LISTEN: A report from an organization that advocates for equity in health care ranks Georgia among the worst states for women’s health. The Commonwealth Fund says the state has several key issues to address. Georgia findings rank the state's performance on maternal and infant mortality rates, access to maternity providers and uninsured rates among pregnant women. GPB’s Ellen Eldridge has more.

Raquel Robinson poses with her one-year-old daughter Londyn Crenshaw

Ohio mother Raquel Robinson poses with her daughter Londyn Crenshaw in 2024. But after Londyn's birth, Robinson was diagnosed with postpartum depression — a problem in Georgia as well.

Credit: (AP Photo/Phil Long)

The Commonwealth Fund's scorecard ranks states' performance on maternal and infant mortality rates, access to maternity providers and uninsured rates among pregnant women.

Georgia's report specifically mentions maternal and infant mortality, poor access to health care and a lack of insurance for people of reproductive age (15 to 44), lead author Sara Collins said.

"Women's inability to afford needed health care of all kinds is most pronounced in states that haven't expanded their Medicaid programs," Collins said. "And we see that pattern play out in Georgia in particular."

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When people don't have physical and mental health care prior to pregnancy, they lack an established networks of physicians and health care providers.

Georgia is one of 10 states including Texas and Alabama that has not expanded Medicaid.

Georgia has the second-highest rate of uninsured women in the United States after Texas, with about 15% of women in the state who are uninsured.

This is three times the rate of Massachusetts, the top-rated state, Collins said.

    Gov. Brian Kemp's program to expand health care coverage in Georgia is called Pathways to Coverage, and he said it is meant to help more lower-income Georgians receive Medicaid health insurance. But it includes a work requirement.

    Georgia is the only state in the nation requiring 80 work hours per month or participation in education, job training, or other approved activities, such as community service.

    Qualifying adults are between ages 18 and 64, earn less than 100% of the federal poverty level, and are not otherwise eligible for Medicaid.

    For 2022, the federal poverty level was $13,590 for a single person and $27,750 for a family of four.

    The fund's scorecard ranks Georgia 46th overall for women’s health, and notes that, nationwide, mental health conditions are the most frequently reported cause of preventable pregnancy-related death, including deaths by suicide and overdoses related to substance use disorders.

    States that screened for postpartum depression at the highest rates also had the lowest rates of postpartum depression, Collins said.

     

    'Maternal mental health must be taken into consideration'

    Perinatal mood and anxiety disorders (PMADs) can affect all women, regardless of ethnicity, age, or socioeconomic status. Often, the term “postpartum depression” is used to generalize these conditions, but mothers can experience more than just depression.

    An estimated 30,000 Georgia women experience these illnesses every year, according to the Georgia Department of Behavioral Health and Developmental Disabilities, and close to 700 Georgians reported postpartum depressive symptoms in 2020, though the number of unreported cases likely makes that number much higher.

    Between 2015 and 2020, there were 28 deaths by suicide in Georgia where the person was “pregnant at time of death, within one year of death or not otherwise specified,” according to data from the Centers for Disease Control and Prevention.

    Overall, Georgia also has one of the highest rates of maternal mortality in the country. 

      As of 2010, more than half of mothers of infants participated in the labor force (56%), making these statistics especially significant to employers across the country losing $44 billion a year in lost productivity and $12.4 billion in health care expenses.

      “Maternal mental health must be taken into consideration, if not for the human and quality of life cost, for the economic savings,” according to the Mental Health of America’s Georgia chapter.

      The fund's scorecard notes that the U.S. Supreme Court decision overturning Roe v. Wade in June 2022 significantly altered both access to reproductive health care services and how providers are able to treat pregnancy complications in the 21 states that ban or restrict abortion access.

      Georgia's six-week ban on abortion is a factor in the number and quality of maternity health care workers available, Collins said.

      "In states with bans we're seeing a drop off, for example, in medical students who are applying for residencies," she said. "So, it raises concern about that policy decision, raises concern about Georgia's ability to maintain an adequate maternal health care workforce, and also raises concerns about being able to attract physicians in all specialty areas."

      Tags: Georgia  maternal death  maternal and infant health  Mental Health  health  postpartum depression