Nursing Crisis Looms over Iowa

Lynda Waddington

Shortages of nurses continue to cause concern among elected officials and health care analysts in Iowa, increasing pressure for solutions.

A shortage of nurses has caused concern among elected officials and
health care analysts for decades. At least two Iowa governors have
convened task forces to investigate the problem and offer
recommendations.

With all the added scrutiny and few practical solutions to show for
it, most signs point to a nursing crisis that continues to get worse,
and Iowa is likely to bear the brunt of it.

The American Health Care Association estimated in July that 116,000
nursing positions in hospitals and more than 19,000 positions in
long-term care facilities were vacant. The problem is projected to
skyrocket by 2010 to an estimated shortage of 275,000 nurses. By 2020,
the U.S. Department of Health and Human Services anticipates a shortage
of 1 million nurses.

A significant cause of the problem is a lack of qualified educators
to train new nurses. Nearly 2,000 otherwise qualified applicants to
Iowa nursing programs were not able to attend in 2008 due to educator
shortages.

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“It is the single largest contributor to the shortage,” explained Dr. Rita A. Frantz, professor and dean of the University of Iowa College of Nursing.
“We have a national shortage of nurse faculty as well as a shortage of
practicing nurses. The two are intricately intertwined. That is,
without the appropriate number of nurse faculty, we can’t admit all the
qualified applicants to our nursing programs.”

And new nurses are not only needed to fill existing vacancies but to replace a rapidly aging nursing workforce.

In December 2007, the Iowa Board of Nursing stated that 41 percent
of the state’s active licensed practical nurses (LPNs) were age 47 and
up. In addition, 51 percent of the active registered nurses (RNs) in
the state were age 47 and above.

“Here at the University of Iowa, the average age of a faculty member
is 56,” Frantz said. “If you look at them by rank, with the most senior
rank being a full professor, the average age is 59. Those are your more
senior, experienced researchers and teachers. We’re going to have large
numbers of them leaving the academic environment to retire in a fairly
short period of time.”

Demographic shifts, worsening economy exacerbate Iowa’s nursing crisis

The Iowa Nursing Task Force, which presented a written report
in March 2008, predicted that by 2020, the state would experience a
shortfall of about 9,000 RNs, or one-fourth of the current workforce.

This is dire news for the Hawkeye State, whose aging population
places increasing demands on health care services, especially on
long-term facilities. An older population, combined with trends of
younger families vacating rural counties, could result in a magnified
problem in Iowa’s rural areas and smaller hospitals.

“Because rural hospitals have a primary population of older
patients, their primary revenue stream is from Medicare,” Frantz said.
“Those reimbursement rates for acute care hospitalization are in many
cases not sufficient to cover the costs of delivering care to that
patient population. … Hospitals in larger areas draw from a larger
cross-section of the general population and have more sources for their
revenue stream.”

As more of the population is impacted by the economic downturn, more
people will likely turn to public health care coverage like
Medicare/Medicaid as their primary coverage. This forces even
mid-sized, urban hospitals in Iowa to tighten their belts, implementing
hiring freezes to control costs. That can have the effect of masking
the underlying nursing shortage.

“Hiring freezes are the case in some pockets of the country,” said
Frantz. “I worry that might be misinterpreted by the public to mean
that the nursing shortage is over. That is not the case. It is a blip
on the economic radar screen.”

Frantz believes that once the economy improves and unemployed or
underemployed people return to work, many will once again begin full
use of health care benefits.

“There is a projection that once the economy turns around again, we
will have a huge upswing in the demand for health care services,” she
said. “Along with that will come a major upswing for nursing services.
At that same time, we have these factors that we know are contributing
to the shortage. Those will be more evident and place further stress on
health care facilities at the same time."

More Educators Could Stem Crisis

Though reforming the U.S. health care system will likely produce
controversial answers to a long list of complicated questions, one
proposed solution to the nation’s worsening nurse shortage is
alluringly simple.

Each year, nursing schools turn away thousands of qualified
applicants for lack of the instructors and resources to accommodate
them. If only schools could admit more students, the looming nursing crisis might be reversed.

