EDITOR’S NOTE: This story has been changed to correct a word in the quote of DPH Director Kathleen Toomey, who referenced “near misses.”
Georgia’s maternal mortality rate — already among the worst in the nation and even the developed world — got even worse during the pandemic, Dr. Kathleen Toomey, Georgia Commissioner of Public Health, told state legislators on Wednesday.
Toomey did not detail the increase or the new rate, saying the exact numbers would be released in a report next month.
“We are going to see an increase in maternal mortality during the time of COVID,” Toomey said. “It’s sad but not unexpected.”
Toomey spoke during budget hearings at the state Capitol, saying her agency is pivoting away from an all-hands-on-deck pandemic focus. She said her department would use some of its available bandwidth now to focus on the maternal mortality issue.
For the years 2018-2020, DPH posted pregnancy-related deaths for white women at 22.7 deaths per 100,000 births, and pregnancy-related deaths for Black women at 48.6 deaths per 100,000 births. It did not post overall figures for those years.
Georgia’s data takes years to investigate, collect and report: The state’s overall rate of maternal mortality in 2016 was 37.2 mothers’ deaths per 100,000 births, DPH told the AJC in 2019. That rate was worse than Uzbekistan’s. In the previous state report for the year 2014, the rate was 26 deaths per 100,000 births.
While some may consider those numbers small, they harbinger much broader problems with women’s health and health care, public health experts say.
Maternal death is “an unfortunate and tragic event, but it’s a relatively rare event,” Toomey said. “What isn’t a rare event are near misses.”
Maternal mortality is not just deaths in childbirth. Large numbers of maternal deaths happen in the months before and after the mother gives birth, often from strokes related to the pregnancy or birth.
Black women are more than twice as likely as white women to die for reasons relating to pregnancy and childbirth. The disparity happens across economic lines.
DPH is implementing some programs funded last year that should help the agency better understand the problem of maternal ill health. In a $1.2 million program, DPH will work with Augusta University try to identify mothers at high risk to have the worst outcomes and follow their health before bigger problems develop. In addition, Toomey said DPH hopes to work on maternal health with hospitals in two rural counties at a cost of $146,000.
The quality of Georgia’s data is insufficient, Toomey said, so Toomey is asking for $4.2 million for a better overall public health data surveillance system. Right now, she said, there’s a different system for each of 159 counties. When she gives numbers to state officials, she said, sometimes they have to be added up on paper.
On the front lines, there are data problems too, CDC officials have said. Those who fill out death certificates often don’t specify when the root cause of something like a stroke turns out to be pregnancy or childbirth.
Georgia lawmakers were just beginning to grapple with the issue when the pandemic hit. In September 2019, the Legislature held a special study committee on maternal mortality, which heard testimony from experts and from women who had experienced poor medical care while pregnant or postpartum.
The Legislature did end up expanding Georgia’s Medicaid coverage, or low-income government health insurance, for new mothers, from the previous cap of 6 months. Now Georgia covers low-income moms with Medicaid during their pregnancies and until one year after they give birth.
Studies such as the Yale Global Health Justice Partnership have called out Georgia’s lack of Medicaid coverage for the poor throughout adulthood as one reason for its high maternal mortality standing.
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Credit: Nathan Posner for the AJC