LOUISVILLE — For more than a year, Jessica Lewis has made the 50-minute drive north from her home in Louisville to her doctor’s office in the Augusta suburb of Grovetown.
At times, the 35-year-old tax preparer made weekly trips so she could see the obstetrician who was providing her care while pregnant. She gave birth a year ago and still goes to Grovetown for her son’s pediatrician visits. Lewis said the nearly two-hour round trip was the best way for her to get consistent care.
The prenatal care options in her hometown are more limited. She could have seen a certified nurse midwife through Jefferson Hospital, but Lewis said she was more comfortable traveling to Grovetown.
Lewis said she is fortunate to have access to transportation while she was pregnant. Not everyone in her two-stoplight town is as fortunate. The median income in Jefferson County is less than $47,000, according to Census data.
“It can make you feel depressed because you can’t provide for your child and you can’t give them the necessary care,” Lewis said. “It’s very important when you’re pregnant to make sure you’re doing everything you need to do to prevent any issues during labor and delivery.
Eighty of Georgia’s 159 counties do not have a full-time doctor certified in obstetrics and gynecology, according to data acquired by The Atlanta Journal-Constitution from the Georgia Medical Composite Board, which licenses health care professionals.
The data was compiled by the AJC using the address listed on each doctor’s license. That does not account for doctors who may travel to other locations to provide care on a part-time basis.
Georgia is consistently ranked among states with the worst maternal mortality rate with 49.2 deaths per 100,000 live births annually, according to the National Institutes of Health.
Over the years the crisis has been exacerbated by hospital closings. Since 2010, nine rural hospitals have closed in Georgia, according to nonprofit advocacy organization Georgians for a Healthy Future. And earlier this year, St. Mary’s Sacred Heart Hospital in Lavonia announced it would cut its labor and delivery unit to save money.
Those closures result in some patients making long drives for checkups or to deliver their babies.
“Most everybody in Louisville actually goes to Augusta, because I know for a fact they deliver babies (at the hospital) there,” Lewis said.
Importance of access
Margaret Master, executive director of the Chamblee-based nonprofit Healthy Mothers, Healthy Babies Coalition of Georgia, said access to prenatal care ensures that everyone “will be the healthiest they can be.”
“Having medical care to screen, manage any potential complications, comorbidities, chronic diseases and prepare for birth is very important, and it affects both mom’s health and the baby’s,” she said.
A 2023 study by March of Dimes, a Virginia-based nonprofit focused on maternal and infant health, found that 15.8% of birthing-age Georgia women had no hospital with a labor unit within 30 minutes of their home, compared with the national figure of 9.7%.
The study also found 16.6% of birthing-age Georgians received inadequate prenatal care, slightly more than the national rate of 14.8%. The study defined “inadequate prenatal care” as pregnancies that had no prenatal care, prenatal care that didn’t begin until at least the fifth month of pregnancy or included fewer than half the recommended visits for the fetus’ gestational age.
Georgia Department of Public Health data shows that 10.8% of the state’s 126,304 live births in 2024 had fewer than five prenatal visits and 14.6% of births had “late or no prenatal care.” That is an increase of 30% from 2023 for Georgians who had fewer than five prenatal visits and an increase of 55% for those who had “late or no prenatal care” out of 125,000 births.
Master said she was shocked at the increase and reached out to the state to see if there was a problem with the data. But DPH said no.
Further, the prenatal visit data seems contradictory to that of infant mortality rates: As prenatal visit data gets worse, infant mortality rates have improved.
DPH defines infant deaths as those that occur after birth and before a child’s first birthday. According to state data, there were 6.5 infant deaths per 1,000 births in Georgia in 2024, down from 7.2 infant deaths per 1,000 births in 2023 and 7.1 deaths per 1,000 births in 2022.
Availability of providers
Georgia passed one of the country’s most restrictive abortion laws in 2019.
The law bans most abortions once a doctor can detect fetal cardiac activity, which is typically at about six weeks of pregnancy and before many know they are pregnant. It took effect in July 2022, after the U.S. Supreme Court overturned Roe v. Wade, which had guaranteed a nationwide right to an abortion since 1973.
