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How We Got Here: Georgia鈥檚 Maternal Health Crisis

In Georgia, the Department of Public Health has determined that 85% of pregnancy-related deaths could be avoided.

By Jess Mador, WABE News

A growing number of women are dying during and after pregnancy in Georgia. The state鈥檚 maternal mortality rates have long ranked among the worst in the United States.

The crisis is not new.

And pregnancy, childbirth and postpartum dangers are higher for some in the state than others.

鈥淲hat is well known is that the disparities by race and ethnicity are persistently high,鈥� said Sarah Blake, an associate professor in the Department of Health Policy and Management at the Emory University Rollins School of Public Health.

Black Georgians are more than twice as likely as white women to experience severe complications or die related to pregnancy, according to the Georgia Department of Public Health.

The top causes of maternal death in Georgia include cardiovascular conditions, hemorrhage, and mental health conditions. In 2021, COVID-19 was the second-leading cause.

And a state board has determined that roughly 85% of maternal 鈥嬧�媎eaths are preventable, a number that echoes the national picture.

鈥淚t comes back to access鈥�

Why have maternal deaths continued escalating in Georgia, even as the state has dedicated millions of dollars to maternal mortality prevention efforts over the last decade?

Barriers to accessing timely pregnancy and postpartum health care in the state are major contributors, according to an analysis by the March of Dimes.  

More than half of Georgia鈥檚 159 counties have little or no access to maternity care.

鈥淚t comes back to access to health care and prenatal care and early care, perinatal care. When it comes to pre-birth post-birth, it comes to better health care for women across Georgia,鈥� said Decatur Democratic state Rep. Mary Margaret Oliver, who serves on the House Public Health Committee. 鈥淧oor women, rural women, African American women do not have the access to medical care that we need with Georgia.鈥�

See .

Oliver is among a coalition of state Democratic lawmakers continuing to push a proposal for full Medicaid expansion in Georgia, which stalled during the last legislative session.

Georgia is one of 10 states that have not fully expanded Medicaid under the Affordable Care Act, which would cover adults with incomes up to 138% of the federal poverty level, or $20,783 for an individual in 2024.

Nonprofit health policy research, polling, and news organization KFF has projected more than 430,000 more uninsured Georgia adults would be insured under Medicaid expansion.

Republican Gov. Brian Kemp has opposed full expansion, opting instead for smaller expansion programs, such as Georgia Pathways to Coverage, which offers adults with incomes up to 100% of the federal poverty line Medicaid coverage in exchange for meeting 80 hours per week of work, education, or volunteering requirements.

So far, Pathways has seen a sluggish rollout, with fewer than 4,000 people enrolling since it launched last summer.

Kemp has said the program needs more time to grow.

He reiterated his opposition to full Medicaid expansion at a recent live event hosted by the Atlanta Journal-Constitution.

鈥淭hat鈥檚 just not good policy,鈥� Kemp said. 鈥淚t doesn鈥檛 matter if you鈥檙e a Republican or a Democrat,鈥� adding that he remains 鈥渋n the 鈥榥o鈥� camp鈥� for full Medicaid expansion.

鈥淚 think we need to make clear that we need to address both social factors and medical factors. Because it鈥檚 not just one or the other.鈥� 鈥� Julie Zaharatos, a public health advisor on the CDC Maternal Mortality Prevention Team

Kemp鈥檚 administration has enacted a number of recent initiatives designed to address Georgia鈥檚 health care gaps and improve maternal health outcomes.

They include extending postpartum Medicaid coverage up to a year after pregnancy 鈥� a policy supported by advocacy groups, including the March of Dimes, for helping to promote equity in maternal and infant health outcomes.

The state Department of Public Health has also launched a home visiting program for women during and after pregnancy that鈥檚 now operating in nearly two dozen rural counties across the state.

The causes of a pregnancy-related death are often complex.

They can include doctors or other health care workers missing critical maternal warning signs. A patient鈥檚 health before pregnancy also plays a big role.

Communication issues and disparities in mistreatment during maternity care could also be a factor, according to a recent U.S. Centers for Disease Control and Prevention survey.

鈥淭here isn鈥檛 just one thing that contributed to that tragedy. It鈥檚 multiple things. And we really need to use that information to act more systemically on solutions. I think we need to make clear that we need to address both social factors and medical factors. Because it鈥檚 not just one or the other,鈥� said Julie Zaharatos, a public health advisor on the CDC Maternal Mortality Prevention Team.

How maternal deaths are tracked in Georgia

Determining which deaths in the state can be counted as pregnancy related is the job of Georgia鈥檚 Maternal Mortality Review Committee.

It鈥檚 a group of experts 鈥� including dozens of maternal health physicians, nurses, epidemiologists, and other specialists 鈥� that investigates every single reported maternal death in Georgia that occurs within a year of pregnancy.

They pore over patient medical records, autopsies, police reports, social service records, and any other available documents, and interview a patient鈥檚 family members.

The goal of the investigations is to piece together exactly what led to a woman鈥檚 death.

鈥淭he committee asks, would she have died if she had not been pregnant? And that guides whether the death was related to pregnancy or not,鈥� said Katie Kopp, who directs maternal health programs at the Georgia Department of Public Health and manages the Maternal Mortality Review Committee.

The committee鈥檚 findings help inform state and federal policies on maternal mortality prevention.

Its last report analyzed data between 2019-2021. The next report is expected to come out later this year.

Kopp acknowledged the lag, pointing to the committee鈥檚 painstaking process. 

鈥淭he great benefit of the Maternal Mortality Review Committee is that we can go so in-depth, but it does take time. We have a really extensive review process,鈥� she said. 鈥淚 do not have concerns that we鈥檙e missing deaths.鈥�

Georgia鈥檚 committee launched more than a decade ago with support from the CDC.

The agency recommends states operate their own Maternal Mortality Review Committees as one key tactic to combat rising maternal mortality rates.

Still, Georgia鈥檚 maternal death rate ranks seventh-highest in the nation, according to a KFF analysis of federal 2018鈥�2021 data.

What happens next

Health advocates and families affected by pregnancy-related death or a loved one鈥檚 severe complications want more action from state and local officials, and the health system to improve the quality of maternal health care and save more lives.

Dr. Natalie Hernandez-Green, an associate obstetrics and gynecology professor, said she is hopeful that Georgia鈥檚 maternal health disparities would improve as awareness grows and there is more collaboration to find solutions at the community level.

鈥淲hat gives me hope is that there are so many people that are working on this, and that we can get to the root causes. We have to work on systems, and we have to be really creative on a policy level on how we make systems work for people,鈥� said Hernandez-Green.

As executive director of the 极品探花 School of Medicine Center for Maternal Health Equity, Hernandez-Green is spearheading a national project to document the stories of Black women and other women of color 鈥� who face the highest risk for maternal mortality and morbidity.

The project is expanding this year to record the accounts of physicians, nurses, and other health care workers, as well as family members in the orbit of a maternal death.

Hernandez-Green said she hopes creating an archive of first-person stories can broaden experts鈥� understanding of the causes of maternal mortality and morbidity.

鈥淭his is a type of methodology that鈥檚 congruent with cultural practices of communities of color. You know, how we鈥檝e dealt with past traumas has been through storytelling,鈥� she said. 鈥淎nd so it was a unique opportunity to not just gather data, but do it in culturally congruent ways, and really centering and amplifying the voices of our communities.鈥�

This story is part of our series . Jess Mador鈥檚 reporting is part of a fellowship with the Association of Health Care Journalists supported by The Commonwealth Fund. It is produced in partnership with the Georgia Health Initiative.