First Place Winner
Policy Memo: Lowering Preventable Maternal Deaths in Rural Georgia
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Gabrielle Delima (1), Amanda Engstrom (2), Emily Michels (3), Jay Qiu (4)
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Keywords: maternal mortality; rural; Certified Nurse Midwives (CNM); tax credit; preventive care
Executive Summary: Georgia’s maternal mortality rate (MMR) is one of the highest in the U.S. and shows few signs of improvement, despite government intervention. Women living in rural areas are exposed to significantly higher risk than their urban counterparts and have reduced access to life-saving health care. 60% of Georgia’s maternal deaths are preventable, however the lack of available providers—especially in rural areas—makes it hard to address these avoidable issues. As such, we propose an amendment to the Georgia legal code that would allow Certified Nurse Midwives (CNM) to practice independently, removing unnecessary restrictions on the low-risk and routine care that they are trained to provide. This change could lower systemic and individual health care costs while allowing an existing workforce to augment preventive care efforts.
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References
- 2010 Georgia Code. 2020. “O.C.G.A. 48-7-29 (2010).” Justia Law. Accessed April 2. https://law.justia.com/codes/georgia/2010/title-48/chapter-7/article-2/48-7-29/.
- 2018 Georgia Code. 2020. “GA Code § 43-34-25 (2018).” Justia Law. Accessed April 2. https://law.justia.com/codes/georgia/2018/title-43/chapter-34/article-2/section-43-34-25/.
- Adams, E. Kathleen, and Sara Markowitz. 2018. “Improving Efficiency in the Health-Care System: Removing Anticompetitive Barriers for Advanced Practice Registered Nurses and Physician Assistants.” Brookings, June, 1–32. https://www.brookings.edu/wp-content/uploads/2018/06/AM_Web_20190122.pdf.
- Altman, Molly R., Sean M. Murphy, Cynthia E. Fitzgerald, H. Frank Andersen, and Kenn B. Daratha. 2017. “The Cost of Nurse-Midwifery Care: Use of Interventions, Resources, and Associated Costs in the Hospital Setting.” Women’s Health Issues 27 (4): 434–40. doi:10.1016/j.whi.2017.01.002.
- Barnett, Jessica C., and Edward R. Berchick. 2017. “Health Insurance Coverage in the United States: 2016.” Census.gov Publications. The United States Census Bureau. September 17. https://www.census.gov/library/publications/2017/demo/p60-260.html.
- Boockholdt, Tara. 2019. “Maternal Mortality in Georgia.” Georgia House Budget & Research Office. April. http://www.house.ga.gov/budget/Documents/2019_Session/2019_Policy_Brief_Maternal_Mortality_in_Georgia.pdf.
- CDC Division of Reproductive Health, and National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP). 2020. “Pregnancy Mortality Surveillance System.” Reproductive Health. Centers for Disease Control and Prevention (CDC). February 4. https://www.cdc.gov/reproductivehealth/maternal-mortality/pregnancy-mortality-surveillance-system.htm.
- Ferreira, Heather. 2020. “The Role of the Midwife in Primary Care.” Brattleboro OBGYN. Brattleboro Memorial Hospital. Accessed April 5. https://www.bmhvt.org/the-role-of-the-midwife-in-primary-care/.
- Georgia Department of Public Health. 2019. “Maternal Mortality.” Women and Children. Georgia Department of Public Health. November 22. https://dph.georgia.gov/maternal-mortality.
- Georgia House Budget & Research Office. 2019. “House of Representatives Study Committee on Maternal Mortality.” State of Georgia House of Representatives. State of Georgia. http://www.house.ga.gov/Documents/CommitteeDocuments/2019/MaternalMortality/HR_589_Final_Report.pdf.
- Georgia State Office of Rural Health. 2008. “Georgia's Rural Counties.” Georgia Department of Community Health. August. https://dch.georgia.gov/documents/georgia-rural-county-map.
- Gluck, Michael E. 2018. “Rapid Evidence Review: What Are Effective Approaches for Recruiting and Retaining Rural Primary Care Health Professionals?” Translation and Dissemination Institute. Academy Health. January 23. https://www.academyhealth.org/publications/2018-01/rapid-evidence-review-what-are-effective-approaches-recruiting-and-retaining.
