Examining Interventions to Reduce Maternal Death in Georgia

Brenna Daly

University of Georgia

Research Question: What are the most effective intervention methods for reducing maternal

mortality in Georgia?
EXAMINING INTERVENTIONS TO REDUCE MATERNAL DEATHS IN GEORGIA

Abstract:

Access to maternal health care and education before, during, and after pregnancy is

important in ensuring the safety for both mothers and their children. Various racial and ethnic

minorities, low socioeconomic groups, and women living in rural communities often have more

negative pregnancy-related outcomes due to these lack of resources. The target population in this

literature review is women that gave birth in the state of Georgia in the past ten years. This state

was specifically chosen due to high maternal mortality rates in the area. The purpose of this

review is to examine intervention methods that can reduce maternal deaths in Georgia. The aims

include to explore a variety of intervention methods concerning health professionals, care

accessibility, education, and hospital protocols. The databases utilized for research included

PubMed and Medline and a total of ten articles were selected. The findings of the review were

that effective intervention methods include educating health professionals, implementing

hospitals programs, and expanding access to maternal care.

Table of Contents

Introduction………………………………………………………………………………………..4

Purpose…………………………………………………………………………………………….5

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EXAMINING INTERVENTIONS TO REDUCE MATERNAL DEATHS IN GEORGIA

Methods…………………………………………………………………………………………....6

Results……………………………………………………………………………………………..8

Educating Health Professionals……………………...……………………………………8

Implementing Hospital Programs…………………………………………………………8

Expanding Access to Care………………………………………………………………...9

Table 1. Article Reviewed………………………………………………………………..10

Discussion………………………………………………………………………………………..13

Limitations……………………………………………………………………………….14

Implications……………………………………………………………………………... 14

Conclusion………………………………………………….……………………………15

References………………………………………………………………………………………..16

Introduction

Georgia has one of the highest maternal mortality rates in the country. Between 2013 and

2017, there were 66.3 deaths per 100,000 live births in Georgia (Grady News, 2020). This is

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EXAMINING INTERVENTIONS TO REDUCE MATERNAL DEATHS IN GEORGIA

about double the national maternal death rate of 29.6 deaths per 100,000 live births (Grady

News, 2020). These maternal deaths disproportionately affect women of a racial or ethnic

minority and women of lower socioeconomic status (CDC, 2018). This is due to a multitude of

factors: improper communication from health professionals, access to quality care, and

pre-existing diseases. These women are more at risk for not being able to access quality care

during and after pregnancy, putting them at greater risk for birthing complications (severe

bleeding, high blood pressure, infection) or post pregnancy complications, including death.

Some of the current methods being utilized to address this issue include maternal safety

bundles and efforts to extend healthcare coverage for mothers. Maternal safety bundles are a set

of practices that are meant to improve patient outcomes by closely monitoring the patient’s stats.

In terms of healthcare coverage, many women fall victim to insurance gaps in maternal care

coverage. Women that are unable to afford this insurance or procure it through their workplace,

are reliant on state Medicaid programs. To qualify, pregnant women must have an income of less

than 225% of the Federal Poverty Level (McMorrow & Kenney, 2018). Some downfalls of this

are that eligibility thresholds for current parents are much lower than those for expecting women,

leaving many of these future mothers without insurance. The coverage is also usually terminated

60 days after delivery. The lack of insurance leads to lessened access to postpartum care, making

women more susceptible to maternal mortality. Without access to postpartum care, women are at

a greater risk for post-birth complications and not being diagnosed for postpartum depression

(Maternal Health Task Force, 2021). Though, there have been recent strides in trying to resolve

this issue. In Georgia, a legislative study committee on maternal health has proposed a bill to

extend this coverage to a year postpartum (Williams, 2020). The committee also recommended

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EXAMINING INTERVENTIONS TO REDUCE MATERNAL DEATHS IN GEORGIA

that the state should support and fund efforts to address healthcare workforce disparities in rural

Georgia. A lack of infrastructure in rural and mountainous areas can make it difficult to travel to

healthcare professionals. In rural Georgia the maternal mortality rate was 24.3%, compared to

16.5% in non-rural areas in 2012 (Romain-Lapeine, 2015). No rural counties have a

maternal-fetal medicine specialist and 93 do not have a hospital with a labor and delivery unit

(Warren, 2019). The lack of specialists in these counties often has to do with professionals

choosing to work in counties that are more financially stable.

