Improving Georgia Maternal Health: A Multipronged Approach

While the high maternal mortality rate in the U.S. has been a major public health concern, it has been of particular importance in Georgia, ranked 46 out of 50 states for maternal health. The latest data shows that Georgia has a maternal mortality rate of 27.7 per 100,000 live births compared to the national average of 17.4, and that 1 in 9 infants in the state is born preterm (before 37 gestational weeks). Ongoing efforts to address maternal health in the state have helped, but there is still work to be done.

Improving maternal health in Georgia requires a multipronged approach that includes increasing access to adequate maternal care, ensuring early screening of pregnancy complication risks, addressing health disparities, and eliminating maternity care “deserts”—areas in the state that lack birthing care providers. Underpinning the success of all these strategies is the need for quality, real-time data that allows the state to know who needs help, where to allocate resources, and how to target efforts for greatest impact.

Ensuring Adequate Prenatal Care

Ensuring access to adequate prenatal care is critical to support healthy pregnancies, deliveries, and infants, as well as helping to reduce the risk of pregnancy-related deaths. The Georgia Maternal Mortality Review Committee (MMRC), part of the Georgia Department of Health, aims to ensure, “All women in Georgia would have equitable access to health and health care before, during and after pregnancy to eliminate all preventable maternal deaths.”

According to the latest data from March of Dimes, the percentage of Georgia residents who received less than 50% of the appropriate number of prenatal visits (starting 5 months into the pregnancy or later) was 17.1% compared to the national average of 14.9%, and 1 in 11 infants is born to someone receiving late or no prenatal care. National Institutes of Health (NIH) reported that inadequate prenatal care, consisting of late onset of visits and/or less prenatal visits, is associated with: higher risk of low gestational and postnatal weight; smoking during or after pregnancy; premature membrane ruptures; not breastfeeding; and precipitous labor. Another analysis shared in the report found that among pregnancy-related deaths with documented prenatal care status, 8.5% had not had any prenatal care visits and 24.5% didn’t begin prenatal care until the second or third trimester. This suggests that ensuring adequate and timely prenatal care could help reduce the risk of pregnancy-related deaths and could lead to better health outcomes overall.

Ensuring adequate prenatal care requires collecting, aggregating, and sharing more data regarding the number and timing of prenatal care visits and insurance coverage status of pregnant patients. Data collection should include risk factors such as real-time patient status changes, new diagnosis codes, and abnormal lab results. Behavioral health issues and social determinants of health, including socioeconomic or environmental factors, are also important to capture and track. For example, inadequate access to transportation is a common barrier to receiving adequate prenatal care. Providers and public health agencies could leverage real-time alerting technology to track new and high-risk pregnancies for proactive outreach and interventions.

Increasing Access to Postpartum Care

The postpartum period is just as crucial for maternal health. According to the Commonwealth Fund’s 2020 report on maternal mortality, 52% of pregnancy-related deaths in the U.S. occur postpartum. Of that total, 19% of deaths occur in the first week postpartum, 21% between one and six weeks postpartum, and 12% between six weeks to a year postpartum. With more than half of pregnancy-related deaths happening in the postpartum period, any programs aiming to reduce maternal mortality rates should focus on expanding access to postnatal care.

There are efforts in Georgia to increase postpartum Medicaid coverage. Two years ago the Georgia General Assembly approved expanding Medicaid coverage from two months postpartum to six, and the state legislature is currently looking to extend that coverage to at least 12 months postpartum with Senate Bill 338 passing in the Georgia State Senate and the House.

Improving access to postnatal care through expansion of insurance coverage will help ensure many patients receive the care they need in the months following delivery. However, to make the most out of expanded coverage, Georgia healthcare professionals and policymakers must ensure high-quality, timely data is available to make the best clinical decisions with patients. Unfortunately, this data is often siloed within care organizations and difficult to access, or delayed in reaching the right members of the care team.

Clinical care teams and Medicaid managed care organizations (MCOs) need access to timely data about patient risk factors such as timing of pregnancy, number of prenatal care visits, comorbidities, complications, social needs, and timing of delivery to ensure appropriate and close follow up for the highest risk patients in the postpartum period.