- Hart, Ariel. 2018. “Georgia Faces Rural Doctor Shortage.” Politics. The Atlanta Journal-Constitution. August 17. https://www.ajc.com/news/state--regional-govt--politics/georgia-faces-rural-doctor-shortage/JqAwfs1SLiqCwVNronKScM/.
- Hoyert, Donna L, and Arialdi M Miniño. 2020. “Maternal Mortality in the United States.” National Vital Statistics Reports 69 (2): 1–16. https://www.cdc.gov/nchs/data/nvsr/nvsr69/nvsr69_02-508.pdf.
- Kleiner, Morris, Allison Marier, Kyoung Won Park, and Coady Wing. 2016. “Relaxing Occupational Licensing Requirements: Analyzing Wages and Prices for a Medical Service.” Journal of Law and Economics 59 (2): 261–91. doi:10.1086/688093.
- Laff, Michael. 2016. “Tax Incentives Aim to Attract Primary Care Preceptors.” AAFP News. American Academy of Family Physicians. June 14. https://www.aafp.org/news/education-professional-development/20160614preceptorcredits.html.
- “Loan Repayment Programs.” 2020. Loan / Scholarship Information. Georgia Board of Health Care Workforce. Accessed April 1. https://healthcareworkforce.georgia.gov/loan-repayment-scholarship-programs/loan-repayment-programs.
- “Maternal Mortality Rate By State 2020.” 2020. World Population Review. https://worldpopulationreview.com/states/maternal-mortality-rate-by-state/.
- Misfeldt, Renee, Jordana Linder, Jana Lait, Shelanne Hepp, Gail Armitage, Karen Jackson, and Esther Suter. 2013. “Incentives for Improving Human Resource Outcomes in Health Care: Overview of Reviews.” Journal of Health Services Research & Policy 19 (1): 52–61. doi:10.1177/1355819613505746
- National Advisory Committee on Rural Health and Human Services. 2018. Health Resources and Services Administration. https://www.hrsa.gov/sites/default/files/hrsa/advisory-committees/rural/publications/2018-Rural-Health-Insurance-Market-Challenges.pdf.
- Nursing@Georgetown. 2019. “How Does the Role of Nurse-Midwives Change from State to State?” Nursing@Georgetown Blog. Georgetown University School of Nursing & Health Studies. February 5. https://online.nursing.georgetown.edu/blog/scope-of-practice-for-midwives/.
- Pedley, Andrew J. 2018. “Analyzing the Impact of Incentive Programs on Retention of Family Practice Providers in Rural Nebraska.” University of Nebraska–Lincoln Community and Regional Planning Program: Professional Projects, July. https://digitalcommons.unl.edu/arch_crp_profproj/14/.
- Scott, Sandra, "Able" Mable Thomas, Dar'shun Kendrick, Valencia Stovall Stovall, Erica Thomas, and Renitta Shannon. 2020. 2019-2020 Regular Session - HB 800 Medical Assistance; Health Care Services by Providers in Bordering States to Georgia Medicaid Recipients under Certain Conditions; Provide. Georgia House of Representatives. http://www.legis.ga.gov/Legislation/en-US/display/20192020/HB/800.
- Spetz, Joanne, Lisel Blash, Matthew Jura, and Lela Chu. 2018. “2017 Survey of Nurse Practitioners and Certified Nurse Midwives.” Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, April, 1–133. https://healthforce.ucsf.edu/sites/healthforce.ucsf.edu/files/publication-pdf/survey2017npcnm-final.pdf.
- “States That Allow CNMs to Practice and Prescribe Independently vs Those That Require a Collaborative Agreement.” 2020. State Regulations for CNMs. MidwifeSchooling.com. Accessed April 1. https://www.midwifeschooling.com/independent-practice-and-collaborative-agreement-states/.
- Ungar, Laura, and Caroline Simon. 2018. “Which States Have the Worst Maternal Mortality?” 50 States. USA Today. November 1. https://www.usatoday.com/list/news/investigations/maternal-mortality-by-state/7b6a2a48-0b79-40c2-a44d-8111879a8336/.