“If I can put it in anatomical terms, there’s not enough red blood
cells flowing through the blood stream. We need to make more red blood
cells,” said Dr. Rita A. Frantz, professor and dean at the University
of Iowa’s College of Nursing. “It’s not that we don’t have the
students. We definitely have the applicant pool — way more than we can
accommodate. And this isn’t a problem unique to our school. It’s
happening throughout the country.”

U.S. Rep. Tom Latham (R-Ames), who has been an active participant in
policy discussions related to nursing for years, thinks the federal
government can help give schools like Frantz’s the resources they need
to attract more nurse educators. Together with U.S. Rep. Tammy Baldwin, a Wisconsin Democrat, Latham introduced a bill
that would establish a federal student loan repayment program for
nurses who agree to teach full-time at an accredited school of nursing.

Programs already exist to help nursing school graduates pay student
loans, but none specifically target prospective instructors. In 2004,
Iowa began a new Nursing Education Loan Repayment Program
that took aim at alleviating the shortage of nurse educators and
registered nurses (RNs), especially those who work in long-term care
facilities or in rural communities. The program, administered by the Iowa College Student Aid Commission,
does not eliminate required payments to student loans, but supplements
the payments. Depending on the nurse’s chosen place of employment, the
supplements can range from $5,000 to $20,000, spread over a four-year
commitment.

The bill proposed by Baldwin and Latham would specifically target
individuals who are interested in pursuing advanced degrees to become
nurse educators.

Frantz is all for it. “It gives individuals an option of working off
their loan by being a faculty member,” she explained. “If the
legislation passes as it is currently written, these educators could
work off as much as 80 percent of their total loan debt — which is just
amazing.”

Among other benefits, the bill might do a better job keeping nursing
school graduates in Iowa than efforts targeted at other types of
nurses. Students who hope to become nursing instructors “have family
and other ties to the state that will keep them here, which is not
necessarily the case with our undergraduate students,” Frantz said.

A few interest groups have already come out in support of the
Latham-Baldwin bill. Dr. Polly Bednash, executive director of the
American Association of Colleges of Nursing, applauded it.

“A significant barrier to addressing the nurse faculty shortage is
enticing nurses with advanced degrees to pursue careers in academia
when salaries in the practice setting are much higher,” Bednash said.
“One way to compensate for these lower salaries and attract younger
nurses into teaching roles is to relieve their educational debt.”

The Service Employees International Union, which counts 80,000 nurses among its 2 million members nationwide, has also endorsed the measure.

When free market incentives go wrong, government help may be needed

Recognizing that its own nursing instructors were growing older and
that few replacements were coming in to fill the void, the University
of Iowa launched a multi-faceted program in 2007 that shifted more
emphasis toward the preparation of new nursing instructors.

The program has achieved some success. Forty-five students are
expected to graduate at the end of this summer with an advanced degree
that will have prepared them to teach in Iowa’s community college
system. An additional 70 students were admitted to that program this
spring and are scheduled to graduate next summer.

Despite the university’s efforts to train more nurse educators, once
students graduate with advanced degrees, it is often in their financial
interests to work in clinical practice instead. The average annual
salary for nurse educators is about 20 percent less than nurses with
higher degrees can earn in clinical practice. (This despite the fact
that nurse salaries are low industry-wide.)

Latham and Baldwin hope their bill will correct the disparity, making it less of a sacrifice to teach.

“I believe this would go a long way toward addressing the nursing
shortage,” Latham said. “There are plenty of qualified applicants who
want to become nurses that are shut out each year.”

Latham says he is not opposed to the bill being grouped into a
larger health care reform package. He understands that either way it
would require a new appropriation, but he says the cost is necessary to
avert a health care disaster.

“Nurses really are the face of health care,” he said. “If left
unaddressed, this shortage is going to undermine access and quality of
care in Iowa and throughout the nation.”

 

Culture & Conversation Law and Policy

The Modern Struggle Over Anti-Trans Bathroom Laws Has Its Roots in Decades of Title VII Fights

Jessica Mason Pieklo

Because of Sex: One Law, Ten Cases, and Fifty Years That Changed American Women’s Lives at Work, written by Gillian Thomas, senior staff attorney with the American Civil Liberties Union Women’s Rights Project, goes beyond cases that helped shape workplace anti-discrimination policies. Rather, it focuses on ten key women whose own lives changed the law.

