Reproductive Justice Organizations Battle the Maternal Mortality Crisis in Georgia
Written by Farimata Mbaye
7/31/2023
Farimata Mbaye is a second year MD candidate at the Icahn School of Medicine at Mount Sinai. She graduated cum laude from Harvard University with a degree in the Studies of Women, Gender, and Sexuality and Government. Her primary research interests include broadening access and increasing quality of reproductive healthcare for marginalized populations using a reproductive justice framework.
Georgia has one of the highest maternal mortality rates in the country with a rate of 33.9 pregnancy-related deaths per 100,000 live births between 2018 and 2021 — more than the national rate of 23.5 deaths per 100,000 live births.[1] The maternal mortality crisis in Georgia has been created and amplified by a lack of health insurance coverage, a sparse number of health care providers in rural regions, and systemic race-based disparities in the state.[2]
Before 2020, pregnant people in Georgia who qualified for Medicaid were likely to lose coverage sixty days after giving birth which was a particularly detrimental action given that “79% of pregnancy-associated deaths occurred between 43 days and one year after pregnancy.”[2] Additionally, it was reported that 93 out of the 109 rural counties in Georgia lacked a hospital-based labor and delivery unit in 2019, making it necessary for pregnant persons to travel long distances for prenatal, delivery, and postpartum care.[3] Further, because of systemic racism within the medical system, the maternal mortality crisis affects Black pregnant persons at a significantly higher rate with the mortality ratio being 48.6 deaths per 100,000 live births compared to a ratio of 23.3 deaths per 100,000 live births for White pregnant persons.[2]
The tremendous risks associated with pregnancy and birth especially for birthing people of color coupled with the global COVID-19 pandemic induced a political shift. In April 2021, healthcare coverage through Medicaid was expanded from covering the post-partum period for sixty days to providing coverage for six months.[4] In November 2022, this coverage was once again expanded to ensure 12 months of postpartum Medicaid eligibility.[5]
These changes did not come about easily. Reproductive justice organizations were instrumental to this shift in Georgia. These organizations, such as SisterSong and SisterLove, operate within a framework crafted by women of color and advocate for a person’s right to have children, not have children, and parent their children in safe and healthy environments. Through their political advocacy efforts and operations within their communities they have launched initiatives and supported policies to mitigate the maternal mortality crisis in the state.
Specifically, the efforts of reproductive justice organizations were prominent in the introduction and passage of H.B. 1114 which extended Medicaid coverage for low-income mothers from two to six months postpartum.[6] The six-month extension — H.B. 1114 — was re-introduced in 2020 by Republican representative Sharon Cooper and cosigned by a slate of Republican representatives.[6] It passed the House with a vote of 162 - 1 and the Senate with a unanimous vote of 114 – 0 in April 2021.[6] While a postpartum Medicaid expansion had been introduced many times before, the bill’s passage in 2021 not only emphasizes the focus on health forced on politicians by COVID-19 but also speaks to the advocacy efforts of reproductive justice organizations as they begin to assert a greater influence on the political landscape by building awareness.
Before these organizations could achieve such political successes, they first had to raise awareness about the issue. The maternal mortality crisis in Georgia was never a secret, but awareness about the issue had not been substantial enough to prompt political action until 2019, and much of this awareness was built by reproductive justice organizations. Reproductive justice organizations such as SisterLove and SisterSong have created initiatives to educate communities of color and community leaders about the high maternal mortality rate and the consequences of complicated legislation for people of color in an attempt to mobilize community members and stakeholders to place pressure on elected officials.[7] SisterLove hosted webinars and panels where they partnered with organizations such as Black Mommas Matter Alliance and Bellies to Babies Foundation to educate communities of color about maternal mortality, the steps that pregnant persons can take to have a healthier pregnancy, and the advocacy work that individuals can engage with through donations to birth funds or support for bills meant to improve maternal health.[8] By mobilizing larger constituencies of people into vocalizing their outrage about the maternal mortality crisis, reproductive justice organizations contributed to increasing the visibility and gravity of this reproductive health issue. Similar advocacy was undertaken when Senate Bill 338 was introduced in 2022 to expand postpartum Medicaid access from six months to one year after birth.
