The Story Behind ‘Dangerous Deliveries’

Capital B’s “Dangerous Deliveries” investigation examines the uneven distribution of maternal care deserts and poor birth outcomes in Georgia, one of the most dangerous states for childbirth.  Read the full project here.

Awareness of the United States’ maternal health care crisis has been growing. Lawmakers have been campaigning on bold policy change aimed at reducing the number of deaths. Public health organizations have pivoted to focus on addressing the crisis, which has left Black people three times more likely to die in childbirth.

Yet, the disparities persist. 

As Capital B’s national health reporter, I wanted to understand why. What untold stories are left to be revealed? What might they tell us about why these disparities are so persistent?

In this investigation, I hoped to identify and hold accountable the institutions that have played a role in maintaining the status quo — one that threatens the lives of Black moms and babies disproportionately. We zeroed in on Georgia, whose maternal and child health outcomes are among the worst in the nation. The state has a large Black population and is home to Capital B’s first local newsroom, in Atlanta.

It also has a large rural community, and it is well-documented that maternity care deserts — or areas with no birth centers, obstetric providers, or hospitals providing labor and delivery services — are linked to poor birth outcomes. Are Black folks in Georgia more likely to live in maternity care deserts? Are those Georgia care deserts related to worse outcomes?

The results of Capital B’s analysis show that not only are Black counties more likely to be maternity care deserts, but counties with a high Black population also experience worse outcomes. Records obtained demonstrate that over time, Black rural counties are being disinvested in, while more labor and delivery units are opening in majority white rural counties. 

Fighting for the data

Georgia’s lack of transparency in releasing maternal health data has made it difficult for researchers, policymakers, advocates, and journalists to get a handle on how severe the crisis has been and what communities need the most assistance.

That means parts of the state’s maternal care crisis are concealed, making it hard to quantify exactly what the toll of the current health care system is on Black families and women who look like me. What data could I collect that might tell the story of how race, access to care, and outcomes intersect? And how could we shed light on not only deaths, which experts say is a relatively rare event, but also the labor and delivery complications that result in near-death experiences and inflict lifelong trauma? 

What might the data tell us about how maternal health systems and care networks are working against Black people and their babies?

To start the analysis with a sense of place, I requested the data underlying the March of Dimes’ 2022 report on maternity care deserts to determine which Georgia counties had limited access to maternal health care. And, a map obtained from the Georgia Obstetrical and Gynecological Society, a professional organization of physicians, outlined a list of opened and closed labor and delivery units across the state since 1994.

Then, I submitted multiple open records requests to the state of Georgia for key indicators, including number of obstetricians by county, number of deaths by year, maternal and child health outcomes by county, and a comprehensive list of certificate of need application submissions.

A part of those requests was for the rate of severe maternal morbidity, or major complications in childbirth, by county. The Department of Public Health never completed the request, citing HIPAA, a federal law that protects individuals’ medical records. The agency then said the severe maternal morbidity data is collected by the Georgia Hospital Association, an organization made up of hospital administrators aimed at advocating for health care systems, before it is submitted to the state’s Department of Community Health. That agency is still processing the request, sent in October.

Requests for the same hospital discharge dataset through the federal government are subject to the association’s approval, a process unique to Georgia. In other words, without the approval of Georgia’s hospital administrators, who hold tremendous political power, the data is not released.

After multiple attempts to get the dataset through the state failed, I spoke with national maternal care experts who guided me to a federal HCUP, or Healthcare Cost and Utilization Project, dataset that holds essential statistics like preterm birth and low birth weight statistics. Researchers often use those pieces of data as indicators of the state of maternal and child health overall. 

Each dataset that I was able to access was combined with U.S. Census Bureau demographic data to analyze trends by race using pivot tables. Black counties are defined as those with a Black population greater than 32%, which is Black folks’ overall representation in Georgia. White counties are those with a white population above 60%, their overall representation in the state.

I also requested the number of pregnancy-related deaths among Black women for each year since 2015. The Georgia Department of Public Health never completed my request, saying it would “release the data holistically — not in bits and pieces — so there is context” in an upcoming maternal mortality report, according to Nancy Nydam, the spokesperson.

Key Takeaways

In Georgia: 

• More than a quarter of Black Georgians live in a county with little to no access to care. 
• Nearly half of Black counties are maternity care deserts, compared with less than a third of majority white counties.
• Since 1994, more labor and delivery units have closed in Black counties compared with white counties.
• Twice the number of labor and delivery units opened in white rural areas versus Black areas over the same time period.
• The rate of preterm births and low birth weight babies are worse in the Black counties.
• Black people experience labor and delivery complications, such as hemorrhage, infection, and cardiac issues, at twice the rate of white people.

I interviewed dozens of pregnant people and their families, academic researchers, epidemiologists, maternal health advocates, doulas, midwives, historians, and lawyers, and reviewed hundreds of pages of research and public records. This project was reported as a part of the USC Annenberg Center for Health Journalism’s 2022 National Fellowship. It was supported by the Dennis A. Hunt Fund for Health Journalism.