In 1966, Ida Phillips, a single mother working as a waitress, sat down at her kitchen table and wrote a letter to then-President Lyndon B. Johnson. She told him her story: Despite her qualifications, Phillips had been told by a Martin Marietta employee not to apply for an assembly-line position at one of the construction-material company’s manufacturing plant. The job would have paid more than double what she was making as a waitress. It included a pension plan and insurance, benefits unavailable in most female-dominated industries at the time (and which since have only marginally improved.) The reason Phillips was turned away? She was a woman with a preschool child.

That letter, Phillips’ subsequent lawsuit, and her Supreme Court win would help spark a civil rights revolution in the workplace—one with consequences that reverberate today.

So opens Because of Sex: One Law, Ten Cases, and Fifty Years That Changed American Women’s Lives at Workwritten by Gillian Thomas, senior staff attorney with the American Civil Liberties Union (ACLU) Women’s Rights Project. Despite its full title, though, Because of Sex goes beyond cases that helped shape workplace anti-discrimination policies, focusing on ten key women whose own lives changed the law.

Title VII of the Civil Rights Act of 1964 prohibits employment discrimination based on race, color, religion, sex, and national origin. And it was Phillips’ case, and the nine others profiled in the book, that would ultimately shape that law into one that, decades later, is an important tool in advancing gender and sex equality. As Thomas explained to Rewire in an interview, Title VII it is not just a foundational piece of civil rights legislation important for its historical effect on workplace equality. In the face of anti-transgender bathroom bills and statewide “religious liberties” legislation sweeping the country, it is a crucial tool for pushing equality forward.

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Thomas’ book is organized along three key themes in employment discrimination law: pregnancy-related workplace policies, gender stereotypes in the workplace, and sexual harassment. Those themes act as an inroad toward thinking more broadly about how, in Thomas’ words, we achieve “substantive equality” in the workplace. They illustrate how early fights over promotions and workplace policies that kept women out of certain jobs due to concerns of harming their potential fertility foreshadowed the legal showdowns over contraception coverage in employee health-care plans in cases like Burwell v. Hobby Lobby and Zubik v. Burwell.

“The subject matter areas that I saw [as a researcher and employment discrimination litigator] were, number one, women’s capacity for pregnancy, and then their subsequent roles as mothers, which, historically, has played a huge role in their second-class status legally,” Thomas told Rewire. “Women of color have always been seen as workers, irrespective of whether they had children, so that’s not an entirely universal stereotype. But I think it’s pretty safe to say that generally pregnancy and motherhood have proven to be enormous conflicts in terms of what equality looks like when you have these distinct differences” in how race and gender are perceived.

Take, for instance, the case of Peggy Young and the question whether an employer can refuse to make on-the-job accommodations for pregnant employees when it does so for nonpregnant employees. Young, another one of the women featured in Thomas’ book, was a United Parcel Service (UPS) “air driver” who became pregnant. When Young told her employer she was pregnant, UPS told her they couldn’t accommodate the light-lifting recommendation made by Young’s medical providers. Instead, UPS told Young, she would have to take unpaid medical leave for the remainder of her pregnancy.

In March 2015, the U.S. Supreme Court ruled against UPS, vacating the Fourth Circuit Court of Appeals ruling that had supported UPS’ policy. The decision produced a new test for assessing pregnancy discrimination claims and sent Young’s case back to the lower courts for another look. Not long after the Roberts Court’s decision, UPS and Young settled the lawsuit, bringing an end to Young’s case.

The decision was a qualified win for advocates. The Roberts Court had accepted Young’s argument that UPS had no legitimate business reason for failing to accommodate her particular request, but the decision went short of ruling businesses must accommodate any pregnancy request.

