisions, studies suggest the problem will continue to get worse — both in Georgia and across the country.

In the summer of 2019, U.S. Reps. Alma Adams, D-N.C. and Lauren Underwood, D-Ill. founded the Black Maternal Health Caucus, a coalition of 75 U.S. Representatives seeking to understand what practices and policies contribute to the wide disparity between white and Black maternal mortality rates in the country.

Perhaps the work taking place on the state and nation level will begin to show practical change in the heinous racial disparity Georgia’s maternal mortality statistic indicates. But as of now, very little data is available for doctors and lawmakers to work with. The City of Atlanta, for example, has not released their maternal mortality rates since 2014. New York City, one of the only major metropolises to release their data in the past year, reported that a Black mother is 12 times more likely to die from birth or postpartum complications than a white mother in the same situation.

The primary reporting system employed by the state of Georgia for the past 25 years has been a check-box on death certificate that questions whether or not the deceased person has been pregnant within the last 12 months. A high number of these marks, however, are made on death certificates for men, children under 13, and women over 60, a fact that renders the validity of the produced statistics dubious.

And if false positives are so often reported on this form, how many false negatives have there been that have gone unrecognized?

“We learn it when we are young — that doctors will not listen to us or believe that we are in pain,” says Nia Cook, an activist from the Black community. “Soon, we begin to distrust our own bodies, like we’ve been taught to.”

Black women have been conditioned to believe that they are less competent at giving birth. By passing the blame onto the individual, Georgian (and national) birth practitioners are able to continue working in a system fraught with racial inequity. The lack of available data works to keep people in the dark about the problem and the possible solutions.

What should be done about this problem? Atlanta Black Birth group BelliestoBabies President Corrinna Partera says, “Basically the maternal death rates continue to go up every year in the U.S. as we get further away from listening to mothers in healthcare and push for evidence-based and the science of it all. How about we need both?”