- WHO, UNICEF, UNFPA, World Bank Group, and United Nations Population Division. 2019. “Trends in Maternal Mortality 2000 to 2017.” World Health Organization. WHO. https://apps.who.int/iris/bitstream/handle/10665/327596/WHO-RHR-19.23-eng.pdf?ua=1
- Xue, Ying, Zhiqiu Ye, Carol Brewer, and Joanne Spetz. 2016. “Impact of State Nurse Practitioner Scope-of-Practice Regulation on Health Care Delivery: Systematic Review.” Nursing Outlook 64 (1): 71–85. doi:10.1016/j.outlook.2015.08.005.
- Yang, Y. Tony, Laura B. Attanasio, and Katy B. Kozhimannil. 2016. “State Scope of Practice Laws, Nurse-Midwifery Workforce, and Childbirth Procedures and Outcomes.” Womens Health Issues 26 (3): 262–67. doi:10.1016/j.whi.2016.02.003
Gabrielle Delima is a 4th year graduate student in the Microbiology and Molecular Genetics program at Emory University. She uses reverse genetics to map genetic determinants underlying influenza A virus gene expression as it pertains to host adaptation. After earning her PhD, Gabrielle plans to pursue a career in science policy and outreach.
Amanda Engstrom just received her PhD in Biochemistry and Cell Biology from Emory University. Her research focused on the mechanism of neuronal cell death in Alzheimer’s disease and other related dementias. She will continue her research as a post- doctoral fellow. In addition to scientific research, Amanda is interested in science policy, STEM outreach, and being part of innovative mechanisms to communicate science to general audiences.
Emily Michels operates as a liaison between science, tech, and policy, working to educate policymakers and companies on the importance of ethical and scientifically sound internal and external policies. After working as a health policy analyst in Colorado, she received her Masters of Bioethics from Emory University in May 2020 with focuses on the ethics of HIV genetic sequencing-based interventions, community engagement, and artificial intelligence in health care.
Jay Qiu is a genetic counseling student in the Emory Genetic Counseling Training Program. His research is focused on the public’s opinion and understanding of the limitations of direct-to-consumer genetic testing. He has an active interest in science and health policy and is passionate about the implementation of genomic research into clinical practice.
Acknowledgements
The authors would like to acknowledge the Emory Science Advocacy Network (EScAN) at Emory University especially Alyssa Scott, Erin King, Julia de Amorim, and Emily Hill for their comments on this publication.
Disclaimer
The authors disclose that they have no conflict of interest in this form.
Amanda Engstrom just received her PhD in Biochemistry and Cell Biology from Emory University. Her research focused on the mechanism of neuronal cell death in Alzheimer’s disease and other related dementias. She will continue her research as a post- doctoral fellow. In addition to scientific research, Amanda is interested in science policy, STEM outreach, and being part of innovative mechanisms to communicate science to general audiences.
Emily Michels operates as a liaison between science, tech, and policy, working to educate policymakers and companies on the importance of ethical and scientifically sound internal and external policies. After working as a health policy analyst in Colorado, she received her Masters of Bioethics from Emory University in May 2020 with focuses on the ethics of HIV genetic sequencing-based interventions, community engagement, and artificial intelligence in health care.
Jay Qiu is a genetic counseling student in the Emory Genetic Counseling Training Program. His research is focused on the public’s opinion and understanding of the limitations of direct-to-consumer genetic testing. He has an active interest in science and health policy and is passionate about the implementation of genomic research into clinical practice.
Acknowledgements
The authors would like to acknowledge the Emory Science Advocacy Network (EScAN) at Emory University especially Alyssa Scott, Erin King, Julia de Amorim, and Emily Hill for their comments on this publication.
Disclaimer
The authors disclose that they have no conflict of interest in this form.
DISCLAIMER: The findings and conclusions published herein are solely attributed to the author and not necessarily endorsed or adopted by the Journal of Science Policy and Governance. Articles are distributed in compliance with copyright and trademark agreements.
ISSN 2372-2193
ISSN 2372-2193