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GEORGIA, ONE OF THE LEAST SAFE STATES FOR WOMEN  
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Samantha Hogan
February 22, 2024
Governing
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_ Women across the state are dying from pregnancy-related causes at
the highest rate that has been documented by the state in the past
decade. Between 35 and 40 mothers die every year. _

Representatives gather to speak about maternal mortality at the House
of Representatives in the Capitol in Atlanta on Tuesday, Jan. 9, 2024.
, Arvin Temkar/The Atlanta Journal-Constitution/TNS

 

On August 16, 2022, Amanda Jones logged on to Facebook to share the
good news. She posted pictures of a positive pregnancy test, a grainy
black-and-white ultrasound image and test results confirming that she
was expecting a second girl.

Jones had been a stay-at-home mother in Macon, Ga., since she and her
partner, Donald Tullius, welcomed their first child, Katie, two years
earlier. That December, Jones gave birth to Miranda during a planned
cesarean section.

“She was doing great. Fine. She had no real problem, other than her
blood pressure was a little high,” Tullius said.

In the next several months, Jones’ legs began to swell and hurt. The
couple looked online for the side effects of the blood pressure
medication she was prescribed after the birth and scheduled an
appointment with Jones’ doctor. Then, early one morning in June
2023, Jones went into the kitchen to prepare a bottle of formula for
the baby.

“She dropped,” said Tullius, who called 911. “She passed out.”

Later that morning, Jones was pronounced dead. Doctors determined she
had a blood clot in her right lung.

Jones and other women who die during pregnancy or within a year after
giving birth are closely studied by state health officials.
Policymakers have worked in earnest for a decade to improve pregnancy
outcomes, yet Georgia remains one of the least safe states in the
country for women to give birth.

Georgia women are dying from pregnancy-related causes at the highest
rate that has been documented by the state in the past decade. Each
year, between 35 and 40 mothers die, recent state health data show.

“These deaths are very complex. It’s not that these are people who
just died during childbirth because they received bad care. It’s
often that there are really complex social determinants of health
contributing to the death,” said Katie Kopp, director of maternal
programs for the Department of Public Health.

Under the Gold Dome this session, the House has passed a bill to study
maternal and infant health services and lawmakers may propose
expanding Medicaid. If passed, the expansion could be the state’s
most effective tool in helping women access health care prior to
becoming pregnant, which could lower maternal mortality in the state,
advocates said.

For the families who have lost mothers, life is never the same.

Tullius watched with his 3-year-old and 6-month-old daughters as the
ambulance took Jones to the hospital. In less than two hours, his
whole world changed when doctors were unable to revive the mother of
his children. Tullius said it never crossed his mind that he would be
a single parent or face raising their girls alone.

In Katie’s bedroom, there is a picture of Jones, and the 3-year-old
still has memories of her mom.

“Every now and then, because mommy went to the doctor, she says,
‘When mommy gets better, can I see her?’ And I have to explain
again that mama can’t come back,” Tullius said.

For Tullius, the realization on his daughter’s face each time he
explains Jones’ death has been the hardest part.

“It hurts me to break her little heart,” Tullius said.

A Decade of Research

Maternal mortality has been a perplexing problem in the United States
for decades.

In 2010, the human rights group, Amnesty International, identified
maternal mortality as a national health care crisis. The group issued
a report [[link removed]]
that said women in the U.S. had a greater lifetime risk of dying from
pregnancy-related complications than 40 other nations. More than two
women were dying each day in America from pregnancy-related causes,
the report said.

The group ranked Georgia last among the states — 50th in country —
for its high maternal mortality rate. Only the District of Columbia
ranked worse.

Four years after the report, the legislation that created Georgia’s
Maternal Mortality Review Committee noted that the deaths of mothers
were a “serious public health concern” with “tremendous family
and societal impact.”

The committee’s research paints a stark picture of who these missing
mothers are. The vast majority of those lost during and after
pregnancy have a high school education or less. Many are poor. They
are disproportionately Black. And most of the deaths were preventable,
the mortality review committee found.

Georgia’s climbing maternal death rate is happening amid the flight
of obstetricians from the state, with some counties having no
obstetrical services.

