The high Georgia ranking that’s getting attention: maternal mortalityCapitol Views by Kelly Jordan
By Maggie Lee
State boosters are quick to print banners and stickers proclaiming Georgia is No. 1 state for doing business, based on rankings from two trade magazines. But it’s critics who are making posters claiming a No. 1 ranking for maternal mortality that comes, though in a roundabout way, from the U.S. Centers for Disease Control.
The latest data say black women are about three times more likely to be the victims of these largely preventable deaths.
Looking at 2012 through 2014, Georgia researchers have found about 26 pregnancy-related deaths per 100,000 live births. Or, 101 deaths. About 60 percent of those deaths were preventable. That’s the latest data that’s been minutely classified.
“It’s a very rigorous process and we go through every case and go through a lot of details and it’s very time-consuming,” said Dr. Michael Lindsay, chair of the Georgia Maternal Mortality Review Committee, which is in charge of reviewing those deaths.
“Having said that, I would say that Georgia has a high maternal mortality ratio,” Lindsay told a state House hearing last week. “Whether it’s the worst in the country, I’m not sure. But it’s bad.”
It’s hard for him or anyone to give ranks because not all states review their data as thoroughly as Georgia — and there are tons of complications. How to classify if death from a drug overdose two months after a pregnancy, for example, was related to the pregnancy?
(The number 46.2 maternal deaths per 100,000 live births has gone around — and it is what people are talking about when they say that Georgia is the worst. It came from a report from the United Health Foundation that drew on 2011-2015 data from U.S. Centers for Disease Control mortality files. This year, that same foundation has published a table for 2013-2017 data that puts Georgia’s number at 66.3, better only than Louisiana. The CDC mortality files are more of a first look first through each state’s data, without that review that Georgia gives.)
But whether Georgia is the worst or fifth from the bottom or if it has inched up or down is a bit academic: there’s no question that Georgia lags. The CDC itself puts the national maternal mortality rate for 2011 through 2015 at 17.2 deaths per 100,000 live births — still lower than Georgia’s most flattering estimate.
Black non-Hispanic women were 3.3 times as likely to die from a pregnancy-related complication as white non-Hispanic women, according to 2011-2015 statistics from the CDC and from the Georgia report for 2012 through 2014.
The fact that Georgia lags is something that some are trying to keep front and center. The topic is important enough that perhaps 100 people attended Thursday’s first hearing of the Georgia state House Study Committee on Maternal Mortality, the one where Dr. Lindsay spoke.
Co-chaired by state Rep. Sharon Cooper, R-Marietta, a nurse, and state Rep. Mark Newton, R-Augusta, a doctor, the hearing was heavy on technical questions. Like how exactly Georgia reviewers classify complicated deaths. Or what the national gold standards are in national perinatal care. And where and how the Georgia Perinatal Quality Collaborative helps hospitals implement what are called “bundles” of best practices around various things like hemorrhage prevention.
None of those are controversial. State data collection is good and getting better. About 87 percent of births in Georgia happen at a hospital where one or more of these “bundles” of national best practices are happening.
But one thing that rankled some in the audience were some questions from the co-chairs about whether Georgia is actually “the worst” or if statistics simply make it look bad.
Nudged by a question from one of her colleagues asking her to confirm that this is crisis for women of color, Cooper said: “In no way am I trying to deny that or not emphasize that. It is a major problem that we have. I just believe we need to work from good data and to understand it.”
But about a dozen folks joined a state Capitol press conference on Friday to talk about what they thought was left out of the hearing. Many were health care providers like midwives, nurses and doulas.
“We will not stop until we make sure that this maternal mortality crisis is no longer a crisis, but that we are thriving in this state,” said Monica Simpson, executive director of Sister Song, the national women of color reproductive justice collective.
“And that we are no longer against a par of any other state but that we are actually thriving,” Simpson said.
On the one hand, there are things meant to improve maternal mortality like the $2 million in the state’s budget for the year that ended in June that gave grants to 20 rural hospitals to implement more of those “bundles” of best practices.
On the other hand there are things like the threat to cut $500,000 in state money that Morehouse School of Medicine wants to use to start what it’s calling the Center for Excellence on Maternal Mortality. (Though the Georgia Recorder has reported that Morehouse will continue the work.)
Dr. Melissa Kottke is the co-chair of the Georgia Perinatal Quality Collaborative, the organization working with stakeholders like hospitals to get better perinatal outcomes and health equity for every Georgia mother and baby. She spoke to the hearing on Thursday said there’s a need still to look out for people who were recently pregnant; and that to move the needle on maternal mortality, it’s necessary to move the needle on maternal health.
“I think that we need to find ways to improve health, to pay attention to blood pressure and healthy weight and risks for cardiovascular diseases,” Kottke said. “We need to ensure access to family planning, [to] make sure that … they’re going through this because they want to, and they have access to that. I think we want to expand into additional settings and include additional stakeholders.”
Cooper said the committee plans to hold a total of five meetings and will wrap up, probably with some recommendations to the next Legislature, in December.
Georgia Maternal Mortality 2014 Case Review; published March, 2019.