As state health leaders come to grips with the recent news of Georgia’s increasing maternal mortality rate, pilot projects to address the problem and drive those numbers down are multiplying. But not sweeping solutions.
Georgia Department of Public Health staff on Tuesday presented to the agency’s advisory board the latest results of its multi-year investigation into Georgia deaths related to pregnancy, from 2018 through 2020. The rate of 30 deaths per 100,000 live births was 20% higher than the previous such report. The rate of death for Black moms is more than twice as high as for white moms.
It is the first time the state’s Maternal Mortality Report has included a year of the COVID-19 pandemic. Some of the increase shown may also result from better tools that the state is using to identify maternal deaths.
The proliferation of modest initiatives, designed to show progress that might someday be expanded to larger programs, delighted the Board of Public Health.
“It’s going to take us a while to make those changes but you have to start at some point,’ Dr. Mitch Rodriguez, a member of the board and a neonatal specialist, told the staff.
State public health staff are convincing some hospitals to implement best practices with women facing problematic births. For a select group of moms, in 21 of Georgia’s 159 counties, they’re sending health staff on home visits to new moms. Nonprofits have worked with doulas to get more on board with pregnant women who wouldn’t normally be able to afford one.
All such initiatives have been shown to reduce sickness and death by women from pregnancy. One of those DPH pilot programs at some smaller rural hospitals showed a 49% reduction in deaths from hypertension in 2022, according to the staff presentation.
But they are piecemeal. With hospital initiatives DPH has no ability to force hospitals to join in. Twelve of the state’s 70 birthing hospitals have declined to take on any of the three of best practices bundles shown to reduce death from childbirth, saying they don’t have enough staff.
The state Legislature recently expanded Medicaid for poor new moms to a full year after they give birth. But they are reluctant to go beyond that. “Give it time,” to see how the one-year program for moms works, said Sen. Ben Watson, R-Savannah, chairman of the Senate Health and Human Services Committee.
In addition, Watson pointed out, Gov. Brian Kemp has just launched a limited expansion of Medicaid to those who perform certain activities 80 hours a month or more, such as working or volunteering at a registered organization. Taking care of a child full-time wouldn’t count. A spokesman for Kemp, Garrison Douglas, said the governor has taken “concrete steps” toward improving maternal mortality.
Some advocacy groups say that by expanding Medicaid to all poor adults would eliminate hurdles that cause patients to drop in and out.
Precious Andrews is director of special projects and innovations at the nonprofit Healthy Mothers, Healthy Babies. She’s part of an initiative gathering patients to test the impact of having fully comprehensive care, as opposed to piecemeal services. She pointed out that missing comprehensive services can drive up stress and blood pressure, which adds to maternal mortality.
Jemea Dorsey, CEO of the Center for Black Women’s Wellness nonprofit, said she was thrilled Medicaid to a full year for new poor moms. But having it fully expanded would enable them to get care before they develop chronic conditions that increase maternal mortality when they eventually get pregnant.
“I feel like there’s a lot of work that needs to happen so that truly there is this ecosystem” of connected health care before, during, and after pregnancy, Dorsey said. “Because you’re in the hospital for a moment in time to deliver. But there’s a whole life before you get there.”
Dr. Jim Curran, who chairs the DPH board, said in an interview after the meeting that data must drive big decisions.
He noted in the meeting that Medicaid had been expanded to a year after birth for poor women. “One might even ask whether it could be expanded before pregnancy, to deal with some of these issues that are among women that are high risk.” However, he said, for that to happen, there must be good data like the numbers that DPH’s pilot programs are researching now.
“And if you can show even the skeptical people that policy will improve health outcomes,” Curran said, “they will be convinced as they were convinced about the expansion to 12 months.”
MATERNAL MORTALITY
Maternal mortality is measured as a ratio: the number of maternal deaths per 100,000 live births. This is Georgia’s maternal mortality rate over time. Data for maternal mortality is usually poor, but these numbers were determined by intensive investigation into case files by a state committee of experts. Experts caution that if investigative tools improve, the data may rise for that reason.
The majority of pregnancy-related deaths don’t happen in childbirth; they happen in the weeks and months after the patient gives birth.
Georgia’s Maternal Mortality Ratio
2012-2015: 28
2015-2017: 25.1
2018-2020: 30.2
Maternal Mortality in Racial/Ethnic groups
Non-Hispanic white: 23.3
Non-Hispanic Black: 48.6
Source: Georgia Department of Public Health
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