1 in 10 Georgians know someone who died during or after pregnancy, maternal mortality survey shows

Heather Dobbs shared her personal story at the conference of surviving life-threatening complications.

“I nearly hemorrhaged to death and had to have an emergency hysterectomy because of that experience,” said Dobbs, who had also previously had an emergency C-section and described struggling to receive medical care.

“I could feel everything that was happening. I told the anesthesiologist, I said, ‘I believe my epidural has worn off.’ And he patted my shoulder, and he said, that’s not pain. That’s pressure,” she said. “And it took me crying and convulsing on the table to get more medication.”

Dobbs, who is Black, now works as a doula and patient advocate through Morehouse School of Medicine’s Perinatal Patient Navigator certification program and says her own birth-related trauma motivates her to want to help other women.

“I don’t want any woman to go through what I went through. And I also want people to, when this does happen, to be more sensitive because there are long-term effects from this,” she said, pushing for better training for physicians and nurses who treat women of color.

Black women are more than twice as likely as other women in Georgia to die during and after pregnancy. And the state has some of the worst overall maternal mortality rates in the country.

The survey found:

• Substance use disorders (47%), lack of insurance (47%) and mental health (41%) rank as top factors perceived to contribute to an increased risk of maternal mortality.
• People living in rural areas are more likely (65%) to have experienced complications during pregnancy or to know someone who has compared to people in urban areas (56%).
• Georgians say that improving the affordability of maternal health care (73%) and access to health insurance coverage are top priorities (70%) in reducing maternal mortality.
• Eighty-two percent of Georgians say it is important for the State of Georgia to increase investment in initiatives to reduce maternal mortality and support including maternal mortality as a state budget item.
• Many Georgians think that our health care system treats people unfairly at least somewhat often based on whether they have health insurance (79%), how much money they have (65%), their racial or ethnic background (61%) and how well they speak English (61%).
• More than half of Georgians (54%) say the top barrier is that health care is too expensive, even with insurance. Twenty-nine percent say they do not have insurance, while 28% face difficulties making appointments due to a lack of available initial and follow-up appointment times.
• More than a third of respondents say that racism is a major obstacle (36%) to people achieving equal health outcomes. African Americans are more likely (49%) to say it is a major obstacle.
• Eighty-seven percent of Georgians say it is important to conduct research to combat health disparities.
• Despite significant concern (70%), Georgians are hopeful about the future of maternal health (74%).

Zogby Analytics conducted the online survey on behalf of Research!America in October 2023, among 803 adults in Georgia plus 606 additional adults for minority oversampling.

Department of Public Health Commissioner Dr. Kathleen Toomey said the data should be a call to action for improving maternal health care in Georgia.

“We are at a tipping point in Georgia. We can either make things better, or we’re going to fall back to the same old, same old and not see the improvements that we need to see,” Toomey said. “And so in my mind, I’m really framing this as our tipping point to really rethink, reframe, re-envision what we have in this state.”

More than 200 people attended the daylong conference.

Toomey said that while more progress is needed to improve maternal health in Georgia, the state has made some significant gains in tackling maternal mortality and morbidity.

She pointed to recent policy changes, such as Georgia’s extension of Medicaid health insurance coverage to a year after pregnancy for low-income women.   

Georgia is one of 10 states that have not fully expanded Medicaid under the Affordable Care Act, which estimates show would cover around 400,000 uninsured Georgians. 

Republican Gov. Brian Kemp has opted instead for piecemeal expansions, such as the 12-month postpartum Medicaid extension and the Georgia Pathways to Coverage program. Pathways offers Medicaid to low-income adults who successfully complete 80 hours per month of work, volunteering, education or other approved activities. 

But support for a full Medicaid expansion in Georgia may be increasing among state GOP lawmakers.

The issue came up a state House committee meeting earlier this month on the issue of hospital certificate of need-reform that could scale back the state’s regulations on where new health-provider businesses, such as freestanding birth or surgical centers, can operate near health system-affiliated hospital facilities. 

Committee members listened to more than two hours of testimony from officials from other states with majority Republican legislatures, including North Carolina, that have recently expanded Medicaid as part of their own certificate of need-reform efforts. 

Speakers included healthcare consultant Dave Richard, formerly North Carolina’s Medicaid director, who said North Carolina’s 2023 law enacting Medicaid expansion came about as a compromise between that state’s Democratic Governor and Republican legislature tying certificate of need-reform to negotiations around expansion.

“The leader of the Senate and the Speaker of the House both came to a place where they believed that expanding Medicaid would be in the best interest of the citizens of North Carolina,” he said.

At the Emory-hosted maternal health conference, Dr. Natalie Hernandez-Green, executive director of Morehouse School of Medicine’s Center for Maternal Health Equity, said she hoped to share more stories of “near-miss survivors.” These are people who have survived life-threatening pregnancy complications and could help make the case for further Medicaid expansion in Georgia.

“Our stories were actually used for testimony to pass postpartum Medicaid expansion,” Hernandez-Green said. “And a couple of states were able to train near-miss survivors on how to advocate and do policy training around this.”