There were 66.3 deaths per 100,000 live births in Georgia between 2013 and 2017 (Grady

News, 2020). This is over two times the national maternal death rate of 29.6 deaths per 100,000

live births (Grady News, 2020). It is important to identify the factors that contribute to this and

the best way to reduce these rates. If we do not address the problem, then women will continue to

die even though many of these deaths can be prevented with adequate intervention strategies.

Purpose

The purpose of this literature review is to compile and evaluate interventions that can be

used to prevent maternal deaths from occurring. The aim of this paper is to identify the best ways

to address maternal mortality in the state of Georgia. There is a lack of research examining the

different intervention methods to reduce maternal deaths, specifically ones that would best

address the issues that contribute to higher rates in Georgia.

Methods

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EXAMINING INTERVENTIONS TO REDUCE MATERNAL DEATHS IN GEORGIA

To determine the interventions that are being conducted or proposed to address maternal

mortality, a literature search was conducted. The article selection process for this literature

review is detailed in Figure 1. The articles utilized within this literature review were selected

from the PubMed and Medline databases.

As the topic of interest in maternal mortality interventions in Georgia, the Medline

database was chosen because this database includes information about a variety of relevant

subjects, giving broader information about current maternal mortality interventions. The first

search in the Medline database was “maternal mortality” and this produced 41,752 results. The

second search used was “maternal mortality and Georgia”. This produced 87 results.

The PubMed database was also chosen because this database includes information about

a variety of relevant subjects, such as medicine and the health care system. This database had

information about a multitude of studies concerning maternal health interventions in the state.

This PubMed search was “maternal mortality” and this produced 43,299 results.The second

search used was “maternal mortality and interventions”. This produced 19,890 results. To further

narrow the results, the third search was “maternal mortality and interventions and United States”.

This produced 3,287 results. The fourth search conducted was “maternal mortality and

interventions and United States and Georgia” producing 164 results. The final search used was

“maternal mortality and interventions and United States and Georgia and education”. This

narrowed the search to 39 results.

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EXAMINING INTERVENTIONS TO REDUCE MATERNAL DEATHS IN GEORGIA

For this paper, articles from the past 10 years were chosen from both databases to ensure

relevant and up to date information was utilized. This paper focuses on “Georgia”, which was

used as a key research term. Georgia differs from other parts of the United States in terms of

population makeup and healthcare accessibility. Deaths that are included in the maternal

mortality rate are deaths during or within one year of the end of the pregnancy from a pregnancy

complication or an unrelated condition that was aggravated by the pregnancy. This search

resulted in a total of 10 articles.

Results

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EXAMINING INTERVENTIONS TO REDUCE MATERNAL DEATHS IN GEORGIA

After a thorough review of the 10 selected journal articles, three main intervention

strategies would be the most effective in addressing high maternal mortality rates in Georgia. A

detailed summary of the findings of each journal article is presented in Table 1 at the end of this

section.

Educating Health Professionals

One effective maternal mortality strategy is to educate health professionals on racial and

economic status disparities. Multiple reviewed studies acknowledged that women of low

socioeconomic status and racial minority women were at increased risk for maternal mortality

(Mobley et al., 2014; Kramer, 2019). A national data study found that women of racial and

ethnic minorities had inequalities in health services and maternal health outcomes (Sutton et al.,

2021). A Georgia based study of pregnant African American women found that low

socioeconomic status contributes to maternal mortality and morbidity due to lessened access to

quality care and miscommunication issues (Shahin et al., 2020). In order to address this disparity,

these women need access to high quality maternal services with professionals that are able to

communicate clearly. It is essential that health professionals are well versed on this topic and

properly disseminate necessary information to patients. One specific avenue of spreading this is

utilizing a multitude of platforms: social media, attending conferences, speaking with the media,

reaching out to policy makers, and releasing publications on maternal health to ensure that

information reaches as many patients and practices and possible (Logsdon., et al., 2019).

