Georgia public health leader sounds alarm as report confirms spike in pregnancy-related deaths

Dr. Kathleen Toomey, the commissioner of the state Department of Public Health, had warned lawmakers early this year the report would show an increase. The June 30 report was released quietly but was the focus of Tuesday’s Board of Public Health meeting, where board members called for a sustained focus on addressing the problem.

The report found that there were 30.2 deaths for every 100,000 live births in Georgia from 2018 to 2020. That is about a 20% increase from the previous three-year period, when the rate was 25.1. Black women are twice as likely as white women to die from pregnancy-related causes.

There have been some changes in how the data is collected since the Maternal Mortality Review Committee first started analyzing maternal mortality cases in 2012.

Of the deaths studied in the new report, 113 were concluded to be related to pregnancy – and 89% of them were deemed preventable, meaning they had “at least some chance of being prevented,” according to the report.

Hemorrhage, mental health conditions, cardiomyopathy, cardiovascular conditions, embolism and preeclampsia and eclampsia were the leading causes of pregnancy-related deaths.

Toomey said the report intentionally uses a broad and complex view of what counts as a “preventable” death.

“Although it seems daunting, I think we’re setting that bar very high, that this is preventable,” Toomey said during a live-streamed-only board meeting. “It means that we are working with all aspects of the medical care system, the social services system and community to address these issues collectively. I think that’s how we’ll have successful outcomes.”

State lawmakers have taken steps in recent years to improve maternal care. Most notably, legislators just last year extended Medicaid to cover treatment a full year after the end of a pregnancy.

Public health officials also outlined several projects underway, such as a home visitation pilot in two pockets of the state. Some initiatives, they said, are showing signs of progress that board members said they hope will prod lawmakers to continue to support these efforts – and even expand them.

For example, Dr. James Curran, the board’s chair, floated the idea of expanding Medicaid coverage to women who are considered high risk before they are pregnant. Curran is also the dean and professor of epidemiology at the Rollins School of Public Health at Emory University.

“Good surveillance and good analysis, that’s really the conscience of public health. And the conscience has got to be honest. It can’t be political, but it’s got to be honest,” Curran said.

“And once you show people that something works, everybody will want to support it,” he said.

The report issued a series of recommendations, such as encouraging providers, insurers and hospitals to offer a year of case management after the end of a pregnancy.

Curran said the problem “requires a long-range commitment to improving maternal and perinatal health” and understanding the complexities behind the preventable deaths.

“You can either be committed to recognize how these things fit in and deal with them slowly but inexorably, or you can despair. And despairing is not the way to do it. The way to do it is to say, ‘We can do this,’” he said.

Advocates have celebrated the steps taken in recent years but also argue more must be done.

“Although this data is alarming, I am convinced that this is a solvable problem given the preventability of over 3/4’s of these deaths,” said Ky Lindberg, CEO of Healthy Mothers, Healthy Babies Coalition of Georgia and a member of the Maternal Mortality Review Committee. “We have to do better for Georgians, and we must start somewhere, for us… the data is clear. We must support the unique needs of Black families while also enhancing care options for ALL.”

The report was published as another from the medical journal JAMA found that the national maternal mortality rate has doubled between 1999 and 2019. U.S. Sen. Raphael Warnock cited the national report when announcing Tuesday that he had revived a proposal aimed at lowering death rates for women of color, calling it “an ongoing and worsening crisis.”

In the Georgia report, the highest rate – 65.7 per 100,000 live births – was documented in a southwest Georgia region stretching out from Columbus. The Macon-based public health district was not far behind with a 59.5 rate.

The new Georgia data was horrifying but not necessarily surprising, said Alysia Cutting, rural health equity director for Albany-based SOWEGA Rising.

Cutting said the report mirrors what she sees in her work: a bias that can lead to little time spent educating less educated, rural women with a lower socio-economic status – particularly women of color – about important health concerns.

The report found that bias and discrimination likely factored into 15% of the pregnancy-related deaths.

She called extending postpartum Medicaid a good start but said more needs to be done to bolster local health care resources down to the doulas and midwives, particularly in rural areas where access to care is often limited.

“We have to empower our communities to be able to meet those needs and extend that care and education,” Cutting said. “It really is a combination of education for the actual pregnant person and their families and the providers about implicit bias and policymakers about funding the resources to make sure that all of this comes together.”

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