A Midwife Speaks: When Birth Costs Are Too High, Health Can Be Compromised

Amie Newman

When some women are literally begging their midwife not to transfer them to a hospital because they can't afford to pay the costs associated with a hospital birth, or women must spend part of their pregnancy searching for ways to pay for prenatal care instead of actually getting the care they need, we're talking about a crisis of coverage in this country.

Rewire continues to look for and accept personal stories of women being denied coverage based on a pre-existing condition related to reproductive and sexual health issues.

As noted, the practice of denying coverage for pre-existing conditions like pregnancy, previous c-sections, or being the victim of domestic violence is not only unfair, it can be dangerous to women’s health. Yes, covering pre-existing conditions may cost the insurance companies more money (and we wouldn’t them to have to compromise profit by actually covering necessary health care costs, would we?!) but as the system is set up currently, no matter what the pre-existing condition is, we are forcing Americans to sacrifice their health to the deity of the almight dollar. 

I asked a Certified Professional Midwife, Erin Curtiss, what all this can sometimes mean for women who seek her prenatal, postpartum and out-of-hospital birth services. Does she see this denial of coverage for pregnancy frequently? What, then, do her clients do to cover the costs of the pregnancy, birth and postpartum period?

Erin says she sees couples denied coverage "several times a year" in her practice. In her words:

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Dad (or mom) gets a new job and also new insurance coverage and
pregnant mama is denied coverage because she’s pregnant and this is a
pre-existing condition so the couple either qualifies for DSHS medical
coupons or they don’t and have to pay my fee out of pocket…I haven’t ever seen a situation where an insurance
company is willing to reverse their stance on this pregnancy as a pre
existing condition thing. We all just kind of hang our heads and say,
"Well gee, this sucks, huh?". Doesn’t seem to be too much we can do
about it. I’ve had some women make phone calls and write letters but to
no avail.
Since Erin is a midwife working in Washington state, I followed up with a question about what a woman can do in this situation but the specifics apply to Washington state medicaid programs and are not necessarily the same in other states: If the pregnant woman is denied coverage and qualifies for DSHS medical coupons (Medicaid), do the coupons
cover the kind of care she would receive with insurance or are we
usually talking about a severely compromised range of services? Erin’s response:
"If she/her family makes below a certain income then she will be offered
Healthy Options pregnancy coverage (DSHS Medical Coupons) [Editor’s note: "Healthy Options" is a Washington state program]. She is
covered through her pregnancy, for her labor and delivery, and for 6
weeks postpartum. During that time she is eligible for dental, vision,
and any other emergent or routine medical event that may occur for her.
But, here’s the sh**** part, it ends COMPLETELY at 6 weeks postpartum.
I tell all my mamas in this situation to go for it and do it up now,
i.e. go to the dentist, get your vision checked, get your IUD put in
etc. and go see their primary care physician NOW because she’ll be
completely cut off a month and a half after giving birth.

So, for women who are denied health care coverage because pregnancy is considered a pre-existing condition, we’re not just talking about the lack of coverage for pregnancy and birth costs but postpartum costs as well. What if a woman suffers from post-partum anxiety and needs medication? If her symptoms are diagnosed quickly enough, prior to the 6 week cut-off date in Washington state, maybe she’ll be lucky enough to receive medication. And after 6 weeks, then what? It is not safe or advisable to stop medication or even pause medication for anxiety or depression. If a switch to a government subsidy program is necessitated, there is bound to be bureacratic red tape to wade through before obtaining coupons. If you don’t qualify, medications like these are prohibitively expensive, out-of-pocket, for many. And what about assistance with breastfeeding? Lactation consultants? Follow up visits with a midwife with breastfeeding concerns? If it falls within that 6 week time period, you’re golden. If you’re body and concerns don’t fall on a 6 week cycle in Washington state, I suppose you fall into the health care system whirlpool – spinning around, hoping to obtain coverage in some way, shape or form under which you can continue receiving similar care. Either that or you go into debt paying for these services yourself. Or, of course, you just forsake your own physical, mental or emotional health because it costs too much money to address them. 