But Because of Sex doesn’t stop at unpacking overt discrimination like the kind detailed in Young’s 2015 case or Phillips’ one in 1966. The book also takes a look at what the law has described as more “benevolent” kinds of discrimination. These include employment policies designed to “protect” women from endangering possible future pregnancies, such as prohibiting women employees from working jobs where they may be exposed to hazardous chemicals.

“It really all boils down to two issues that we are talking about in all these things,” Thomas explained, when discussing workplace policies that, employers have argued, were put in place to protect their female employees from potentially endangering a pregnancy. “One is [employers] ignoring hazards that apply to men and making women into baby-making machines. And number two is [employers] treating health effects or health hazards on the job as reasons for diminishing women’s opportunities, instead of arming women with information and assuming that they will make the right choice for themselves.”

This disconnect is most apparent in the case of United Automobile Workers vJohnson Controls, Inc., another case Thomas highlights in her book. In 1982, the car battery manufacturer Johnson Controls sent a memorandum to all its employees that said “[w]omen who are pregnant or who are capable of bearing children will not be placed into jobs involving lead exposure or which would expose them to lead through the exercise of job bidding, bumping, transfer or promotion rights.”

The policy amounted to a demotion for many female employees and a closed door for others.

Title VII actually permits employers, in a limited context, to have employment policies that discriminate on their face, such as policies that permit churches to only hire members of the same faith. Johnson Controls argued its policy of keeping women out of certain positions due to employer concerns of health risks to future pregnancies fit within Title VII’s narrow window for permitting explicit discrimination.

The Supreme Court would eventually rule in 1991 that Johnson Controls’ policy violated Title VII because it forced female employees to have to choose “between having a child and having a job,” thereby rejecting the argument made by Johnson Control’s that a woman’s fertility—or infertility—can in most situations be considered a bona fide occupational qualification.

As Thomas noted in her book, “It was no coincidence that fetal protection politics were most prevalent in well-paid, unionized industries from which women historically had been excluded. Indeed they had been excluded precisely because they had been deemed physically unsuited for the dirty, sometimes strenuous work.”

But “in female-dominated fields, though, fetal protection policies made no business sense; they effectively would gut the workforce. That reality apparently trumped any hypothetical harm to employees’ future pregnancies,” Thomas wrote.

In other words, these policies didn’t exist in female-dominated fields.

Johnson Controls may have helped grant women the agency to determine how and when they earned a paycheck with regard to policies targeting their potential fertility, but it hardly ended the debate around when and how employers attempt to diminish women’s opportunities related to their roles as potential mothers. This has played out in the hundreds of lawsuits over the contraception benefit, for example.

In other words, if Johnson Controls had settled the question of whether a woman’s fertility was an appropriate grounds for discrimination, we would not have Hobby Lobby.

Because of Sex draws another connection between the historical fight over Title VII and the contemporary one: How do employers adjust workplace policies around shifting gender norms, and when is it discriminatory if they don’t?

The law asks, “What are women supposed to want to do?” said Thomas in her interview with Rewire. “What work are they able to do? What work do they want to do? [Given] assumptions and stereotypes that are about their abilities, their preferences, their interests and how [they are] conforming to [those] in terms of stereotypes about what femininity is—what [are] women … supposed to look and act like?”

Gender nonconforming behavior, and the manner in which employees experience discrimination as a result of that behavior, is a key component over the debate around transgender rights. But it would take a “shrill” woman and the birth of the notion of “workplace harassment” to get us and the law there first.

By every measure, Ann Hopkins should have been made a partner in the global accounting firm Price Waterhouse. She was smart. Ambitious. Worked hard and constantly outperformed her peers. But it was those very attributes that her male partners deemed “too aggressive” or as evidence that she needed “charm school,” and ultimately used to deny her a partnership that by every objective measure she had earned.

The Supreme Court would ultimately disagree. In 1989, it ruled Hopkins should have been made a partner and that the comments relating to her demeanor amounted to improper gender stereotyping, a violation of Title VII’s sex discrimination provisions.

If Hopkins was initially shut out of workplace advancement due to her defiance of feminine stereotypes, so too are women subjected to on-the-job harassment, as Thomas draws out in Because of Sex. “Sexual harassment didn’t even have a name in 1974, but was such a prevalent force driving women out of the work force, driving them into different jobs [and] subjugating them just generally in terms of the identity as sexual objects on the job,” Thomas further explained in her interview.