Implementing Hospital Programs

Implementation of programs in hospitals that specifically focus on reducing maternal

mortality are effective. Georgia’s 2012-2013 maternal mortality review committee identified that

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EXAMINING INTERVENTIONS TO REDUCE MATERNAL DEATHS IN GEORGIA

“more than half (52%) of the pregnancy-related deaths occurred within 42 days after pregnancy

(Lindsay et al., 2107). The five most common causes of pregnancy-related deaths were

hemorrhage (28%), hypertension (16%), cardiac disease (16%), embolism (16%), and seizures

(12%)” (Lindsay et al., 2107). If the hospital staff knows how to identify and handle these

common causes of pregnancy-death, then women will be less at risk for experiencing these

complications. These types of interventions have been proven to show results. For example, the

Hemorrhage Quality Improvement Project was implemented at 58 hospitals across New Jersey,

Georgia, and Washington, DC. All hospitals that implemented this project saw participation

improvements in debriefings, quantification of blood loss, and hemorrhage risk assessment:

pre-birth risk assessment increased from 2% to 52%, post-birth risk assessment increased from

2% to 57%, hemorrhage assessment risk increased from 10% to 70%, drill participation for

registered nurses increased from 0% to 92%, and debriefing increased from 1% to 13%

(Bateman et al., 2018). Considering that hemorrhage was the leading cause of pregnancy related

death in Georgia, maternal deaths can be reduced by creating initiatives that target this risk

directly. Also, it is important that there is a standardized methodology of evaluating maternal

level of service across all hospitals. Currently, most hospitals in Georgia self-report their level of

maternal service and this makes it difficult to evaluate which hospitals need to implement

programs for improvement (Vanderlaan et al., 2019).

Expanding Access to Care

The third effective maternal mortality intervention is addressing lack of access to quality

care. The Georgia Maternal and Infant Health Research Group investigated the shortage of

providers outside of the Atlanta area and identified factors that prevent access to care: delays in a

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EXAMINING INTERVENTIONS TO REDUCE MATERNAL DEATHS IN GEORGIA

woman's decision to seek prenatal care (awareness of pregnancy and stigma); delays in accessing

an appropriate healthcare facility (choosing a doctor and receiving insurance coverage); and

delays in receiving appropriate care (Meyer et al., 2016). The Georgia Maternal and Infant

Health Research Group assessed possible ways to address this obstacle (Zertuche et al., 2016).

The Group has established an initiative meant to improve “perinatal regionalization” in Georgia.

“Perinatal regionalization” is a system that establishes providers and hospitals throughout the

region to assure proper levels of maternal care for mothers and expecting mothers. Implementing

these regional centers creates more facilities where women would be able to access this care. The

Georgia Maternal and Infant Health Research Group concluded that this intervention is effective

and cost efficient. Programs that expand the number of facilities where maternal care can be

accessed addresses the scarcity of providers outside of the Atlanta area. To address the obstacle

of receiving insurance coverage, expansion of eligibility and insurance coverage has been shown

to lower maternal mortality rates (Eliason, 2020). This study analyzing maternal mortality in

states that expanded Medicaid found that these states not only had decreased maternal mortality

rates, but also noted that expansions can help reduce racial disparities (Eliason, 2020). This is

because the effects of expanding coverage tend to be more concentrated in disadvantaged racial

and ethnic minority groups.

Table 1:

Author(s) Year Article Title and Purpose of article Sample Info Type of Research Findings Limitations of
Journal Research article

1 Bateman, B. 2018 Structure, process, describe the processes registered nurses Field study Pre-birth risk all the structures
Bingham, D. and outcome data and structure and nurse assessment and processes
Scheich, B. of AWHONN’s improvements that were hospital leaders increased from 2% were able to be
Postpartum implemented at 58
at the 58 to 52%, post-birth implemented by
Hemorrhage hospitals in Georgia,
Quality New Jersey, and hospitalsHemorr risk assessment the hospitals
Improvement Washington, DC through hage Project. increased from 2% during the 18
Project. Journal of the Association of to 57%, debriefing

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EXAMINING INTERVENTIONS TO REDUCE MATERNAL DEATHS IN GEORGIA

obstetric, Women’s Health, increased from 1% month phase of

gynecologic, and Obstetric, and Neonatal to 13%, drill implementation
neonatal nursing Nurses Postpartum participation for
Hemorrhage Project
registered nurses
increased from 0%
to 92%, and
hemorrhage
assessment risk
increased from 10%
to 70%.