And that is the most looming issue, according to Erin –  a woman’s health is sacrificed, while pregnant, or immediately postpartum if she suddenly finds herself without insurance coverage or needing to switch from private insurance to Medicaid. Of course, this isn’t unique to pregnancy or other reproductive health care but pregnancy brings special circumstances to the table as well. But needing to prioritize finding health care coverage, in some capacity, instead of taking the time to care for yourself while pregnant or postpartum is not just twisted; it’s dangerous, according to Erin.

Making people work so hard to get coverage costs time. Instead of
dealing with their insurance companies they should be receiving care.
Many women delay care because they are trying to get coverage. Luckily,
DSHS reimburses retroactively. If a woman does not qualify for DSHS
coverage then she pays me out of pocket. My fees for an entire course
of prenatal care, labor and delivery, and postpartum and newborn care
costs a total of $2,800.00 dollars. These women literally beg me not to
transfer them to a hospital because they wouldn’t be able to pay the
doctor/hospital/c-section bill. They literally beg me. It’s a tough
situation to be in. Of course it’s dangerous.

This is, of course, rather shocking to those of us who are not privvy to the inner workings of midwifery. Women begging not to be taken to a hospital because of the associated costs? It’s no secret that out-of-hospital birth, with a midwife, costs considerably less than an in-hospital birth with an Ob-Gyn. Hospital births can run as high as $30,000 or more, if a women needs or requests a c-section. Home birth costs fall more in the range of $2-3,000 if there are no medical interventions needed. So, it would make sense that for some women home birth is an option purely because of its economic favorability and not for any heart-felt belief in natural childbirth:

I’ve delivered women out of hospital
not because they believe in homebirth but because they can’t afford
doctor and hospital care. It’s really terrible to deliver a baby at a
beautiful homebirth only to have the woman tell you, "That was the most
painful…thing I’ve ever done. I would have had drugs in
a hospital if I could have afforded it. I felt like an animal and I’m
embarassed. I didn’t really want to do that but I had to." This very
thing has happened twice in my career and it still makes me feel icky.
I’m all for homebirth but if you want your epidural you should be able
to have one.
And yes, women have begged me not to transfer them because they
know they can’t afford the cost of a hospital delivery. Of course, I
always transfer women if that’s what they need but it’s sad. I’m not
sure how they end up paying for the bill. I think it ends up being a
sliding scale type situation or a make-payments-for-the-rest-of-your-life type situation.

Women and their families are forced to sacrifice their own health when the fear of debt outweighs concern for ones’ safety. That’s not how a healthy health care system should operate. Not at all. 

 

 

 

Analysis Maternity and Birthing

Pregnant Women Are Being Shackled in Massachusetts—Even Though It’s Been Illegal for Years

Victoria Law

According to a new report, not a single jail or prison facility in the state has written policies that are fully compliant with the law against restraining pregnant women behind bars.

Korianne Gamble was six months pregnant in November 2014 when she arrived at the Bristol County Sheriff’s Office Women’s Center, a jail in North Dartmouth, Massachusetts. Six months prior, the state had passed “An Act to Prevent Shackling and Promote Safe Pregnancies for Female Inmates.”

According to the new law, the jail should have been prohibited from using any type of restraint on Gamble during labor, and using of leg and waist restraints on her during and immediately after her pregnancy. It also guaranteed her minimum standards of pregnancy care and required—as with everyone incarcerated while in their second or third trimesters—that she be transported in the jail’s vehicles with seat belts whenever she was taken to court, medical appointments, or anywhere outside the jail.

But that wasn’t the case for Gamble. Instead, she says, when it came time for her to give birth, she was left to labor in a cell for eight hours before finally being handcuffed, placed in the back of a police cruiser without a seatbelt, and driven to a hospital, where she was shackled to the bed with a leg iron after delivering.

