Visualizing the Maternal and Reproductive Health Crisis in Georgia
Data snapshots highlight the extent of the challenge.
Restrictions to reproductive rights, limited access to health care during and immediately after pregnancy, and rising health care costs have placed a significant burden on women’s health in Georgia. The toll is particularly great for those residing in rural or low-income areas, where barriers to care may also include a limited (or nonexistent) health workforce and minimal transportation options to access treatment. Racial disparities, too, continue to impact women’s lives, with Black women—regardless of income, and those covered by Medicaid or who are uninsured—experiencing disproportionate rates of death associated with pregnancy and the postpartum period. The issues examined here are prevalent across the state and could be addressed through policy changes.
Mapping Maternal Health Deserts
The United States ranks worst among developed nations in the world for pregnancy-related deaths—defined as deaths occurring during pregnancy or within one year of the end of pregnancy.
Several factors contribute to the high U.S. maternal mortality rate, including systems-level factors. These include a lack of affordable access to quality prenatal and postpartum health care, barriers to mental health and substance use screening and treatment, and individual-level barriers—such as individuals’ co-morbidities, social determinants of health, lack of social support, and experiences with discrimination and racism from the medical community. Maternity care deserts, or areas that lack designated maternal health care providers (such as OB-GYNs or certified nurse midwives), are a major barrier for birthing persons seeking the care they need to protect their health and the health of their infants.
Citation: Fontenot, J, Lucas, R, Stoneburner, A, Brigance, C, Hubbard, K, Jones, E, Mishkin, K. Where You Live Matters: Maternity Care Deserts and the Crisis of Access and Equity in Georgia. March of Dimes. 2023.
Tracking the High Cost of Maternal Care
In addition to the lack of maternal health care resources available to many in rural areas, other structural barriers prevent pregnant persons from accessing needed care. These include limited medical leave workplace policies, limited insurance coverage, and high out-of-pocket costs for maternity care. Some birthing persons, especially those in part-time and low-wage positions, have limited time off for health care appointments or limited medical or family leave policies after the birth of an infant. Relatedly, they are less likely to have full insurance coverage or be able to afford maternal health care.
Costs associated with pregnancy, labor, and delivery can be life-altering, especially without insurance. Peterson-KFF’s Health System Tracker identified the average costs of labor and delivery clocking in at $18,865 without insurance ($26,280 for Cesarean delivery) and $2,854 out-of-pocket for enrollees on major health plans ($3,214 for Cesarean delivery). These costs are for uncomplicated deliveries, with additional life-saving procedures, surgeries, lengthened hospital stays, and time in the NICU escalating costs further. And, according to March of Dimes data, as of 2021, about 1 in 6 women of childbearing age were uninsured in Georgia.
These numbers align with the fact that the state’s poverty rate is at 12.9%, and at 17.2% for those under 18, based on 2022 Census data. In Georgia, the average household income was $71,355 in 2022 dollars, and the weighted poverty threshold for a family of four was $26,496 in 2020.
Researchers note that expanding Medicaid could help alleviate this burden and prevent maternal deaths and improve the pregnancy and postpartum health of birthing persons and their infants across the state.
“Expanding Medicaid coverage is essential so that birthing individuals have continuous health care coverage before, during, and after the end of pregnancy,” says Sarah Blake, PhD, associate professor of health policy and management. “Medicaid expansion is proven to reduce adverse maternal and infant health outcomes and has been shown to improve preconception care and improve utilization of primary and preventive care. In 2022, Georgia extended Medicaid coverage for mothers until 12 months postpartum, joining more than 40 other states in doing so. This is a great start, but we hope the state can do more to protect the health of mothers and their children by enacting a full Medicaid expansion.”
Average costs of prenatal care, delivery, and postpartum care for those enrolled in large group health plans versus the total projected costs without insurance
Source: KFF analysis of MarketScan data
Understanding the Impact of Abortion Restrictions on Maternal Death Rates
In July 2022, Georgia House Bill 481 went into effect, prohibiting women from legally obtaining an abortion in Georgia after approximately six weeks of gestation (about two weeks after a missed period), except in cases of incest or rape, when the pregnant person’s life is at risk, or when the pregnancy is confirmed by medical professionals to be incompatible with life due to congenital or chromosomal abnormalities. Since this legislation was passed, the number of abortions has dropped in the state as illustrated below.
Researchers anticipate this law will directly impact rates of maternal death in the state as those pregnant persons seeking abortions for medical or personal reasons may carry their pregnancies to term despite medical, personal, or financial concerns. Past research has pointed to direct correlations between states with restrictive abortion policies and rates of maternal death.
“Research shows that restricting abortion access increases the risk for morbidity and mortality via numerous pathways,” says Sara Redd, PhD, director of research translation at the Emory Center for Reproductive Health Research in the Southeast. “First, pregnancy and childbirth are inherently more dangerous than abortion care; second, people living in states with more restrictive policies likely also experience other structural barriers to care; and third, being denied wanted health services and navigating structural barriers all increase the psychosocial stress a pregnant person may experience, which increases the risk for poor outcomes.
“This set of mechanisms becomes particularly worrisome in a state like Georgia, where we have very few state policies supporting maternal and family health and well-being and a vastly under-resourced maternal health care system, with 82 of our 159 counties lacking an OB-GYN," Redd continues. "Thus, reducing abortion access for Georgians and those traveling from surrounding states has very real implications for the autonomy, health, and well-being of pregnant people and their families.”
This data visualization presents data collected from Georgia Department of Public Health and shows abortions in Georgia by month and year from 2019-2022.