Despite the urgency coming from the General Assembly to identify the
root causes of maternal mortality and to provide updates “on a
routine basis” to lawmakers and later annual reports to the
governor’s Office of Health Strategy and Coordination, the committee
has been slow to release information. Four reports were published in
nine years, and the data lagged years behind. That made it challenging
to assess the effectiveness of actions the General Assembly took to
address maternal health.

Georgia lawmakers budgeted millions during that time to expand
Medicaid coverage for women up to 12 months after the birth of a child
and piloted multiple initiatives, including home visits in rural
counties, echocardiograms for pregnant women, and remote maternal and
fetal heart monitoring programs for high-risk mothers.

The lag in data is unavoidable, said Nancy Nydam, spokeswoman with the
Department of Public Health. She said the committee aims to publish
reports more frequently. The next maternal mortality report covering
2019 to 2021 is expected to be published in the spring.

A one-page description [[link removed]] of
the upcoming report’s findings shows that the state’s maternal
mortality rate has increased again. Kopp, the state’s maternal
programs director, attributed Georgia’s rising maternal mortality
rate to improved data collection and not more women dying. Still, she
expects there will need to be more long-term investment from the state
to address the problem.

“There is not one intervention that we can do that is going to lower
the number tomorrow, unfortunately,” Kopp said.

A positive outcome of the review committee’s work is that it has
started conversations about maternal health that weren’t possible a
decade ago, said Ky Lindberg, the leader of the Healthy Mothers,
Healthy Babies Coalition of Georgia and a member of the review
committee.

“One could argue that it may not be enough, but it’s a start,”
Lindberg said. “… We couldn’t have this conversation 10 years
ago, and we are now. And we have both sides of the aisle’s attention
on it, so we need to really honor that.”

Dr. Anthony Kondracki with the Mercer University School of Medicine in
Savannah, has independently analyzed some of the state’s data. He
said maternal deaths are going up and doubted that the increase was
only due to better data collection.

“The only thing I know for sure is that maternal mortality is a huge
issue in this state,” Kondracki said.

Barriers to Accessing Health Care

About half of the pregnant women in Georgia are on Medicaid at the
time they give birth, according to a Kaiser Family Foundation
estimate.

For many women, pregnancy can be the first time they qualify for state
assistance with health insurance. That includes mothers like Jones,
who despite working, did not have health insurance. She was obese and
did not have a primary care physician before she became pregnant and
received Medicaid.

“Part of the challenge, too, is when these women become pregnant and
become Medicaid eligible, they were not healthy when they got
pregnant,” said Anna Adams with the Georgia Hospital Association,
which lobbies for medical facilities across Georgia.

The majority — 60 percent — of pregnancy-related deaths occurred
to women receiving Medicaid at the time of delivery, the state’s
latest mortality review committee report said.

Rep. Teddy Reese, a Democrat from Columbus, has witnessed the side
effects of inaccessible health care in ways many in the General
Assembly have not. His constituents and surrounding communities in
Georgia’s West Central Health District
[[link removed]] are burdened with the
state’s highest maternal mortality rate.

That’s one of the reasons he is pushing for full Medicaid expansion.
Republicans may propose a bill to fully expand Medicaid this session.
This is a notable shift, he said, because expansion used to be
unmentionable in the Capitol. He could not give his blanket support
without first seeing the bill and time to debate a bill is running
short, he said.

Without it, many women will not have affordable access to health care,
he said.

“You can’t prevent maternal mortality if the mother is not seeing
a doctor, and a mother can’t go to the doctor if she doesn’t have
adequate access,” to health insurance, Reese said.

Maternal mortality is increasing across the United States, but one
recent study 
[[link removed](20)30005-0/fulltext]found
that it increased much less in states that had expanded Medicaid than
those that had not fully expanded the program.

Georgia partially expanded Medicaid in July 2023 to provide health
insurance to some low-income residents who did not qualify for
traditional Medicaid. The program has not helped as many people as
originally estimated.

Rep. Sharon Cooper, R-Marietta, has not seen a draft of a bill to
further expand Medicaid, and she is starting to doubt one will
submitted this session.

“We have Medicaid expansion,” said Cooper, who has a master’s
degree in nursing and chairs the House Public Health Committee. “If
the governor wants to entertain a different kind of program, I
certainly would consider it.”

Shifting Focus to Moms Who Survive

As the state continues to work on reducing maternal mortality,
advocates and lawmakers say the focus should not solely be on the
women who die, but also those who came close to death and survived.

