To: Governor Brian Kemp

From: Brenna Daly

Re: Maternal Legislation and Healthcare Access

Problem Statement:

Maternal health issues in the state of Georgia are severe compared to the national

average. This continuous struggle with poor maternal health is due to a lack of resources,

education, and funding to provide proper healthcare to women during and after pregnancy.

Background:

Georgia has a range of issues surrounding maternal health. Firstly, the state has an

alarmingly high maternal mortality rate. The World Health Organization defines maternal

mortality rate as “Women dying as a result of complications during and following pregnancy and

childbirth” (World Health Organization, 2019). For every 100,000 live births, the maternal

mortality ratio is 40.8. The maternal death rate for white women in Georgia is double that of the

national average and black women have an even higher risk (ACLU Georgia, 2018). Most of

these deaths do not occur while the woman is in labor, but instead days, weeks, or months after

the delivery once the mother has settled back into the community (Petersen, E., Davis, N.,

Goodman, D., et al., 2019). Further struggles include: low maternal healthcare coverage, closing

of labor and delivery facilities, and a lack of OBGYNs. Women are also more directly affected

by geographical barriers to access care and lack of affordability for healthcare insurance
(Miteniece, E., Pavlova, M., Shengelia, L. et al., 2018). Also, Georgia also mainly abstinence

based sex education. There is a lack of data supporting the state of Georgia's abstinence-based

sex education curriculum leading to misconceptions about birth control and increasing unhealthy

behavior (Peel, 2018). Young mothers may struggle with financial stability that could lead to

lessened access to quality healthcare. They also may not be as educated ways to ensure good

health during pregnancy (Peel, 2018).

Landscape:

Many women in Georgia fall victim to insurance gaps, especially when it comes to

maternal care coverage. Women that are unable to afford this insurance or procure it through

their workplace, are reliant on state Medicaid programs. To qualify, pregnant women must have

an income of less than 225% of the Federal Poverty Level (McMorrow & Kenney, 2018). Some

downfalls of this are that eligibility thresholds for current parents are much lower than those for

expecting women, leaving many of these future mothers without insurance. The coverage is also

usually terminated 60 days after delivery. The lack of insurance leads to lessened access to

postpartum care (making women more susceptible to maternal mortality). Though, there have

been recent strides in trying to resolve this issue. In Georgia, a legislative study committee on

maternal health has proposed a bill to extend this coverage to a year postpartum (Williams,

2020). The committee also recommended “To address geographic disparities in pregnancy

outcomes,... the panel suggested the state continue to fund and support efforts to increase

Georgia’s rural healthcare workforce”(Williams, 2020). A lack of infrastructure in rural and

mountainous areas can make it difficult to travel to healthcare professionals. In rural Georgia the
maternal mortality rate was 24.3%, compared to 16.5% in non-rural areas in 2012

(Romain-Lapeine, 2015). No rural counties have a maternal-fetal medicine specialist and 93 do

not have a hospital with a labor and delivery unit (Warren, 2019). The lack of specialists in these

counties often has to do with professionals choosing to work in counties that are more financially

stable (Romain-Lapeine, 2015).

Options:

I have developed three possible options for addressing this issue of high maternal

mortality rates in the state of Georgia. The first policy would be to follow the earlier mentioned

recommendation of the legislative study committee on maternal health to “address geographic

disparities in pregnancy outcomes,...the panel suggested the state continue to fund and support

efforts to increase Georgia’s rural healthcare workforce”. More funding could be utilized within

the states’ health spending budget to attract healthcare workers to rural areas. By using funding

to help rural hospitals become more financially stable, more professionals and specialists would

be drawn to the region, knowing they would have stable career options. Increased funding could

also go towards providing incentives (higher pay, better hours, better insurance) for nurses,

doctors, and other healthcare professionals to choose to continue their careers in rural areas. An

obstacle for this option would be getting a majority of support from citizens and officials in the

state. The more urban areas of Georgia will not want to lose any funding, especially if they feel

they will not reap any of the benefits of this rural area targeted policy. The second policy option

would be to expand maternal care coverage insurance options in the state. The legislative study