According to a new report, Gamble isn’t alone. Advocates have been monitoring pregnancy-related care since the law’s passage. After obtaining and analyzing the policies of the state’s prison and jail system, they found that no facility has policies that are fully compliant with the 2014 law. They issued their findings in a new report, Breaking Promises: Violations of the Massachusetts Pregnancy Standards and Anti-Shackling Lawco-authored by Marianne Bullock of the Prison Birth Project, Lauren Petit of Prisoners’ Legal Services of Massachusetts, and Rachel Roth, a reproductive-justice expert.

In addition to analyzing policies, they spoke with women who were pregnant while in custody and learned that women continue to be handcuffed during labor, restrained to the bed postpartum, and placed in full restraints—including leg irons and waist chains—after giving birth.

“The promise to respect the human rights of pregnant women in prison and jail has been broken,” the report’s authors concluded.

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Medical experts, including the American Congress of Obstetricians and Gynecologists, the American Medical Association and the American College of Nurse-Midwives, have all agreed that shackling during pregnancy is unnecessary, inhumane, and dangerous. Shackling increases the risk of falling and injury to both mother and fetus while also preventing medical staff from assessing and assisting during labor and delivery. In 2014, both the Massachusetts legislature and then-Gov. Deval Patrick (D) agreed, passing the law against it.

“The Massachusetts law is part of a national trend and is one of the most comprehensive in protecting pregnant and postpartum women from the risks of restraints,” said Roth in an interview with Rewire. “However, like most other states, the Massachusetts law doesn’t have any oversight built in. This report clearly shows the need for staff training and enforcement so that women who are incarcerated will be treated the way the legislature intended.”

Gamble learned all of this firsthand. In the month before her arrest, Gamble had undergone a cervical cerclage, in which a doctor temporarily stitches up the cervix to prevent premature labor. She had weekly visits to a gynecologist to monitor the development of her fetus. The cerclage was scheduled to be removed at 37 weeks. But then she was arrested and sent to jail.

Gamble told jail medical staff that hers was a high-risk pregnancy, that she had had a cerclage, and that her first child had been born six weeks prematurely. Still, she says she waited two months before seeing an obstetrician.

As her due date drew closer, the doctor, concerned about the lack of amniotic fluid, scheduled Gamble for an induction on Feb. 19, 2015. But, she says, jail staff cancelled her induction without telling her why.

That same evening, around 5 p.m., Gamble went into labor. Jail staff took her to the medical unit. There, according to Gamble, the jail’s nurses took her blood pressure and did a quick exam, but did not send her to the hospital. “They [the nurses] thought I was ‘acting up’ because my induction was canceled,” she told Rewire.

She was placed in a see-through cell where, as the hours progressed, her labor pains grew worse. “I kept calling to get the [correctional officers] to get the nurse,” Gamble recalled. By the time a nurse came, Gamble was bleeding. “The nurse made me pull down my pants to show her the blood—in front of a male [correctional officer]!” Gamble stated. Still, she says, no one called for an ambulance or made arrangements to drive her to the hospital.

At 1:45 in the morning, over eight hours after she first went into labor, the jail’s captain learned that Gamble was in labor. “[He] must have heard all the commotion, and he called to find out what was going on,” she said. He ordered his staff to call an ambulance and bring her to the hospital.

But instead of calling an ambulance, Gamble says jail staff handcuffed her, placed her in the back of a police cruiser without a seatbelt—in violation of the law—and drove her to Charlton Memorial Hospital. “My body was already starting to push the baby out,” she said. She recalled that the officers driving the car worried that they would have to pull over and she would give birth by the side of the road.

Gamble made it to the hospital, but just barely. Nine minutes after arriving, she gave birth: “I didn’t even make it to Labor and Delivery,” she remembered.

