The Georgia Department of Public Health has released its investigation of maternal deaths for the years 2018 through 2020, finding a 20% higher rate of deaths from pregnancy than the last time the state issued such a report.
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.
Over the three years studied, Georgia recorded pregnancy-related deaths of 113 women who were either pregnant or had delivered within the past year.
New Georgia moms died from reasons relating to the pregnancy at a rate of 30.2 deaths for every 100,000 live births, according to the report by the Maternal Mortality Review Committee. That’s an increase of 20% over the previous three-year period, which showed 25.1 deaths for every 100,000 live births for the years 2015-2017.
By comparison, the U.S. maternal mortality rate for 2021 was 23.8 in 2020, according to a report by the Centers for Disease Control and Prevention.
Black moms were more than two times as likely as white ones to die a pregnancy-related death. Hispanic women had the lowest maternal mortality rate, according to the report.
Almost all the deaths in the report, 89%, “had at least some chance of being prevented” if only the right steps were taken, the report found.
The major causes of maternal deaths varied: hemorrhage and mental health conditions were most lethal, followed by heart and vascular conditions and blood clots, and high blood pressure associated with pregnancy.
The report listed numerous factors that probably contributed to the pregnancy-related deaths. They ranged from health workers inadequately assessing risk factors or failing to respond, to patients’ chronic disease, obesity or mental health conditions. It found that discrimination “at least probably contributed” to 15% of the pregnancy-related deaths.
But to address each of them, some recommendations came over and over: A better, more connected health care system offering follow-up for patients, and follow-through from them.
Credit: NATRICE MILLER
Credit: NATRICE MILLER
In late January, Dr. Kathleen Toomey, the head of the Georgia Department of Public Health, spoke during budget hearings at the state Capitol and said her agency was pivoting away from an all-hands-on-deck pandemic focus and would work to focus on the maternal mortality issue this year. Toomey was not available Friday to comment on the report. A spokesperson for the agency said the report will be discussed at the Board of Public Health meeting Tuesday.
After the pandemic began in 2020, COVID-19 posed an additional danger for the health of pregnant women. The pandemic also worsened existing gaps in maternity care.
“How do you problem-solve in a state where a crazy number of counties don’t have an ob-gyn family practice doctors? People struggle with transportation to care. There’s a lot of stuff,” said Polly McKinney, advocacy director for Georgia Voices, a nonprofit child policy and advocacy organization. “It takes a long time to right the ship, and then you plunk COVID smack in the middle of it.”
According to estimates by the Georgia Alliance of Community Hospitals, 78 of the 159 counties in Georgia have no obstetrician/gynecologist; 63 have no pediatrician.
The area in Georgia with the state’s worst maternal mortality rate, according to the report, was the 16-county area in southwest Georgia around Columbus. A Columbus ob/gyn, Dr. Thomas Malone, said he understands why.
Malone may be the nearest ob/gyn for patients four counties away. Patients who are in the earliest stages of labor may be told to return later by hospital staff, not realizing they live 60 miles away. Patients in his own county sometimes walk miles to see him for appointments because they have no other transportation. When they arrive, he doesn’t assume they’ll be back for their next visit; he does as much as he can at one time.
He thinks of his patients as people given a bucket of water, but with holes in the bucket.
“So when you have a patient in front of you, you’ve got to really take advantage of trying to fill all those holes,” Malone said. “Immediately.”
Malone says several other doctors in the area have dropped patients for not complying with their appointment instructions, for fear of being sued if the patient’s health deteriorates. He said he takes those patients on so they won’t lose care altogether, and just keeps good records in case they later fail to follow his directions.
Credit: NATRICE MILLER
Credit: NATRICE MILLER
Insurance in Georgia is another barrier. More than half of all births in Georgia, 54%, are paid for by Medicaid. Some are turned away at first for not having insurance, he said, because adults usually can’t get Medicaid in Georgia until they get to an office and file the correct paperwork stating that they’re pregnant. “You know, here is a woman who’s at your office, who’s pregnant, who needs care, but because a machine has said she’s inactive, now you’ve sent her back to the Medicaid office. It’s like a black hole,” he said.
The state recently expanded Medicaid health insurance coverage for poor mothers to a full year after giving birth, up from 6 months, and advocates are hopeful that that will make a difference. In addition, a new home visit pilot program, which was allocated $1.7 million in the state budget for the upcoming fiscal year, is expected to begin this month with five nurses and six community health workers.
Malone also understands the racial disparity. “The hoops that you have to jump through, just to get the access,” he said, disproportionately affect Black patients. In addition, he said, those patients’ complaints may be ignored because health workers don’t realize they’ve got preconceived notions about what pain truly looks like in a Black patient.
Shelmekia Hodo, director of maternal and infant health for the Georgia chapter of the nonprofit March of Dimes, agrees.
“There’s a lot of implicit bias within the health care system where women are kind of judged,” she said. “Just by the color of their skin. Sometimes Black women are just blatantly ignored when it comes to their health care and decisions made for their health care.”
The maternal mortality report does not address associated infant mortality.
Hodo said the staggering number of maternal deaths in Georgia and across the country that are preventable raises serious red flags and indicates a critical need for better access to health care and mental health care resources for pregnant and postpartum women.
Maternal deaths, she said, “can be prevented. So the question is, what are we going to do to prevent these deaths from happening?”
How we got the story
In late January, Dr. Kathleen Toomey, the head of the Georgia Department of Public Health talked to lawmakers about the need to focus on causes of maternal mortality. She indicated the DPH maternal mortality report would be released within about a month. The report was posted on June 30 without any public notice. The AJC learned of the report from a tipster.