1974 was the year Mechelle Vinson first hired a lawyer to represent her in a case against her boss, who was chronically sexually abusing her on the job. But at the time, courts largely wrote off those kinds of complaints as a kind of chasing-around-the-office, and not sexual harassment, or in Vinson’s case, on-the-job rape. As described by Thomas in her book, “throughout the 1970s, many courts responded to complaints about abusive bosses with a collective shrug that conveyed, ‘You can’t blame a guy for trying.'”

“Sexual harassment was such a prevalent force driving women out of the workforce, driving them into different jobs, and subjugating them just generally in terms of the identity as sexual objects on the job,” Thomas told Rewire.

That “you can’t blame a guy for trying” attitude hasn’t completely gone away as far as the federal courts are concerned. After all, in 2013 the Roberts Court in Vance v. Ball State made it even harder for employees to bring workplace harassment suits, and employees still face losing jobs for “being too cute” or having their sexuality be a perceived threat to their employer’s ability to remain professional in the workplace.

Which is why, in the fight over transgender bathroom access in 2016, Title VII should be a powerful force in defeating these latest attempts to stymie social progress. The idea that “you can’t blame a guy for trying” has morphed into “how the hell can we police gender roles if we don’t know where you pee.” That’s thanks almost entirely to the manner in which the law has wrestled with gender stereotypes under Title VII, Thomas explained.

In 2012, the Equal Employment Opportunity Commission (EEOC), the federal agency charged with enforcing workplace anti-discrimination laws, issued the landmark decision Macy v. Holder, which held that employment discrimination based on transgender status was a form of unlawful sex discrimination under Title VII. Then in 2015, it issued a ruling stating that denying employees access to restrooms consistent with their gender identity is also a violation of Title VII. Meanwhile several federal courts of appeals have ruled that Title VII protects against gender identity discrimination.

But the Roberts Court has yet to weigh in.

“I think sexual orientation in a way is the sort of a final frontier” in Title VII litigation, said Thomas. “The court seems really fixated on this idea of analogizing very precisely from Hopkins. In other words, if you look or act in a way that doesn’t conform to gender stereotypes then, OK, [the courts] can understand that’s sex discrimination,” said Thomas. “But if your identity is not conforming to stereotypes in that you, you know, are romantically attracted to someone of your sex, that is harder for [the courts] to get, even though it’s obviously the most obvious manifestation of stereotype.”

This is, in many ways, a fight that started in the workplace—one that eventually got the backing of the Obama administration before becoming a flashpoint of conservative election-cycle politics. Thomas’ book doesn’t close on a prediction of what the next big Title VII fight will be per se, but it is impossible to finish it and not see the narrative threads of the historical fight for workplace equality woven throughout the the contemporary one. Sex. Gender. How the law understands and navigates the two. All this is what makes Thomas’ Because of Sex the closest thing to an assigned reading I can make.

Analysis Law and Policy

Georgia Legislators Respond to Health-Care Crisis by Funneling Money Toward Anti-Choice Facilities

Regina Willis

Rather than allocating money toward licensed centers that could provide care from trained professionals, or toward strengthening social safety nets, Georgia is poised to join a slate of 22 other states directing public funds to crisis pregnancy centers.

When Georgia resident Rebecca DeHart started experiencing the worst pain she’d ever felt, she turned to what she thought was a medical facility that could provide her care as an uninsured patient.

“I was crying, again I had not ever been in so much pain in my life. I was in tears, at the counter, I thought it was a medical facility. And I said ‘I need to see the doctor, I might have an ectopic pregnancy,'” DeHart testified during a recent Georgia House Health and Human Services Committee hearing.

“She put the [pregnancy] test kind of on a shelf above my head and she said, ‘We’ll get to your results but I want you to look at some things first.’ And she gave me a series of pamphlets …. It wasn’t until I opened a baby announcement with pictures of fetuses on the inside that I understood what was happening,” DeHart said.