But her ordeal wasn’t over. Gamble’s mother, who had contacted Prisoners’ Legal Services and Prison Birth Project weeks earlier, knew that the law prohibited postpartum restraints. So did Gamble, who had received a packet in jail outlining the law and her rights from Prisoners’ Legal Services. When an officer approached her bed with a leg iron and chain, she told him that, by law, she should not be restrained and asked him to call the jail to confirm. He called, then told her that she was indeed supposed to be shackled. Gamble says she spent the night with her left leg shackled to the bed.

When the female officer working the morning shift arrived, she was outraged. “Why is she shackled to the bed?” Gamble recalled the officer demanding. “Every day in roll call they go over the fact that a pregnant woman is not to be shackled to anything after having a baby.” The officer removed the restraint, allowing Gamble to move around.

According to advocates, it’s not unusual for staff at the same jail to have different understandings of the law. For Gamble, that meant that when the shift changed, so did her ability to move. When the morning shift was over, she says, the next officer once again shackled Gamble’s leg to the bed. “I was so tired, I just went along with it,” Gamble recounted.

Two days after she had given birth, it was time for Gamble to return to the jail. Despite Massachusetts’ prohibition on leg and waist restraints for women postpartum, Gamble says she was fully shackled. That meant handcuffs around her wrists, leg irons around her ankles, a chain around her waist,g and a black box that pulled her handcuffs tightly to the waist chain. That was how she endured the 20-minute drive back to the jail.

Gamble’s jail records do not discuss restraints. According to Petit, who reviewed the records, that’s not unusual. “Because correctional officers don’t see it as out of the ordinary to [shackle], they do not record it,” she explained. “It’s not so much a misapplication of the extraordinary circumstances requirement as failure to apply it at all, whether because they don’t know or they intentionally ignore it.”

While Bristol County Sheriff’s Office Women’s Center’s policies ban shackling during labor, they currently do not prohibit restraints during postpartum recovery in the hospital or on the drive back to the jail. They also do not ban leg and waist restraints during pregnancy. Jonathan Darling, the public information officer for the Bristol County Sheriff’s Office, told Rewire that the jail is currently reviewing and updating policies to reflect the 2014 law. Meanwhile, administrators provide updates and new information about policy and law changes at its daily roll call. For staff not present during roll call, the jail makes these updates, including hospital details, available on its east post. (Roll call announcements are not available to the public.)

“Part of the problem is the difference in interpretation between us and the jurisdictions, particularly in postpartum coverage,” explained Petit to Rewire. Massachusetts has 14 county jails, but only four (and the state prison at Framingham) hold women awaiting trial. As Breaking Promises noted: “Whether or not counties incarcerate women in their jails, every county sheriff is, at minimum, responsible for driving women who were arrested in their county to court and medical appointments. Because of this responsibility, they are all required to have a written policy that spells out how employees should comply with the 2014 law’s restrictions on the use of restraints.”

Four jurisdictions, including the state Department of Correction, have policies that expressly prohibit leg and waist restraints during the postpartum period, but limit that postpartum period to the time before a woman is taken from the hospital back to the jail or prison, rather than the medical standard of six weeks following birth. Jails in 11 other counties, however, have written policies that violate the prohibition on leg and waist shackles during pregnancy, and the postpartum prohibition on restraints when being driven back to the jail or prison.

Even institutions with policies that correctly reflected the law in this regard sometimes failed to follow them: Advocates found that in some counties, women reported being restrained to the bed after giving birth in conflict with the jail’s own policies.

“When the nurse left, the officer stood up and said that since I was not confirmed to be in ‘active labor,’ she would need to restrain me and that she was sorry, but those were the rules,” one woman reported, even though the law prohibits restraining women in any stage of labor.