Since these changes to Medicaid access have only come about in the last two years, it is unclear what effect this expansion has and will have on maternal mortality rates. However, the 2022 Georgia Medicaid performance analysis suggests that there has continued to be poor performance regarding improving access to timely prenatal and postpartum care.[9] It is unsurprising that this policy has not translated to direct change, especially amidst intense pressures on the healthcare system caused by the COVID-19 pandemic. Moreover, the increased availability of Medicaid cannot erase the distrust of medicine held by communities of color due to centuries of abuse and willful ignorance.
Knowing that policy changes in Georgia do not always accomplish their intended purposes, reproductive justice organizations have also established initiatives outside of political advocacy that address the maternal mortality crisis through community education and development. In 2019, SisterSong established their Birth Justice Team in response to the maternal mortality crisis.[10] The team began a program referred to as the Maternal Health Awareness Training which has since been renamed to the Advanced Doula Skills Training.[10] The program was designed “to teach basic skills that monitor a pregnant person’s health while birthing and postpartum,” but pays special focus to the postpartum period when many maternal fatalities occur.[10] This program uniquely addresses the consequences of systemic racism in the health care system by educating individuals about the warning signs that are neglected because of physician biases.[10]
SisterSong has also established a Birth Justice Care Fund which — similar to pre-existing abortion funds — provides relief funds for “birthing people of color, especially Queer and Trans folks in need of support during their pregnancy and within one year postpartum.”[11] It also supports people of color birth workers who are exclusive partners of the care fund and can provide help outside of the medical system.[11]
Given the ancestors of the reproductive justice framework have been historically underserved by the government, there is a unique emphasis on creating programming that directly addresses the needs of the community. This has expanded the definition of advocacy work by allowing for more inventive solutions to the maternal mortality crisis that counteract some of the pervasive consequences of systemic racism and classism.
There is no one way to mitigate the maternal mortality crisis. It will take the conjoined efforts of researchers, politicians, maternal health advocates, and health care providers to meaningfully address this tragedy. I take some solace in knowing that the postpartum Medicaid expansion in Georgia (and 37 other states) is outside of the Medicaid continuous enrollment provision that was enacted during the pandemic and is now being unwound. When taken in conjunction with its robust reproductive justice network, the substantial postpartum Medicaid coverage makes Georgia an interesting landscape to consider what could happen and what partnerships may be undertaken for a postpartum Medicaid expansion to significantly decrease maternal mortality rates especially for communities of color. However, we must first move beyond preconceived notions of birthing and try to reimagine a system flexible enough to equitably address the needs of diverse populations. But will political polarization in the state (and country) allow for this?
References
1. Hoyert, D.L., Maternal mortality rates in the United States, 2021. 2023, National Center for Health Statistics (U.S.): https://stacks.cdc.gov/view/cdc/124678.
2. Maternal Mortality Report 2018-2020. 2023, Georgia Department of Public Health https://dph.georgia.gov/maternal-mortality.https://dph.georgia.gov/maternal-mortality.
3. Armstrong-Mensah, E., et al., Geographic, Health Care Access, Racial Discrimination, and Socioeconomic Determinants of Maternal Mortality in Georgia, United States. Int J MCH AIDS, 2021. 10(2): p. 278-286.
4. Hallerman, T., Legislature Passes Maternal Mortality Plan, in The Atlanta Journal-Constitution. 2020.
5. Medicaid, PeachCare for Kids® Postpartum Medical Services Extended. 2022: Georgia Department of Community Health.
6 .Georgia House Bill 1114 2020: LegiScan.
7. Oladipo, G., In Georgia, Black Women Lead the Fight Against High Maternal Mortality Rates and Anti-Choice Legislation, in Rewire News Group. 2020: https://rewirenewsgroup.com/2020/04/13/in-georgia-Black-women-lead-the-fight-against-high-maternal-mortality-rates-and-anti-choice-legislation/.
8. Simon, L., Prevalence of Maternal Morality: A Reproductive Justice View. 2021: https://www.sisterlove.org/post/prevalence-of-maternal-morality-a-reproductive-justice-view.
9. 2023 Quality Performance Dashboard for Georgia Families. 2023, Georgia Office of Analytics and Program Improvement: https://public.tableau.com/app/profile/dch.oapi/viz/2023_GAFamiliesDashboard/2023Dashboard.
10. SisterSong. Birth Justice Programming [cited 2023.
11. SisterSong. Birth Justice Care Fund. [cited 2023.