DeHart had sought help at a crisis pregnancy center (CPC), one of thousands of facilities around the country whose primary goal is to dissuade patients from having an abortion.

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Georgia is facing a health-care crisis; it has one of the highest maternal mortality rates in the nation. It also ranks poorly on infant health and mortality. March of Dimes gave Georgia a “D” for preterm births in its 2015 Premature Birth Report Card, noting in an accompanying press release that “Babies who survive an early birth often face serious and lifelong health problems, including breathing problems, jaundice, vision loss, cerebral palsy and intellectual delays.” The organization also cited preterm or premature births as the leading cause of infant death.

These are symptoms of a wider problem in Georgia: an overall lack of access to facilities where patients, particularly those in rural areas, can obtain comprehensive reproductive health-care services.

Yet rather than allocating money toward licensed centers that could provide care from trained professionals, or toward strengthening social safety nets, Georgia is poised to join a slate of 22 other states directing public funds to CPCs. On Republican Gov. Nathan Deal’s desk right now is SB 308, which creates a potential $2 million grant program to fund CPCs. Deal has until May 3 to veto the legislation. If he does not, it will automatically become law.

In order to qualify to receive funding, an organization need only be a nonprofit operating for at least one year, “whose mission and practice is to provide alternatives to abortion services to medically indigent women at no cost.”

CPCs use deceptive tactics—like lying about the services they provide or implying they are a fully staffed medical clinic when they are not—to get pregnant folks in the door. Their sole goal is to keep these people from having abortions, including by providing medically inaccurate or misleading information about abortion procedures. As Georgia Life Alliance, an affiliate of the anti-choice National Right to Life organization, wrote on its blog in support of SB 308, “The open doors and compassionate support of Georgia’s pregnancy care centers are the most effective tool we have to reach the abortion-minded woman.”

Still, proponents of SB 308 have framed the grant program as a way to address pregnant Georgians’ need for care, especially when they do not choose abortion. “When our party has been a party pushing for decreased access to abortion facilities, and has so stressed the need not to have an abortion, I think we have a moral responsibility to say, ‘If you make the choice, if you choose life, and you need help, we’ll be there to help you,” said the bill’s house sponsor, Rep. Sharon Cooper (R-Marietta), during debate on the house floor last month.

The bill lists quite a few services that the grant program will fund, including pregnancy tests, sexually transmitted infection tests, and ultrasounds; nutrition education; housing, education, and employment assistance; adoption services; parenting education; baby supplies like clothing, car seats, and cribs; and information on receiving Medicaid coverage.

The bills’ opponents, however, expressed concern about the accessibility and quality of those services at CPCs.

“These CPCs, in large part, are simply not equipped to handle pregnant women’s care. Some of them provide only counseling and pregnancy testing,” said Sen. Nan Orrock (D-Atlanta) in opposition to the bill during debate on the senate floor. “Only a limited number of them provide ultrasound and sexually transmitted disease testing. And many [CPCs] have to refer out for prenatal and emergency care services.”

This was the case for Rebecca DeHart, who testified during the public committee hearing days before the bill went to the house floor. DeHart’s pregnancy test came back negative—she did not have an ectopic pregnancy—but she was still in a lot of pain.

“In the end … I had a cyst the size of an orange that burst on my ovary,” DeHart said she learned after going to a health clinic in her hometown, as the CPC was unable to diagnose or treat her medical condition.

DeHart, who is now the executive director of the Democratic Party of Georgia, said she was ultimately able to have a healthy pregnancy when she was ready, but the burst cyst did result in damage to one of her ovaries. “I am very happy that did not prohibit me, even though my ovary is damaged, from being able to have children later,” she said.

“A lot of these crisis pregnancy centers don’t have medical staff on board, and if they do, they are nurse practitioners, or maybe just sonographer technicians that might or might not have the ability to diagnose actual issues with high-risk pregnancies,” said Molly “MK” Anderson, public policy associate and lobbyist at the Feminist Women’s Health Center (FWHC), in an interview with Rewire. FWHC is a key opponent of the bill, with Anderson leading its lobbying and advocacy work.