2 Eliason, E. 2020 explores the effect of 31 states and the difference-in maternal mortality there may be
Medicaid expansion District of -difference ratio among other
under the Affordable Columbia that research Medicaid expansion unexplained
Adoption of Care Act on the maternal expanded their design states has increased reasons for the
Medicaid mortality ratio in the Medicaid much less compared difference in
Expansion Is United States programs under with non expansion trends among
Associated with the ACA by 2017 states expansion and
Lower Maternal and 19 that did non expansion
Mortality not states
Women’s Health could not
Issues account for any
reporting
differences not
captured by
controlling for
the pregnancy
checkbox that
may have
occurred during
the timeframe

3 Kramer, M. 2019 Changing the The purpose of this The results Qualitative The study developed Only based on
Strahan, A. conversation: article is to examine the indicate that methods a framework to surveillance data
Preslar, J. applying a health efforts to solve inequity creating maternal address reproductive
health issues.
Zaharatos, J. equity framework in maternal mortality. mortality review
St Pierre, A. to maternal committees
Grant, J. mortality reviews would allow for
Davis, N. multiple
Goodman, D. American Journal interventions to
Callaghan, W. of Obstetrics and be implemented.
Gynecology

4 Logsdon, M. 2019 Maternal mortality The purpose of this participants in Qualitative The results indicate Does not
Kenner, C. in the United article is to investigate maternal health study that nurses hold a examine other
Choi, K. States: Targeted how synthesizing and programs and special position of intervention
methods
Amankwaa, L. dissemination can disseminating nursing research public trust that can
Walker, D. help to address the knowledge across the conducted by: the allow for optimal
Breedlove, G. problem United States can reduce Center for public health impact
maternal mortality rates. Disease Control through stakeholders
Journal of and Prevention, via knowledge
Advanced Nursing March for Moms translation.
organization,
Alliance for
Innovation on
Maternal Health
and Safety
Initiative, the
American
Academy of
Nursing, and the

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EXAMINING INTERVENTIONS TO REDUCE MATERNAL DEATHS IN GEORGIA

Maternal and
Child Health
Bureau

5 Meyer, E. 2016 Working Towards Identify factors that make 24 mothers who Interviews Not receiving Mothers under
Hennink, M. Safe Motherhood: it difficult for women gave birth and adequate and 18 and
Rochat, R. Delays and living in rural and between July and qualitative appropriate care was undocumented
Julian, Z. Pinto, Barriers to peri-urban areas of August 2013, and methods the main issue in female
M. Zertuche, A. Prenatal Care for Georgia to access who live in either accessing maternal immigrants were
Spelke, B. Dott, Women in Rural maternal care shortage or care not included in
A. and Peri-Urban non-shortage the study
Cota, P. Areas of Georgia. obstetric care
Maternal and child service areas
health journal

6 Mobley, C. 2014 Maternal health To research the impact of 106 low income, Case studies Case management Was difficult to
Thomas, S. literacy the Enterprise high risk, rural was associated with account for
Sutherland, D. progression Community Health Start perinatal African maternal literacy underlying
Hudgins, J. among rural Program American and progression contributing
Ange, B. perinatal women. White women factors to results
Johnson, M. Maternal and child who received
health journal home visits by
Registered Nurse
Case Managers
through the
Enterprise
Community
Healthy Start
Program

7 Shahin Z. 2020 Maternal The purpose of this The population Qualitative The results of the inconsistency in
Hardwick I. Mortality among article is to understand studied was methods study indicated that reporting
Jeffery N. African American the causes of maternal pregnant African low socioeconomic maternal death
data
Jordan J. Mase, Women in the mortality in the state of American status, pre-existing
W. State of Georgia, Georgia, specifically women in health conditions,
Causes, Policy, focusing on African Georgia that and ineffective
and Ethical American women. suffered from communication
Considerations. pregnancy between patients and
complications or providers can
Journal of the death. contribute to
Georgia Public maternal mortality
Health and morbidity for
Association African American
women.

8 Sutton, M. 2021 Racial and ethnic The purpose of this Black, American Summary of The study found The data used
Anachebe, N. disparities in article is to examine the Indian, Alaska national data prevalent racial and did not all have
Lee, R. reproductive racial and ethnic Native, White, ethnic disparities in same
methodology to
Skanes, H. health services disparities for women’s and Hispanic health services,
define results
and outcomes reproductive health in the women that access, and
United States: sought out outcomes. Specific
Obstetrics & contraceptive use, services inequalities include
Gynecology maternal mortality and concerning access to
morbidity, reproductive reproductive contraceptives,
cancers, vaccination for health and maternal deaths, and
human papillomavirus, women with one HIV infections.
sexually transmitted of the
infection care, and low reproductive
birth weights. health outcomes
that were
measured in the
United States

