Georgia’s maternal mortality rate is the worst in the United States, and researchers and medical professionals analyzing state health statistics are beginning to understand the data behind the problem and to move toward creating solutions.

Nationally, maternal mortality has trended upward over the past two decades, increasing from 7.2 deaths per 100,000 births in 1987 to a peak of 17.8 in 2009 before falling to 16.7 in 2010, according to data collected by the Centers for Disease Control and Prevention (CDC).

There were 20.9 deaths per 100,000 births in Georgia from 2001 through 2006, reports the National Women’s Law Center.

It is considered a maternal death when a woman dies while pregnant or within 42 days of termination of pregnancy—no matter the pregnancy’s duration or site of implantation—and from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes, according to the World Health Organization.

State lawmakers created the Georgia Maternal Mortality Review Committee in 2014. Committee members have looked into the causes of high rates of maternal mortality throughout the state and the disproportional effects on women of color.

“It’s one thing to just state, we’re the worst in the country,” said Dr. Michael K. Lindsay, a board certified OB-GYN and associate professor of medicine at Emory University School of Medicine, in an interview with Women’s eNews. “It’s another thing to immediately start taking small steps to turn this around.”

Last year the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) launched an initiative to improve the treatment of pregnancy-related complications, and 22 hospitals in Georgia were selected to participate in the program, Georgia Health News reported. Part of the initiative focuses on improving the treatment of hemorrhage, which is a significant cause of death during childbirth.

After examining the circumstances of 85 Georgia women’s deaths in 2013, the committee determined that 25 were “pregnancy related,” caused by factors including hemorrhage, hypertension, cardiac, embolism, and seizure. Sixty of the deaths were “pregnancy associated,” when women died while pregnant or within one year of end of pregnancy, irrespective of cause, according to the committee’s findings.

State Department of Public Health Commissioner Brenda Fitzgerald said that it’s critical for public health officials to understand why women die during childbirth from complications such as hemorrhages, reported the Atlanta Journal-Constitution.

“Is it because there’s not enough blood product on hand, the patent spent too long in the OR, or the recognition of the problem came too late?” Fitzgerald asked.

Women of color, particularly Black women, have much higher rates of maternal mortality.

“In Georgia, in 2010, 2011 and 2012, the rate of maternal mortality for white women was 14 per 100,000 live births,” Lindsay told Women’s eNews. “For African American women, it was 49 per 100,000.”

The racial disparity in maternal mortality in Georgia is similar to the racial disparity nationwide. Across the United States in 2011, there were 12.5 deaths per 100,000 live births for white women, and 42.8 deaths per 100,000 live births for Black women, according to the CDC. There were also 17.3 deaths per 100,000 live births for women of other races during that same time period.

A report by the Center for Reproductive Rights found that Black women, over the past 40 years, have died in childbirth at a rate three to four times their white counterparts.

Dr. William Callaghan, a senior scientist for the maternal and infant health branch of the CDC’s Division of Reproductive Health, told Women’s eNews that racial disparities go beyond maternal care. “It is all clinical care. It is hard not to find a disparity in care,” Callaghan said. “We talk a lot here about trying to understand social determinants of health … and the biggest predictor of health is wealth.”

Poverty and access to health care in Georgia may be a significant factor in predicting medical outcomes, including maternal mortality. More than one in four women between the ages of 18 and 44 in the state are uninsured. During 2010, there were 56,009 births that were paid for by Medicaid, representing 41.9 percent of all births in Georgia, according to data from the Kaiser Family Foundation.

Georgia is one of just 18 states that have not expanded Medicaid under the Affordable Care Act (ACA). Republican lawmakers in the state have blocked efforts to expand the program despite public opinion polling that shows the majority of the state’s residents support Medicaid expansion.