A legislative committee studying Georgia’s troubling record of maternal deaths has found the state could save lives by extending Medicaid coverage for poor mothers to one year following birth.
In recommendations approved this week, it advised the Legislature to do just that. But the timing could hardly be worse, as the Legislature faces budget cuts.
“We are in a tight budget,” said state Rep. Sharon Cooper, R-Marietta, a co-chairwoman of the committee. However, she said, “If they find a program that’s working, maybe the money needs to be sought. … If the estimate was $17 million, then they might be able to fund it.”
Estimates vary widely, up to $70 million in state money, and she said state officials told her they would figure out the discrepancy to understand the real cost.
House Appropriations Chairman Terry England is interested. “I think we certainly have to take a look at it,” he said.
The House committee to study maternal mortality in Georgia convened last year following reports nationwide and in The Atlanta Journal-Constitution on the high rates of deaths from pregnancy. The U.S. has the worst rates of maternal death among industrialized nations, and Georgia's are among the worst in the U.S. The committee found that about 26 Georgia women die from pregnancy for each 100,000 live births, compared with 17 nationwide.
That's compared with rates of about 3 per 100,000 live births in Finland and the United Arab Emirates, according to the World Health Organization.
There are a lot of reasons why Georgia’s rates are so high, starting with unequal access to good health care.
Poor Georgia women are generally not eligible for Medicaid coverage. They receive it if they become pregnant, but they lose it again 60 days after birth in most cases.
Rural moms were more likely to die than metro ones. The risk for African-American women is three times higher than for others.
There’s also widespread lack of information about maternal mortality.
Many pregnant women and caregivers don’t know, for example, that the majority of maternal deaths happen in the year following birth, not during birth. Or that things such as changes in vision can be a warning sign for heart and blood problems that so often kill pregnant women or new moms.
The committee’s most powerful recommendations are aimed at spreading good health care to underserved populations. That includes the idea of extending Medicaid coverage to new moms, and getting county health departments to offer more prenatal and postpartum health care.
Both those suggestions could take funding, though. Each county decides what services its own health department offers, and they don’t offer the full spectrum of care but focus on prevention, such as vaccinations. Getting them to all provide maternal care would be a heavy lift.
The committee’s approach was to ask the state Department of Public Health to develop a model for the counties to use in providing the care.
Among the 19 recommendations were many that are long-term fixes. They include working on Georgia’s obesity epidemic, since obesity increases the chance of health problems that threaten maternal mortality, such as high blood pressure. Improved access to psychiatrists and cardiologists through telehealth was also recommended.
Cooper stressed the efforts going on across the state in pilot programs that show success, including identifying high-risk moms and assigning them caseworkers, providing focused information to hospitals, and giving updated education to health care workers. But to have statewide effect, they’d have to be implemented and funded statewide.
The state also has a panel of experts that examines cases to sort out which are definitely related to pregnancy. The panel is several years behind on its work but is catching up.
The committee also urged the state to pass legislation that could lead to better data, since no one really knows how many women die from pregnancy. It would include a postmortem examination of all pregnant women or new moms who die.
The group Healthy Mothers Healthy Babies endorsed the legislative committee’s work.
“This list of recommendations from the Committee further supports the critical need to keep that funding in place given the current budget climate and Governor’s calls for cuts,” the group said in a statement.
Cooper is ready to deal.
“Just being realistic, would I like to have a year?” she asked. “Certainly. I love bananas, and if you offer me a banana, I’m going to ask for the whole banana. But you know what, if you give me half to go with my cereal in the morning, I’m going to be OK.”
GEORGIA MATERNAL MORTALITY
The majority of maternal deaths happen not during childbirth, but in the year afterward. Georgia tasked a committee of experts with delving into the data on maternal deaths. No one really knows how many women die of pregnancy, but the state is getting better at it. For example, if a woman strokes out while driving and crashes, no one may know to investigate the crash death as a maternal death. There is also the role of postpartum depression.
This was the breakdown of 101 cases from 2012 to 2014 that the committee determined were related to the pregnancy.
When:
34 – during pregnancy, birth or within a day of birth
40 – within the first 42 days after birth
27 – between six months and a year after birth
Top known causes:
cardiomyopathy
hemorrhage
cardiovascular and coronary conditions
embolism
pre-eclampsia and eclampsia
amniotic fluid embolism
Source: Georgia House Study Committee on Maternal Mortality Final Report
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