PROJECT SUMMARY
The US maternal mortality ratio (26.4 maternal deaths per 100,000 livebirths) is the highest among developed
nations, with wide variation across states and racial/ethnic groups. The state of Georgia has the second
highest maternal mortality (66.3 per 100,000), with a 60% higher rate for black vs white women (95.6 vs 59.7
per 100,000). Nearly 100 times more common than maternal mortality, however, is severe maternal morbidity
(SMM). Maternal mortality and SMM are highest among women who are black, publicly insured or uninsured,
and deliver in safety-net hospitals. In Georgia, nearly two-thirds of maternal deaths and SMM are deemed
preventable, with chronic health conditions, obesity, delays in accessing and fragmentation of care as key
contributors. Current data indicate that postpartum SMM is increasing at a faster rate than SMM during the
delivery hospitalization. Proposed solutions to the maternal health crisis in Georgia include improved prenatal
and postpartum follow-up and case management, control of chronic health conditions, and extension of
Medicaid coverage. However, there is a dearth of evidence regarding whether such strategies can improve
maternal health or reduce racial disparities in SMM or mortality. The proposed study will begin to fill this void
with a multidisciplinary, mixed-methods approach. We will first analyze Georgia linked vital records, hospital
discharge, and claims data to provide an overview of the extent, location and determinants of differences in
SMM among non-Hispanic black and non-Hispanic white women at delivery and 3 to 12 months postpartum.
Using regression-based decomposition methods we will highlight the portions of the racial/ethnic differences
explained by observable and unobservable factors. We will use these findings and in-depth interviews with
postpartum women and their health care providers and case managers to contextualize the analysis of two
postpartum interventions targeting women at risk for adverse outcomes – an existing Medicaid policy and a
newly designed health system intervention. The Georgia Medicaid Planning for Healthy Babies (P4HB)
Medicaid program provides postpartum women with a very low birth weight delivery primary care inclusive of
nurse case management and Resource Mother outreach to link women to social supports. This study will be
the first to evaluate the effects of this Medicaid policy on SMM disparities. These analyses will then be used to
inform the design of the new postpartum care system for women who deliver at a safety-net hospital in Atlanta,
Georgia, and are at increased risk for SMM. Women (N = 320) will be randomly assigned to either this
enhanced postpartum care system vs. standard care, with assessment of outcomes within 12 weeks and 12
months postpartum, including attendance of postpartum care visits, receipt of recommended care, and adverse
outcomes such as hospital readmissions. The insights gained from the proposed work will fill critical knowledge
gaps regarding policy and practice approaches for reducing maternal health disparities and can serve as a
foundation for future prevention and intervention strategies within the state and nationally.