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EXAMINING INTERVENTIONS TO REDUCE MATERNAL DEATHS IN GEORGIA

9 Vanderlaan, J. 2019 To examine delivery women Secondary No correlation The hospitals

Rochat, R. hospitals levels of service experiencing analysis between hospital self reported
Williams, B. association with maternal singleton births service levels and level of service
Dunlop, A. Service Level and and neonatal outcomes in Georgia from maternal and
Shapiro, S. Delivery for women with high risk 2008 to 2012. neonatal outcome
Outcomes pregnancies
Women’s Health
Issues

10 Zertuche, A. 2016 Georgia Maternal To examine the Georgia Politicians, survey The unique There are outside
Spelke, B. and Infant Health Maternal and Infant health interventions factors that
Julian, Z. Research Group Health Research Group’s professionals, methods of Georgia influenced these
Pinto, M. (GMIHRG): research initiatives and the public of Maternal and Infant results other than
Rochat, R. Mobilizing Allied Georgia Health Research the group’s
Health Students Group is a cost initiatives
and Community effective method for
Partners to Put education, advocacy,
Data into Action. and changes in
Maternal and child policy
health journal

Discussion

Maternal mortality rates are higher than the national average in the state of Georgia.

Racial and ethnic minority women and lower socioeconomic status women are at an increased

risk for these pregnancy complications. Current intervention methods are working towards

reducing maternal mortality through improving education, healthcare accessibility, and

communication between patients and healthcare providers.

The overarching findings of this literature review are that health professional education,

maternal mortality hospital interventions, and expanding access to maternal care are effective

methods to reduce pregnancy complications and maternal mortality rates in the state of Georgia.

Educating health professionals on factors that put women of low socioeconomic status and racial

minorities at an increased risk for maternal complications will allow them to adjust their care and

communication method accordingly (Shahin et al., 2020; Sutton et al., 2021). Having specified

hospital programs relating to preventing maternal mortality will allow hospital workers to better

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EXAMINING INTERVENTIONS TO REDUCE MATERNAL DEATHS IN GEORGIA

identify and resolve risks and complications that can contribute to maternal deaths (Bateman et

al., 2018; Lindsay et al., 2107). Increasing the number of maternal health facilities and providers

makes healthcare more accessible to women living in areas with a lack of access to these services

(Zertuche et al., 2016; Eliason, 2020). The findings of this review are consistent with current

information surrounding factors that contribute to high maternal mortality rates in Georgia.

These findings help add to the knowledge known about this issue by discussing the best

proposed methods for maternal mortality that may more directly account for maternal mortality

risk factors that currently implemented programs.

Limitations

This review only provided evidence from 10 articles. There is an unlimited number of

maternal mortality interventions that can occur from the lenses of: education, healthcare

coverage, health policy, communication, and hospital programs. In addition, every maternal

mortality case has its own contributing factors that may be difficult to address with any of the

interventions discussed. Systemic health system issues concerning costs, discrimination, and lack

of education may only be addressed through systematic reform.

Implications

Concerning policy, legislative committees are currently working on maternal healthcare

coverage and implementing hospital bundles (Williams, 2020). Since maternal health has only

recently become a priority in the state, committees have mainly been focusing on figuring out the

factors contributing to these deaths rather than implementing programs to address them. This

research can help political officials become exposed to intervention proposals that would address

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EXAMINING INTERVENTIONS TO REDUCE MATERNAL DEATHS IN GEORGIA

the maternal health issues unique to Georgia. There needs to be more research done on the cost

effectiveness of these programs. To be implemented on a widespread scale, these

implementations will likely need to be handled and funded by the state of Georgia. The

implementations will need to be covered by allocated funds given by the state. One source of

income that can cover these implementations is the Maternal and Child Health Services Title V

Block Grant, which is a federal-state partnership that allocates to health improvements for

women, children, and infants (Georgia Department of Public Health, 2021). Expensive

interventions will be much more difficult to get majority political support to be implemented.

Conclusion

Interventions are needed to address the high maternal mortality rates in Georgia. After

examining a variety of proposed intervention strategies, three appeared to be most effective in

addressing the factors that contribute to maternal mortality in the state. Taking into account the

maternal mortality racial and economic outcome disparities and unique factors to Georgia

(uneven distribution of maternal health facilities and providers), hospital programs, educational

initiatives for health professionals, and expanding perinatal regionalization most directly targeted

these factors. By implementing these interventions, Georgia can improve maternal health

outcomes.

