These lessons made my reporting on the maternal mortality crisis that much stronger
Photo by Benji Aird via Unsplash
The severity of the maternal mortality crisis in the United States has been increasing, data shows. Black people are three times as likely to die due to childbirth complications, and awareness of the startling death and complication rates has been growing in recent years. Lawmakers have been campaigning on policy change. Public health organizations have pivoted to focus on maternal and infant health.
Yet the striking racial disparities persist.
Starting last year, I set out to understand why. What untold stories are left to be revealed? What might they tell us about why these disparities persist? To answer these questions, I found myself in Georgia, one of the most dangerous states in which to give birth.
What I found in my year-long investigation, “Dangerous Deliveries,” was 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 by health care systems, while more labor and delivery units are opening in majority white rural counties. It’s leaving Black patients at risk.
Here’s what I learned from the reporting process:
Knowing little at the beginning can be an asset.
When I began trying to uncover why Georgia had some of the worst maternal health outcomes in the country, it became clear early on that I knew little about that state’s history, infrastructure and policy around health care and hospital access. But that allowed me to ask questions in new ways. I wanted to know if Black communities have less access to care and if they were being disinvested over time. The data on where hospitals had opened and closed shows they were. Next, it was time to uncover who was responsible. What was the system perpetuating the disparity? What were the policies around opening new care facilities? And, what were the requirements around closing care? Some digging revealed that in Georgia, new proposed hospitals, labor and delivery units, and birth centers must complete an intensive application process. The process allows existing hospitals to file objections, giving the politically powerful industry tremendous influence in blocking potential competitors.
It's far easier to shutter a medical facility: A provider can quickly shut down with a 30-day notice to the state, no government approval needed. Black counties statewide are suffering the worst consequences of resulting lack of access to care.
Because I came in with little understanding of Georgia’s regulatory system, the finding was surprising to me. I was able to ask questions in new ways and think through the consequences from a different perspective. I’ll lean into this more in future reporting. What don’t I know? What do I assume is normal that might be perpetuating harm?
Assume you’re wrong.
I found that throughout my entire reporting process I was trying to prove myself wrong in order to bulletproof the journalism. What was I missing? Did I analyze my data correctly? Could I redo my data analysis three, four, or five more times and get the same results? Where were the records that confirmed what I was hearing? I’d ask the same questions to different people, gathering different perspectives on the policy I was digging into. I began to feel more confident that I had found a story worth telling, and that I could be authoritative in my writing.
Those with firsthand experience are the true experts.
I made sure to ask the dozens of pregnant people and their families, academic researchers, epidemiologists, maternal health advocates, doulas, midwives, historians, and lawyers I interviewed the same question: Who is accountable for the racial disparities we see in maternal health outcomes? Where does accountability lie? Because childbirth is so complex and influenced by so many factors, the answer is complicated. But I found those with the lived experience of childbirth complications and near-death experiences related to pregnancy were able to quickly pinpoint areas of their care and experience that raised red flags. What did they wish they had that they didn’t? Who did they feel was responsible for the quality of care or access they received? Sometimes, as journalists, we rush to the data or the academic experts for answers. It was important to me that I centered the voices of those most affected, not just to share their stories but to identify cracks in the system.
About a year passed from when the series idea emerged to its publication. By the time the story hit the web, I had found mountains of research and compiled countless pages of reporting notes. I had sources’ contact information to keep track of and data sets to keep clean and remember how I analyzed them. As it piled on, I was glad that I had started the process with an organization system. Folders for each category. Reporting notes here. A big source spreadsheet. Data sets there.
It made fact-checking much easier. When I was five months in and looking for something I’d dug up within the first few weeks, I knew exactly where to find it.
Honor your feelings and emotions.
Months of reporting on trauma takes its toll on you. For hours, I talked to families about the trauma they’ve been carrying for years after nearly dying in childbirth. Each interview left me drained. Depressed, even. As one tough interview bled into dozens, I had to learn to pace myself. I’d go for walks or call a friend afterward. Sometimes, I’d lay down. Eventually, I let myself cry.
The more I talked to these families, the more I realized that, for them, sharing their stories was comforting. It was the first time some of them had paused to process their feelings. For most, it was the first time someone outside of their family was truly listening.
Even so, I’m still learning how to navigate the emotional toll taken by reporting on such heavy topics.