Georgia Department of Public Health staff told the agency’s advisory board that the state is doing what it can to curb maternal mortality. But it’s an uphill climb.
The presentation to the board Tuesday followed The Atlanta Journal-Constitution's disclosure that the state's rate of maternal death has been the worst in the nation, was called out by an international human rights organization, and has since gotten much worse.
“I think the state of Georgia is doing an excellent job of recognizing the need we have in the state, and we’re making great efforts to implement programs that will attack this issue,” the board’s chairwoman, Dr. Cynthia Mercer, said in an interview afterward. “I think it’s one of our top priorities.”
No one really knows how many women die in Georgia for reasons related to their pregnancy. The DPH and other agencies have cooperated to start combing the data, but they know what they have is likely an undercount, with some maternal deaths not being officially reported to the state. They’re also years behind; the results for 2014, which will have been vetted by the state, are expected later this year.
However, the latest figures available from 2016, which still require vetting by the state, show that for each 100,000 live births in Georiga, about 40 women die per year, either during the pregnancy, in childbirth or within a year. The majority of maternal deaths from pregnancy happen not during childbirth but afterward, often weeks or months later from strokes.
The department’s point person on maternal mortality, Diane Durrence, said some previous efforts stumbled when something was proposed but no agency owned it. Those are being relaunched with the DPH in charge: Working on “bundles” of best practices with hospitals that volunteer to participate. The bundles are a nationally vetted education program but need local and state implementation.
The department is also going to work on establishing an "action committee." Currently, there is the multiorganizational committee that vets and reports on Georgia's data, but that's not the same as driving action. "Yes, we put some recommendations in place, but we can build on that," Durrence told the board. "We need a group that can take recommendations from that committee and really help us develop a plan."
One thing the board was clear on is that it can’t change the world in a year, and although the Legislature in its last session directed $2 million specifically toward the issue of maternal mortality, it won’t be able to immediately report a significant rollback.
The latest actions — and the money itself — all come eight years after the issue first came to light in a report by Amnesty International.
“It takes time to implement plans,” Mercer said. “We’re interfacing with a large state with a large rural population, and it takes time to get a united front.”
In addition, the DPH has to rely on hospitals to participate in its programs, like the best-practices bundles; it can’t force them.
Dr. Patrick O’Neal, the DPH commissioner, said that he used to think that wasn’t enough, but after being on the job he understands it is.
“We have limited control at the state level,” he said. “We try to effect change by offering carrots.”
That is probably more effective than having centralized control, he said.
AJC REPORTING
In September, The Atlanta Journal-Constitution reported on Georgia’s sky-high rate of maternal mortality compared with other states’. Georgia’s rate is currently higher than Uzbekistan’s. Experts say there are many factors at play, a critical one being access to health care for women of childbearing age throughout the state. Another is education, for example educating caregivers on the dangers from pre-eclampsia that can develop in previously healthy moms in the weeks after birth.
These are some of the state’s responses to the issue:
2010: Amnesty International says the U.S. has a "maternal health care crisis" and Georgia has the highest maternal death rate of all states.
2015: Citing the Amnesty International report, Georgia's Maternal Mortality Review Committee issues its first case review, investigating the 2012 data. MMRC reports have found at least half of the deaths are preventable. Top causes are hypertension, hemorrhage, embolism, seizures and heart problems. African-American moms in Georgia and other states are far more likely to die for reasons relating to pregnancy than women of other ethnicities.
2018: The Legislature allocates $2 million specifically for maternal mortality efforts.
2018: The state Department of Public Health forms an action committee.
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