References

Bateman, B., Bingham, D., & Scheich, B. Structure, Process, and Outcome Data of AWHONN’s

Postpartum Hemorrhage Quality Improvement Project.

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EXAMINING INTERVENTIONS TO REDUCE MATERNAL DEATHS IN GEORGIA

CDC. (2015, November 06). Maternal Mortality by State. Retrieved March 17, 2021, from

https://www.cdc.gov/nchs/maternal-mortality/MMR-2018-State-Data-508

Dunlop, A., Rochat, R., Shapiro, S., Vanderlaan, J., & Williams, B. (2019). Service Level and Delivery

Outcomes.

Eliason, E. (2020). Adoption of Medicaid Expansion Is Associated with Lower Maternal Mortality.

Women’s Health Issues, 30(3), 147-152.

Georgia Department of Public Health. (n.d.). Maternal and child health services title v block

grant. Retrieved March 17, 2021, from https://dph.georgia.gov/TitleV

Kramer, M., Strahan, A., Preslar, J., Zaharatos, J., Pierre, A., Grant, J., . . . Callaghan, W. (2019,

September 06). Changing the conversation: Applying a health equity framework to

maternal mortality reviews. Retrieved March 17, 2021, from

https://www.sciencedirect.com/science/article/abs/pii/S0002937819311044

Lindsay, M. G., D. Csukas, S ., Cota, P., Loucks, T., & Ellis, J. (2017). Partnering of Public, Academic,

and Private Entities to Reestablish Maternal Mortality Review in Georgia.

Obstetrics and gynecology, 130(3), 636-640.

Logsdon, M., Kenner, C., Choi, K., Amankwaa, L., Walker, D. & Breedlove, G. (2019).

Maternal mortality in the United States: targeted dissemination can

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help to address the problem. J Adv Nurs, 75(10): 2054-2055.

Maternal Health Task Force. (2018, January 08). Postnatal Care. Retrieved March 17, 2021, from

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McMorrow, S., & Kenny, G. (2018, September 19). Despite progress under the aca, many new

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https://www.healthaffairs.org/do/10.1377/hblog20180917.317923/full

Meyer, H., Rochat, R., Julian, Z., Pinto, M., Zertuche, A., Spelke, B., Dott, A., Cota, P. (2016). Working

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and Peri-Urban Areas of Georgia. Maternal and child health journal, 20(7), 1358-1365.

Mobley, S., Sutherland, D., Hudgins, J., Ange, B., Johnson, M. (2014). Maternal health literacy

progression among rural perinatal women. Maternal and child health journal, 18(8), 1

881-1892.

Romain-Lapeine, F. (2015). Increasing access to maternity care in rural Georgia through public health

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052& context= nursing_dnp_capstone

Shahin Z., Hardwick I., Jeffery N., Jordan J., & Mase, W. (2020). Maternal mortality among

African American women in the state of Georgia, causes, policy, and ethical

considerations. Journal of the Georgia Public Health Association, 8(1). https://doi.org/

10.20429/jgpha.2020.080104

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EXAMINING INTERVENTIONS TO REDUCE MATERNAL DEATHS IN GEORGIA

Sutton, M. Y., Anachebe, N. F., Lee, R., & Skanes, H. (2021). Racial and ethnic disparities in

reproductive health services and outcomes, 2020. Obstet Gynecol, 137(2), 225-233.

https://doi.org/10.1097/AOG.0000000000004224

Vanderlaan R., Williams, B., Dunlop, A., Shapiro, S. (2019). Service Level and Delivery Outcomes.

Women’s Health Issues, 29(3), 252-258.

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https://gradynewsource .uga.edu/in-georgia-the-mos t-dangerous-state-for-pregnant-

women- policy-change-could-save-lives/

Williams. (2020, January 07). Georgia lawmakers recommend expanding Medicaid for pregnant

women. Retrieved March 17, 2021, from https://www.augustachronicle.com/news/

20200107/ georgia-lawmakers-recommend-expanding-medicaid-for-pregnant-women

Zertuche, B. Julian, Z.,Pinto, M., & Rochat, R. (2016). Georgia Maternal and Infant Health Research

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19