Despite concerns about the quality and competency of care CPCs can provide, pregnant Georgians with few options may continue turning to them for services, a prospect that is only made more probable by this grant program.

The Georgia Obstetrical and Gynecological Society predicted that by 2020, 75 percent of Primary Care Service Areas (PCSA) outside Atlanta, “will lack sufficient obstetric services.” PCSAs are geographic regions based on Medicare patient travel to their primary care providers; Georgia has 159 counties, but 82 PCSAs outside Atlanta.

It was also hard to miss the talk at the capitol—from both Republicans and Democrats—about Georgia’s rural hospital closures. This growing problem, coupled with an existing lack of OB-GYNs, means pregnant Georgians find themselves with few options to receive care before, during, and after a pregnancy.

According to the Georgia Maternal and Infant Health Research Group (membership login required), “24 percent of all pregnant women in Georgia now drive more than 45 minutes to access their obstetric provider. These women are 1.5 times more likely to deliver preterm than women who drive less than 15 minutes.”

This lack of access also impacts the ability of pregnant Georgians to manage conditions—such as diabetes, high blood pressure, or anemia—that can become exacerbated by pregnancy, as well as to receive critical care during a high-risk pregnancy.

There are also disturbing racial disparities in access, or lack thereof, and maternal deaths. Throughout the country, Black women are approximately four times as likely to die from pregnancy complications as white women; however, this is not necessarily tied to a greater risk of an underlying complication.

“[I]n a national study of five medical conditions that are common causes of maternal death and injury… black women did not have a significantly higher prevalence than white women of any of these conditions. However, the black women in the study were two to three times more likely to die than the white women who had the same complication,” a 2011 report from the Association of Reproductive Health Professionals stated.

Democrats in both chambers asked why money was being allocated for the CPC grant program, but not for Medicaid expansion, which could potentially be a boon for both rural hospitals and Georgians who are or may become pregnant. For that matter, even as proponents of the bill articulated a need for pregnant people to receive support services, legislation to reduce access to government safety nets gained traction in both chambers: Rep. Cooper, the house sponsor of SB 308, was also the house sponsor of a bill to reduce the maximum time a person can receive cash assistance from the Temporary Assistance for Needy Families (TANF) program.

“And when we are considering bills like SB 389 to cut TANF benefits and make it harder on families with children, I think you can see the hypocrisy in passing SB 308. And additionally when we refuse to expand Medicaid to hundreds of thousands of Georgians, yet we want to give money for what is being seen as health-care services, I think you can see the hypocrisy in that as well,” said Rep. Dar’shun Kendrick (D-Lithonia) in opposition to the bill during debate on the house floor.

Both sides agree on at least one thing: SB 308 is about reducing the number of abortions. But providing grant money to CPCs to expand their reach, at a time when many Georgians struggle to access the reproductive health-care services they need, is dangerous policy. For pregnant Georgians seeking to carry a pregnancy to term, and those seeking to terminate a pregnancy, CPCs just won’t cut it.

“We are talking about facilities that offer services that are free—free pregnancy tests, free ultrasounds—and that often attracts people who are uninsured, who are in our [Medicaid] coverage gap, or don’t feel safe going to a provider,” FWHC’s Anderson said. “And these are folks who need care, need comprehensive care, need professionals who actually know what they are doing to provide care.”

“[SB 308] was under the guise of being comprehensive health care. Which I thought was a total sham,” said Oriaku Njoku, co-founder and executive director of Access Reproductive Care – Southeast (ARC-SE), referring to the extensive comments made by supporters of the bill in both chambers, in an interview with Rewire. ARC-SE was involved in the opposition to the bill at the state capitol.

“And the reason I say that is because when you are talking about comprehensive health care, to me that also includes abortion access, it also includes trans health, it also includes maternal mortality, infant mortality, like all of these things are included,” Njoku said. “And I definitely feel that this was a missed opportunity to do right by Georgians.”

This bill passed 31 to 16 in the senate along party lines, while the house saw a vote of 103 to 52, with several Republican members choosing to walk—that is, skip voting—rather than vote against their party. Gov. Deal has until May 3 to veto the bill; otherwise, SB 308 will become law.