Access to Healthcare is Limited for Women in Rural Georgia
The Georgia Senate Women’s Adequate Healthcare Study Committee met for the first time on Monday, September 14, 2015 at the State Capitol and focused on the availability of OB/GYN services and chronic disease management services in Georgia. The committee heard from Dr. Brenda Fitzgerald, Commissioner and State Health Officer for the Georgia Department of Public Health, Ms. Melanie McNeal, Long-term Care Ombudsman with the Department of Human Services, and Dr. Catherine Bonk, President of the Georgia OBGYN Society.
Dr. Fitzgerald led with the most shocking statistic of the day—Georgia ranks 50th in maternal mortality in the U.S. We lose new moms at a higher rate than any other state in the nation. The Georgia Department of Public Health in partnership with OB/GYNs in the state is conducting more extensive studies to understand better the underlying causes. They have also worked with state coroners to gather better cause of death data on death certificates to help them in their research.
Our infant mortality rate is high, but falling. In 2012, Georgia was ranked 44th in the U.S., and by 2014, we had fallen to 31st. Part of the success can be attributed to a public/private partnership to reduce early elective deliveries in the state. Between 2012 and 2014, the early elective delivery rate dropped from 8 percent of births to 1 percent of births, and as of October 1, 2013, Medicaid no longer pays for early elective deliveries in Georgia.
The leading cause of death for Georgia women is cardiovascular disease. In fact, every day twenty-nine women die in Georgia from cardiovascular disease. The state is fighting this disease on three fronts. They are working to reduce obesity rates. Almost a third of Georgians are obese, up from 10 percent in 1990, and two-thirds of Georgians would be classified as overweight or obese. There are on-going education efforts to teach better eating habits and encourage exercise. Diabetes is also a driver in the rates of cardiovascular disease in the state. Women are diagnosed more than men are, and there is a push to increase the number of Diabetes Self-Management Education sites in the state. The third front is reducing tobacco use in the state through programs like the Georgia Tobacco Quit Line at 1-877-270-STOP. Dr. Fitzgerald also discussed cancer and Alzheimer’s disease.
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Ms. Melanie McNeal, Long-term Care Ombudsman with the Georgia Department of Human Services, talked about the challenges faced by older women in the state. Learning to manage chronic disease is vitally important to our aging population, particularly diseases like diabetes. Preventing falls is another focus for our seniors, and local community groups are offering programs like A Matter of Balance and Tai Chi to help improve balance and reduce falls. Access to care issues from a lack of geriatricians to limits in transportation are also affecting Georgia seniors.
Dr. Catherine Bonk, president of the Georgia OBGYN Society, talked about the challenges of being an OB/GYN and ways the state can improve access to care in Georgia. It takes twelve years of education to become an OB/GYN—four years in college, four years in medical school, and four years of residency training in OB/GYN. Most of these doctors leave school with an average debt of $250,000. Of the twenty-three OB/GYNs who graduate from Georgia medical schools each year, only half stay in the state. An increase in residency slots as well as incentives for graduates to stay in the state would go a long way to increasing the number of OB/GYNs in Georgia.
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A common thread that ran through all the presentations was concern for access to OB/GYN care and support programs for chronic disease in rural areas of Georgia. Forty counties have no obstetrical care of any kind—no OB/GYN, no family physician doing OB, no midwife—and more than 70 counties have no OB/GYN physician. Twenty-four percent of pregnant women in Georgia have to drive 45 minutes or more for obstetrical care.
There were possible solutions offered as well. Telemedicine is one way to deliver services in rural areas and is already in use in Georgia. However, it needs to be expanded. Programs encouraging OB/GYNs to stay in the state and incentives for working in rural areas would help close up some of the access gap. More certified nurse midwife programs would also expand care. As always, public education is vital to encourage women to use the programs available to them.
The Senate Women’s Adequate Healthcare Study Committee will meet three more times. Those dates and times are:
October 6, 2015, 9:00 am to 12:00 noon, at Georgia Regents University, Augusta
Topics will cover diseases that most affect women—cancer, cardiovascular disease, osteoporosis
October 26, 2015, 9:00 am to 12:00 noon, at Tift Regional Health Centers, Tifton
Topics will cover rural healthcare, access to obstetrical care, and telemedicine.
November 9, 2015, 2:00 pm to 5:00 pm, at the State Capitol Room 450
Topics will cover the socio-economic status of women and domestic violence
All committee meetings are open to the public.
Karla Jacobs is a member of the Georgia Commission on Women. She lives in Marietta with her husband, two kids, a dog, and some fish.