Table of Experts: Addressing maternal health disparities in Georgia
To discuss solutions to this important and persistent issue, the Chronicle invited Jemea Dorsey, CEO of the Center for Black Women's Wellness, Dr. Dean Burke, Chief Medical Officer at the Georgia Department of Community Health, and Dr. Chadburn Ray, Professor of Obstetrics Gynecology at Augusta University, to share their experiences. Cheryl Preheim, weekday morning anchor at 11Alive Morning News on WXIA Atlanta, served as moderator. Their conversation touched on the obstacles to maternal healthcare equity, the role of data in identifying solutions, and the progress Georgia has made on the issue.
What is the current state of maternal mortality in Georgia?
Dorsey: I've been involved in work to address maternal and infant mortality for over 20 years and, tragically, there have been persistent inequities in maternal and infant health. We're troubled by the data. While our programming is often geared towards underserved women, the research shows that income and insurance status aren't protective factors for Black women, as Black women with insurance and high incomes still face poorer maternal health outcomes. Addressing these challenges requires shared commitment, innovation, and collaboration, as well as continued federal, local, corporate and philanthropic investments.
At the Center for Black Women's Wellness, our focus for the past 37 years has been on providing a safety net for uninsured and underinsured individuals. We're a community-based nonprofit that provides home visitation, care coordination, linkages and wraparound services to make sure moms are healthy before, during and after pregnancy.
For us, it's about connection and support. How do we make sure that women are healthy before pregnancy? How do we ensure that we're supporting them during that critical time? Has our patient been screened for depression and interpersonal violence? Did she get connected to a therapist? We have perinatal health workers, a mental health therapist and nurse case manager on staff, which allows us to support women who need help the most with wraparound and supportive services. Over time we've seen improved outcomes and great impact.
Why is it so important to track maternal mortality data?
Dr. Ray: When I started my career, I was taking care of one patient at a time, like most doctors do. Eventually, I got into the advocacy space, where I started to appreciate the complexity of an individual and their relationship to population-level health disparities.
In 2010, Amnesty International produced a publication saying that Georgia was the worst state for maternal mortality. That publication came out as I was watching hospitals close and seeing maternity deserts start to form. I wanted to be part of understanding what was going on.
We're now a decade into having a gold-standard process for counting maternal deaths. We've done a really good job in Georgia at understanding the whys. The focus now is what are we going to do to address those whys?
My dream is that every patient is treated the same and that there are no health inequities or disparities. Georgia is leading the charge for that. I caution folks when they compare Georgia to other states or countries, because how you count matters, and every place does it differently. The point is to understand what the problems are and fix those problems. So, I don't really care about the rankings. I just want to be the best that we can possibly be.
On that note, while the maternal death rate gets most of the attention, it doesn't account for individuals who have near-death experiences or who develop lifelong disease because of something that was exacerbated during pregnancy. We talk about it in the framework of 'maternal health,' but it's really just health, period. Pregnancy doesn't typically make your conditions better. It tends to exacerbate issues.
We really need to work on the social drivers of health like housing and food insecurity. Georgia has had good support from lawmakers who have pledged their support for the system that helps identify those issues.
What changes has Georgia made to move the needle on maternal mortality?
Dr. Burke: It all starts with the data that the Georgia Maternal Mortality Review Committee (MMRC) shares with us. We identify when these mortalities occur, where they occur, what the mitigating factors were and what could have been done differently. Then we rank those issues — because you can't fix a system like this all at once.
Georgia's a big state with a lot of people. What works in Massachusetts is not necessarily going to work in Georgia, and what works in Rome, Georgia, is not necessarily going to work in Waycross. The culture is different in different parts of the state.
We get the information first and then we look for the low-hanging fruit. Where can we get the most bang for our buck? For example, we saw that there were a huge number of events during the postpartum timeframe that were being overlooked. MMRC recommended that the state extend postpartum Medicaid coverage from 60 days to a full year. In 2022, the state elected to extend postpartum coverage to 12 months for individuals who are pregnant while enrolled in Medicaid.
The data shows that a lot of maternal mortality events happen in rural areas where there are maternal health deserts. The problem is that rural OB health practices don't make sense from a business standpoint. The hospital systems can't make a margin delivering babies in a rural community because the volume just isn't there. To mitigate that issue, the legislature, with the Governor's support, developed an add-on program to rural providers and hospitals in counties with populations under 35,000. Providers receive add-on payments for each Georgia Medicaid covered delivery. This helps these rural hospitals and providers get closer to financial stability. The Governor and the legislature increased those add-on patients this past legislative session and those new dollars will flow in FY 26 once we get CMS approval later this calendar year.
We are always exploring innovative methods to improve financial stability and outcomes in all of Georgia with a focus on the areas that are struggling the most.
Where can initiatives make the biggest impact going forward?
Dorsey: To achieve big impact, initiatives must focus on removing barriers to care and fostering trust by building community.
Our patients generally fall into two categories. Often, they're women who, due to a major life incident, have lost health coverage. These could be women who just divorced and lost their husband's health insurance, or women who lost their job. But for them, it's episodic. We meet women like this all the time that have good health-seeking behaviors and are used to getting routine healthcare, but because of a gap in insurance, they come to us to get free and low-cost healthcare.