Identifying Pregnancy Complication Risks Early

Identifying pregnancy complication risks early is crucial to ensuring that patients receive appropriate and timely care needed for healthy pregnancies. Providers should screen for any health conditions, behavioral health issues, and socioeconomic or environmental factors that could affect the pregnancy. For example, a screening might entail a conversation about the patient’s medical history, past pregnancies or deliveries, family history, mental health, tobacco or substance use, comorbidities like diabetes or hypertension, food access, social support, access to transportation, insurance coverage, and any other information about social and medical factors that could impact the pregnancy.

If a pregnant patient presents with any risk factors, then the provider can offer referrals to relevant healthcare resources, social services, or community health programs. In addition, hospitals and obstetric care providers can consult with care managers and administrative teams to work with health IT vendors to create customized workflows for monitoring high-risk pregnant patients. It is important that all members of the care team, including health plan administrators, are aware that a patient is at risk for pregnancy complications. This can be made possible through interoperable data systems that provide easy, secure access to relevant patient data that will allow the care team to offer the appropriate services and support at the right point of care in a timely manner.

Addressing Maternal Health Disparities in Georgia

In addition to ensuring adequate maternal care before, during, and after pregnancy, addressing existing health disparities is another prong in the strategy for improving maternal health in the state. According to a report from the Georgia House of Representatives Study Committee on Maternal Mortality, pregnancy-related maternal mortality is three to four times higher among Black Georgians (47 deaths per 100,000 live births) compared to their White counterparts (14.3 deaths per 100,000 live births). The preterm birth rate among Black infants in Georgia is also 45% higher than for all other racial and ethnic groups in the state. A comprehensive study analyzing causes for the health disparities among Black people giving birth in Georgia concluded that factors such as socioeconomic status, the quality of communication between provider and patient, and medical conditions of the pregnant patient all contribute to the higher rate of maternal mortality in that population.

The study also noted that inconsistency in reporting maternal deaths is another issue that could impact the ability to reduce health disparities in Georgia. As race and ethnicity data is not always standardized, many organizations may not have a full picture of the disparities within their population, making is difficult to help care teams understand social needs and address barriers to quality care. Collecting accurate data on race, pregnancy, prenatal care visits, insurance coverage, and pregnancy-related deaths is key to better understanding and addressing health disparities that impact maternal health in the state.

Reducing Maternity Care Deserts in Georgia

The March of Dimes defines a maternity care desert as, “A county in which access to maternity health care services is limited or absent, either through lack of services or barriers to a woman’s ability to access that care.” By this definition, 37% of Georgia’s counties qualified as maternity care deserts according to a March of Dimes report from 2018.

According to the Georgia DCH, at least half of the state’s 159 counties have no obstetricians and 40% of care facilities, including hospitals, have been closed during the past 20 years. In rural Georgia, the lack of access to providers is even greater. Data from the Georgia House Budget & Research Office from 2019 found that of the 93 of the 109 designated rural counties have no hospital labor and delivery unit, 75 of the 109 rural counties have no obstetrician-gynecologist, and no rural counties have a maternal-fetal specialist. The populations living in these areas have lost access to the support networks needed to receive prenatal and postpartum care, and nearly 83% of rural residents no longer live close to a birthing facility, requiring them to travel long distances to access care.

Collecting data on access to maternity care and learning more about how to support maternity healthcare providers throughout the state can help to address the issue of maternity care deserts in Georgia. In addition, supporting rural hospitals to access health IT like joining a real-time care coordination network or working with health IT vendors to leverage data from EHRs can help those providers offer better care coordination for patients, improve outcomes, and, hopefully, begin to reduce the high maternal mortality rates in these areas.

Real-Time Data as a Solution

One strategy for improving maternal health includes keeping members of a pregnant patient’s clinical care team informed about health status with near real-time identification and notification of pregnancy and new risk factors that may lead to adverse pregnancy outcomes. Audacious Inquiry’s Encounter Notification Service® (ENS®) can be configured to rapidly identify pregnant populations and those at higher risk for adverse pregnancy outcomes using near real-time admission, discharge, transfer (ADT) data from many sources. ENS alerts can identify:

• Pregnancy
• High risk pregnancy based on comorbidities and/or demographics
• Pregnancy complications including ER or inpatient visits
• Labor and Delivery
• Severe Maternal Morbidity

To learn more about our solutions for maternal health, contact us today.