One of those pushing this idea is Rep. Lauren Daniel, R-Locust Grove,
who often does her legislative work while carrying her youngest child,
Zane, in a sling across her chest.

Daniel, 29, had her own near-death experience when she was diagnosed
with preeclampsia – a life-threatening form of high blood pressure
that if uncontrolled can cause seizures – at age 17 while pregnant
with her first child. Then, last year, she hemorrhaged and lost a
large amount of blood after an emergency c-section to deliver Zane.

Her hospital room at Piedmont Henry Hospital, where she gave birth,
had a specialized medical cart, and the staff participates in a
nationally recognized program to rapidly address this kind of
life-threatening bleeding. The Maternal Mortality Review Committee
recommends that all hospitals implement this program.

“It literally saved my life,” Daniel said.

Daniel submitted HB 1037 [[link removed]]
this year, which would create a Commission on Maternal and Infant
Health to give the public and lawmakers more real-time information
about health services for women and babies. Daniel said her aim is for
the committee to quantify how many women have been saved, and to
reduce fears some women have about giving birth in Georgia.

Her bill was passed unanimously by the House of Representatives on
Feb. 13.

“One of the things that we should always seek for is for women to
have good experiences in terms of how they give birth and the way that
they feel in that process, because that does carry over afterward,”
Daniel said.

Making birth safer for mothers and babies in Georgia is a shared goal,
particularly among Black women who historically face worse pregnancy
outcomes.

They are twice as likely to die from pregnancy-related causes than
white women in Georgia, while the national rate is even worse, data
show.

“Black maternal mortality is a public health crisis that demands a
public outcry and action. Each death represents a tragic loss to a
family and a community,” said Wanda Barfield, director of the
division of reproductive health with the U.S. Centers for Disease
Control and Prevention, speaking at a press briefing this month.

Dr. Maya Eady McCarthy, a pediatrician in Atlanta, feared she would
be another statistic while pregnant with her daughter in 2020.

From the beginning, it was not a simple pregnancy. McCarthy was obese
at the time and had chronic hypertension and asthma. Her blood
pressure was high and needed to be monitored at home.

“I wasn’t thinking about my own health, because I was just excited
to even be pregnant in the first place,” McCarthy said.

At a routine check-up halfway through her pregnancy, McCarthy was
diagnosed with preeclampsia and HELLP syndrome — which can cause the
liver to swell — and she was admitted to the hospital. The medical
staff was unable to get her blood pressure under control, and McCarthy
said she wasn’t sure she would live to see her unborn daughter. In a
hospital bed, she recorded a video for her just in case.

“Not only was I having end-of-life conversations with my husband,
but I was FaceTiming my family, friends, coworkers, parents
essentially just telling them goodbye,” she said.

McCarthy had an emergency c-section and gave birth to her daughter,
Charlotte, at just 25 weeks gestation. Her baby weighed just 1 pound
and 13 ounces and was taken to the neonatal intensive care unit. Today
Charlotte is 3 years old.

During a rally outside the state Capitol in January, McCarthy proposed
a bold goal: Make Georgia the safest place in the country to give
birth.

She said in an interview that she believes it is possible, but will
require funding for medical research into the causes of maternal
mortality. There also needs to be a shift in public policy to aid
mothers with transportation, child care and time off work to access
health care, she said.

“We are moving the needle, but there’s more that needs to be
done,” McCarthy said.

Birthday’s Missed, A Family’s Loss

Back in Macon, life has fallen into a new rhythm for the family Jones
left behind.

Tullius still wakes at 5 a.m., but now it’s up to him to dress both
girls and drop them off at daycare. Then it’s off to work, until
it’s time for afternoon pick-up.

As a single dad, he said he is doing his best to pick up where Jones
left off. He cooks dinner each night like she did, “but there’s
some nights I just do what I can,” Tullius said.

Their girls have grown in the eight months since Jones’ death.

Miranda, their youngest, was just starting to roll over last June. Now
she says “dad” and is walking. She drinks milk instead of formula
and eats whole foods. She celebrated her first birthday.

“Amanda missed all that,” Tullius said.

_©2024 The Atlanta Journal-Constitution. Distributed by Tribune
Content Agency, LLC._

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