For years, abortion rights activists have said Georgia’s laws would cause doctors to leave the state and discourage students from doing their residencies here, but that doesn’t appear to be the case. In 2018, there were about 1,386 licensed doctors practicing obstetrics and/or gynecology in Georgia. As of this summer, there were about 1,450.
Still, Dr. Keisha Callins, a Macon-based OB-GYN who practices in Jones and Twiggs counties, said she’s aware of doctors who’ve left the state.
“It’s a thing,” she said. “But I think there’s a balance there. I think the bigger focus is, we can’t all leave the state, and I don’t think everybody’s trying to run away, but (if doctors continue to leave), the people who are staying are going to pay for that in terms of being stretched more thin.
“If we look at the number of OB-GYN spots, I don’t think there are any that are not filled,” Callins said. “And that would be what the measure is: Do we have OB-GYN spots that are not filled, which means people are not coming? And that’s not the case.”
Callins has spent the majority of her career working in rural parts of the state. And that is by design, she said. The scholarship she had at Morehouse School of Medicine required her to work in underserved areas for a period of time.
“I tell people all the time that rural chose me,” she said. “Once I got done with my (scholarship) commitment, I decided that the opportunity to work in rural communities really offers a unique opportunity to intersect with the community through servant leadership and advocacy.”
Callins said she understands that many doctors may not want to work in rural areas. Most of her medical school classmates work in urban areas, she said.
“But I really, really love taking care of the patients that I take care of,” she said. “And I know that if I’m not here, then they don’t have anything.”
The way forward
Recently, state lawmakers have taken steps to increase access to medical care during pregnancy, mostly aimed at improving Georgia’s maternal mortality rate.
For example, the state extended the amount of time low-income Georgia mothers can receive benefits under Medicaid, the public health program that provides care to poor and disabled people, from two months to one year after the birth of a child. Lawmakers also passed legislation allowing low-income women to apply to the Temporary Assistance for Needy Families program while pregnant. Previously, those women were only eligible for TANF, commonly known as welfare, once a child was born.
Callins said the extension of Medicaid is “huge.”
“That allows us to really do more,” she said. “That accessibility is not limited to OB-GYNs. So they can see a family physician, and they can get that care for their comorbid conditions that they otherwise would not be able to access.”
Credit: Bob Andres, robert.andres@ajc.com
Credit: Bob Andres, robert.andres@ajc.com
House Public and Community Health Chair Sharon Cooper, R-Marietta, said she’s proud of the strides the state has made toward guaranteeing mothers have a safe and healthy pregnancy.
“We’ve increased the number of our medical schools, and within those there are least two of our schools that have a big emphasis on working in rural areas,” she said. “And there are benefits for them for working in rural areas, like not having to pay back (college loans) if they’ll go and work in areas where we need them for a certain amount of years.”
Georgia Senate Democratic Caucus Chair Elena Parent, an Atlanta Democrat, said the state has a strong foundation, but more can be done to improve access to prenatal care, “especially with the distances.”
“We need to think deeply about how to set up those critical care access pathways through the parts of the state that don’t have the access that’s really needed,” she said.
Cooper said one solution could be having nurses on staff at all of the state’s public health departments that could handle some of the routine prenatal and postnatal visits.
“We’re sitting on the answer to a lot of access,” Cooper said. “We need to reenvision how we use our 150-plus public health offices we have around the state and really use them to their potential.”
Having a trusted medical professional nearby would be a relief for Lewis, the Louisville mother who gave birth last year. She said she was happy with her OB-GYN and takes her son, Desmond, to the practice’s pediatrician. But the 50-minute drive each way can be tiresome.
“That drive, especially when they’re crying, it’s heartbreaking,” she said.
But Lewis stressed that she is fortunate to have a car and a job where she can take the necessary time off work to visit the doctor when needed.
“I do feel bad for the ones that don’t have the transportation, or have to catch a ride or find somebody else to take them, versus being able to get in the car and go,” she said. “Especially when you’re pregnant, those doctors appointments are only like five or 10 minutes long and driving that far for them to just say, ‘Do you have any questions for me? No? All right, you look great. I’ll see you again next week.’”
This story has been updated to correct the number of counties in Georgia.
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