Then there are women who I would define as hard to reach. They're women who historically have gone without care. We might have a plethora of amazing resources in this state, but there are still physical barriers, like lack of transportation, as well as psychological barriers to getting care. There are people who mistrust the healthcare system or have felt disrespected by the healthcare system. We see women every day who come to us that have gone without healthcare for a long time. I think we tend to underestimate the impacts of that. When someone has gone without healthcare for so long, there are going to be health issues. And those health issues may impact pregnancy.
At the end of the day, as much as we can talk about the data, we also have to talk about the people. These are real women with real stories, and we have to take that seriously. We want to build community and help women be healthy before, during and well beyond pregnancy. Our guiding value is to treat everybody with dignity and respect. We don't know your life story. We're just glad you're here.
Why is it important to think about the big picture beyond the pregnancy term?
Dr. Ray: As I seek opportunities for solutions, I think about it as an impact pyramid. Which interventions are the likeliest to have an impact, and how big is the potential impact? Addressing cultural and social drivers of health can create massive impacts. The clinical care and education that I can provide at the bedside is minor by comparison.
We're looking at barriers like transportation. Working in the East Central Health District, there's truly a maternity desert around us. The Augusta-Richmond County area is an oasis in the middle of this desert. It looks the same on the other side of the border in South Carolina, by the way.
Because folks are driving so far, we're seeing higher neonatal complications and pre-term births. That's directly related to the distance to care. Creating hub-and-spoke models and using digital health to drive patient engagement are both part of our holistic approach.
Nutritional health is another component. The condition that's most important to address for postpartum health in the Black, non-Hispanic population turns out to be cardiovascular disease. That insight led us to a develop a robust cardio-obstetrics program, which can support women on Medicaid for up to 12 months postpartum, thanks to the postpartum coverage extension.
Going forward, what is the most important thing to focus on for preventing maternal mortality?
Dr. Burke: We need to find the people at risk and we need to know where they are. When people show up to the emergency room with complications and they're already seven months pregnant, we're starting from way behind. We need to start in the community, building trust with the people and doing outreach so that we identify women that are at high risk. We have some information about them, but we need to contact those folks early on and make sure they have the infrastructure around them.
The state is developing a model with the help of our major health systems in which we partner with Public Health to have home visitation from case managers, who will identify the high-risk folks and get them access to maternal medicine specialists through telehealth.
We also need a central repository for our maternal health data. It doesn't do any good for somebody to have the results of five tests stuck in one system when they're over at a new health system that doesn't have any information about what's happened in the past. That movement of information is a key part of this. And that's a problem in healthcare across the board. It's not unique to women's health.
I will say, I've been in this space for 40 years now, and there are always lots of people working to solve this problem. Frequently, the right hand doesn't know what the left hand is doing. So, when I speak to people that are interested in solving this problem, I always recommend that if they're not partnering with other folks in the community, they should make sure that what they're doing doesn't duplicate what somebody else is already doing. Maybe those resources could be put in a better place.
I'm always hearing about conferences across Georgia about maternal health, and I ask, 'Who are these people? What are they doing? And why do I not know about them?' I'm in a position where I should have a pretty good feel for what's going on, but nobody told me about it. So, I think communication and cross-pollination is critical.
Experts
Dean Burke, M.D., Chief Medical Officer, Georgia Department of Community Health. Dr. Dean Burke is Chief Medical Officer of the Georgia Department of Community Health, the state's healthcare finance and regulatory agency. With a budget of over $4 billion annually in state funds and $18-plus billion in combined state and federal dollars, DCH manages the state's Medicaid and State Health Benefit Plan programs, among others. Dr. Burke has direct oversite of SHBP and the State Office of Rural Health and advises the Commissioner of DCH on healthcare policy and oversight. Previously, Dr. Burke has served for 10 years as the State Senator for District 11 in deep Southwest Georgia. Prior to being elected to the State Senate, Dr. Burke practiced obstetrics and gynecology for 27 years in Decatur County and served for 10 years as Chief Medical Officer at Memorial Hospital and Manor in Bainbridge.
Jemea Dorsey, Chief Executive Officer, Center for Black Women's Wellness. Jemea Dorsey is CEO of the Center for Black Women's Wellness, an Atlanta-based nonprofit organization that aims to improve the health and well-being of underserved Black women and their families. As CEO, Dorsey is responsible for the overall management and operations of the community-based organization, which provides low-cost healthcare services, economic well-being programming, and perinatal case management services to more than 3,100 individuals annually. A creative leader and multi-tasker with a proven track record, Dorsey has more than 25 years of nonprofit management experience. She holds a Master of Science degree in urban policy from the New School.
Chadburn Ray, M.D., Professor of Obstetrics and Gynecology, Augusta University and OB/GYN and Medical Director of Labor and Delivery, Wellstar MCG Health Medical Center. Dr. Chadburn Ray is a Professor of Obstetrics and Gynecology at Augusta University. After completing his undergraduate education at the College of Charleston, Dr. Ray graduated magna cum laude from the Medical University of South Carolina College of Pharmacy. He practiced retail pharmacy in Aiken, South Carolina, and hospital pharmacy at the MUSC Children's Hospital in Charleston before returning to medical school in 1998. He graduated from the MUSC College of Medicine in 2002. Dr. Ray completed his residency in obstetrics and gynecology at the Medical College of Georgia, serving as administrative chief resident. Following graduation from residency in 2006, he joined the academic faculty at the Medical College of Georgia at Augusta University in the department of obstetrics and gynecology. Dr. Ray maintains a busy clinical practice and has been recognized as a Castle Connelly Top Doctor since 2014.
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