committee on maternal health also proposed a bill to extend this coverage to a year postpartum.
Signing a bill for this in the state to make this mandatory for insurance providers/ cheaper for

women to access would allow for postpartum care for almost six times as long. Due to the

majority of maternal deaths occurring after birth, this increased medical and community support

would be effective in directly targeting one of the main contributors of this problem. The

possible downsides are that insurance companies may try to increase the cost for women due to

the expansion of coverage. The third policy option would be more training and education for

healthcare professionals and more community resources to address the great disparity between

maternal mortality rates for women of color. The establishment of more funding and committees

would ensure that these women are receiving proper prenatal care, pregnancy education,

healthcare access, and support post delivery. Further educating health professionals on these

disparities and why they occur, can allow for better patient communication. A difficulty with this

change is that there are hundreds and thousands of disparities within the healthcare system. It

may be challenging to convince hospitals and medical professionals to take time out of their

already busy schedules to focus on this specific topic, when issues in the healthcare system are

vast.

Recommendations:

Of the three policy recommendations, I would recommend that you take action and adopt

the second policy mentioned to expand maternal care coverage insurance options in the state and

extend maternal health coverage a year postpartum. Firstly, I am advocating for this policy

because as I previously mentioned, this policy is most effective in directly attacking the issue

because a majority of these maternal deaths occur days, weeks, or even months after delivery.
This cost would not have to be shouldered by the state alone, as making this a requirement would

mean that women that are covered by their employers or private insurance agencies would not

need these funds from the state. Though, there is still the possibility of this leading to higher

insurance costs due to the extended coverage. To address the possible increased cost of insurance

for this policy: creating policies that would not allow for this gender discrimination will help

prevent this increase in cost and the state can work with these agencies to figure out how to make

this care the most cost-effective. The state could also request funding from the national

government to help lower these state rates to more closely resemble the national average.

Secondly, I believe voters would be strongly in favor of this policy for multiple reasons. With

over half of the registered voters in Georgia being women, a majority of the state’s constituents

would support a policy aimed at improving their safety, if they ever chose to become pregnant.

Many families have been affected by this issue by unexpectedly losing loved ones and would

want legislation that would help stop preventable deaths from occurring any further. Helping

solve this state crisis would reflect back well on the government and help citizens feel as if the

state is improving in overall healthcare measures.

 References

ACLU Georgia. (2019, October 15). The Problem: Georgia Has A Maternal Mortality Crisis.

Retrieved from https://www.acluga.org/en/problem-georgia-has-maternal-mortality-crisis

McMorrow, S. (2018, September 19). Despite Progress Under The ACA, Many New Mothers

Lack Insurance Coverage. Retrieved from

https://www.healthaffairs.org/do/10.1377/hblog20180917.317923/full/

Miteniece, E., Pavlova, M., Shengelia, L., Rechel, B., & Groot, W. (2018, August 13). Barriers to

accessing adequate maternal care in Georgia: a qualitative study. Retrieved from

https://www.ncbi.nlm.nih.gov/pubmed/30103763

Peel, S. (2018, July 30). Sex Ed In Georgia Schools Still Abstinence-Heavy. Retrieved from

https://www.gpbnews.org/post/sex-ed-georgia-schools-still-abstinence-heavy

Petersen EE, Davis NL, Goodman D, et al (2019). Vital Signs: Pregnancy-Related Deaths,

United States, 2011–2015, and Strategies for Prevention, 13 States, 2013–2017.

Romain-Lapeine, F. (2015). Increasing access to maternity care in rural Georgia through public

health advocacy. Retrieved from https://scholarworks.umass.edu/nursing_dnp_capstone/46/

Warren, Jacob. “Maternal Mortality in Rural Georgia.” Mercer University School of Medicine,

2019.
Williams , D. (2020, January 7). Georgia lawmakers recommend expanding Medicaid for

pregnant women. Retrieved from

https://www.augustachronicle.com/news/20200107/georgia-lawmakers-recommend-expanding-

medicaid-for-pregnant-women

World Health Organization. (2019, September). Maternal mortality. Retrieved from

https://www.who.int/news-room/fact-sheets/detail/maternal-mortality