Emory Healthcare Professionals Spearhead Efforts to Tackle Racial Disparities and Improve Maternal Health Outcomes

By Manju Karthikeyan

Georgia’s maternal mortality rate is nearly double the national average, illustrating a severe health crisis. In comparison to other states, Georgia has the worst maternal mortality ratio in the country. Regardless of where they live, mothers should never have to die of easily preventable medical complications during pregnancy or labor. In a country as developed as the United States, maternal mortality and morbidity should not even be a problem to begin with. 

These terms, maternal mortality, and maternal morbidity, are often grouped together. Nell Mermin-Bunnell, a 4th-year medical student at the Emory School of Medicine, distinguishes the two this way: “Maternal morbidity is medical complications that result of pregnancy — something like preeclampsia or gestational diabetes. And maternal mortality is pregnancy-induced or pregnancy-associated deaths up to 1-year postpartum.”

But while maternal mortality and morbidity may be a result of biological consequences, they are undeniably associated with sociopolitical determinants as well. 

Dr. Kathleen Adams, a health economist and professor of health policy and management at Emory University’s Rollins School of Public Health, says: “Georgia has not yet expanded Medicaid, [and] has a high percentage minority population, with very poor [maternal] outcomes.”

Investigators have started studying pregnancy complications, and death during pregnancy especially affects women who are low-income or are part of minority groups. In particular, Black women in Georgia are 3.3 times more likely to die from pregnancy-related complications than white women. “Black women have worse health outcomes than white women in Georgia, in general,” Mermin-Bunnell says. She suggests that this is partially due to the sociodemographic factors Dr. Dunlop emphasized, such as Georgia’s lack of Medicaid, but also rural vs. urban distributions and differences in income across races. 

“There are horrific historical injustices that the medical care system has invoked on Black women,” Mermin-Bunnell adds. “Thinking about how there’s this terrible legacy of mistreatment and lack of access to adequate care, we as a medical community have created a situation where a large chunk of our patient population has no reason to trust and no reason to believe that we are going to help them.” As citizens, patients, and even researchers, it is crucial to keep these racial biases plaguing American healthcare in mind.

Initiatives by Emory professionals

Emory has supported a variety of partnerships and research projects to combat maternal mortality and morbidity in Georgia. One of which was spearheaded by Dr. Adams and her colleague Dr. Anne Dunlop, a practicing OB/GYN and associate research professor at Emory School of Medicine. In particular, they examined Black-white racial disparities in severe maternal morbidity from 2016 to 2020, in collaboration with the NIH and other faculty within the Rollins School of Public Health.

Dr. Adams states: “There were 1.8 times the rate of severe maternal morbidity per 100 discharges among non-Hispanic Black (3.15) than among white (1.73) individuals.” These findings further support the prevalence of racial disparities in maternal healthcare. 

Dr. Adams also emphasized the importance of considering which hospital the patient went to and within-hospital processes. She states that “Within-hospital care processes were [the] most important in explaining the [maternal-morbidity] gap than any other set of factors.” These institutional shortcomings may go hand in hand with social and racial factors. Minorities in Georgia are more likely to experience financial disparities, as well as live in rural areas where hospitals may not have adequate medical or ambulance services. Thus, given that both a patient’s race and the type of hospital influence maternal morbidity outcomes, it is clear that both social and institutional biases are at play.

The Georgia Health Professionals for Reproductive Justice (GRJ), an organization co-founded by Nell Mermin-Bunnell, works to combat these institution-based health detriments through reproductive justice advocacy work, leveraging the position healthcare professionals and trainees have within these hospital settings to invoke meaningful change grounded in evidence-based medicine. 

Mermin-Bunnell emphasizes the importance of uplifting local groups and organizations through GRJ’s advocacy work, whether that be through publishing newsletters or speaking at the State Capitol for Georgia Legislative Action Day. Mermin-Bunnell also mentions the GRJ’s role in contraception access. “Advocacy from an education standpoint in public school systems like Georgia, where sexual education here is like abstinence-based education, brings all of these things together”, she adds, bringing more awareness on maternal mortality to Georgia’s youth.

Combating maternal mortality and morbidity across the nation 

But states across the country are taking steps backward when it comes to reproductive justice. “The entire conceptualization of what it means to be a doctor, and what it means to provide medical care is now threatened,” Mermin-Bunnell says. The loss of Roe v. Wade, new abortion bans in states, and even restrictions on IVF treatments further jeopardize what it means to be a healthcare professional and patient. This makes GRJ’s advocacy and legislative efforts more important than ever, for the organization urges lawmakers to re-assess H.B. 481, which restricts abortion access after 6-weeks. 

Dr. Adams adds that “If you allow it to vary by state, it will”. For example, 41 states have adopted the Medicaid expansion– with Georgia being one of nine that has not. If Georgia does not consider Medicaid expansion moving forward, more citizens’ health will be put at risk. Outside of Medicaid, Mermin-Bunnell says, “More than half of the counties in Georgia don’t have a single practicing OB/GYN.” Thus, making sure that the health policies enforced are equitable to all, providing early and evidence-based interventions, and addressing systemic racism within current systemic structures to lift the most affected patient populations and counties, must also be conveyed.

Mermin-Bunnell adds, “The system is structured to make it difficult for people to be able to access the medical care that they need to not develop complications from pregnancy, and to not end up in life-threatening situations.” Abortion, IVF, and gender-affirming care bans only make this situation worse — making it legally impossible for Americans to have the autonomy to improve their health outcomes, reach an emotional or medical state of well-being, and develop meaningful relationships with their providers.

Mermin-Bunnell also states: “The leading cause of maternal mortality in the US is mental illness — which includes overdose suicide, substance use, and even postpartum psychosis, which can happen in people who have no history of any mental illness.” Having healthcare professionals, including OB/GYNs, more well-versed on the mental and psychological consequences before, during, and one year after pregnancy, and reducing stigmas associated with disorders such as postpartum depression, can help improve maternal mortality and morbidity outcomes.

But that will only occur if government officials are willing to amend harmful legislative endeavors; if medical professionals can address racial biases within their practice; if hospitals are willing to accommodate patients from rural areas; and if the general public are ready to address stigmas surrounding maternal mortality.

To learn more about Georgia Health Professionals for Reproductive Justice, visit their website: https://www.gahealthprofessionals.com/.