But shackling pregnant women during and after labor is only one part of the law that falls short. The law requires that pregnant women be provided with regular prenatal and postpartum medical care, including periodic monitoring and evaluation; a diet with the nutrients necessary to maintain a healthy pregnancy; written information about prenatal nutrition; appropriate clothing; and a postpartum screening for depression. Long waits before transporting women in labor to the hospital are another recurring complaint. So are routinely being given meals without fruits and vegetables, not receiving a postpartum obstetrician visit, and waiting long stretches for postpartum care.

That was also the case with Gamble. It was the middle of the night one week after her son’s birth when Gamble felt as if a rock was coming through her brain. That was all she remembered. One hour later, she woke to find herself back at the hospital, this time in the Critical Care Unit, where staff told her she had suffered a seizure. She later learned that her cellmate, a certified nursing assistant, immediately got help when Gamble’s seizure began. (The cell doors at the jail are not locked.)

Hospital staff told her that she had preeclampsia, a pregnancy complication characterized by high blood pressure. Postpartum preeclampsia is rare, but can occur when a woman has high blood pressure and excess protein in her urine soon after childbirth. She was prescribed medications for preeclampsia; she never had another seizure, but continued to suffer multiple headaches each day.

Dr. Carolyn Sufrin is an assistant professor of gynecology and obstetrics at Johns Hopkins Medicine. She has also provided pregnancy-related care for women at the San Francisco County Jail. “Preeclampsia is a leading cause of maternal mortality,” she told Rewire. Delayed preeclampsia, or postpartum preeclampsia, which develops within one to two weeks after labor and delivery, is a very rare condition. The patient suffering seizures as a result of the postpartum preeclampsia is even more rare.

Postpartum preeclampsia not only needs to be treated immediately, Sufrin said, but follow-up care within a week at most is urgent. If no follow-up is provided, the patient risks having uncontrolled high blood pressure, stroke, and heart failure. Another risk, though much rarer, is the development of abnormal kidney functions.

While Sufrin has never had to treat postpartum preeclampsia in a jail setting, she stated that “the protocol if someone needs obstetrical follow-up, is to give them that follow-up. Follow through. Have continuity with the hospital. Follow their instructions.”

But that didn’t happen for Gamble, who was scheduled for a two-week follow-up visit. She says she was not brought to that appointment. It was only two months later that she finally saw a doctor, shortly before she was paroled.

As they gathered stories like Gamble’s and information for their report, advocates with the Prison Birth Project and Prisoners’ Legal Services of Massachusetts met with Rep. Kay Khan (D-Newton), to bring her attention to the lack of compliance by both county jails and the state prison system. In June 2015, Khan introduced An Act to Ensure Compliance With the Anti-Shackling Law for Pregnant Incarcerated Women (Bill H 3679) to address the concerns raised by both organizations.

The act defines the postpartum period in which a woman cannot be restrained as six weeks. It also requires annual staff trainings about the law and that, if restraints are used, that the jail or prison administration report it to the Secretary of Public Safety and Security within 48 hours. To monitor compliance, the act also includes the requirement that an annual report about all use of restraints be made to the legislature; the report will be public record. Like other statutes and bills across the country, the act does not have specific penalties for noncompliance.

In December 2015, Gamble’s son was 9 months old and Gamble had been out of jail for several months. Nonetheless, both Gamble and her mother drove to Boston to testify at a Public Safety Committee hearing, urging them to pass the bill. “I am angered, appalled, and saddened that they shackled her,” Gamble’s mother told legislators. “What my daughter faced is cruel and unusual punishment. It endangered my daughter’s life, as well as her baby.”

Since then, both the Public Safety Committee and Health Care Financing Committee approved the bill. It is now before the House Committee for Bills in the Third Reading, which means it is now at the stage where it can be taken up by the House for a vote.

Though she has left the jail behind, Gamble wants to ensure that the law is followed. “Because of the pain I went through, I don’t ever want anyone to go through what I did,” she explained to Rewire. “Even though you’re in jail and you’re being punished, you still have rights. You’re a human being.”

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.