ATLANTA — Georgia is poised to implement some of the country's strictest restrictions on abortion after the U.S. Supreme Court on Friday ended constitutional protections for the procedure.
That is likely to heighten the debate over whether Georgia is doing enough to help expectant mothers and newborns or if it needs to strengthen its social safety net.
Until now, Georgia has had a worse record of keeping pregnant women, new mothers and infants healthy and alive than most states.
In 2020, Georgia had the country's fourth-highest percentage of babies born with low birthweights, according to data from the Centers for Disease Control and Prevention. The state was seventh for preterm birth rates that year and had the 15th-highest infant mortality rate. Seven percent of Georgia children live without health care, 13th highest in the country, according to an Annie E. Casey Foundation analysis of Census Bureau data.
Childhood development experts view such statistics as key indicators of whether a baby can get a healthy start in life.
And the state's high maternal mortality rate has for years remained at the bottom of national rankings. A bipartisan state panel in a 2019 report presented staggering figures: Sixty percent of maternal deaths in Georgia were preventable, and Black mothers were three to four times more likely to die in the year after childbirth than their white counterparts.
Anti-abortion advocates and Republican officials argued before Friday's abortion ruling that Georgia has done a lot in recent years to improve the lives of mothers and their children. They say new laws extending Medicaid protections for low-income mothers from two months to one year after a child's birth will have a particularly meaningful impact once fully implemented.
"We've made great strides in our protection of unborn daughters and sons over the past several years. We've made great strides in taking care of women with planned or unplanned pregnancies," said state Rep. Mark Newton, R-Augusta, who chairs a House committee focused on health care access. "I think Georgia is well placed to compassionately take care of both women and unborn daughters and sons."
Abortion rights advocates argue that already bad Georgia numbers could get even worse if more women are forced to give birth. They warn that low-income women, especially Black low-income women, who tend to have less access to care and poorer health outcomes than the broader population, will be the hardest hit.
"Things are stark already in Georgia," said Staci Fox, CEO of the left-leaning Georgia Budget and Policy Institute who until April led Planned Parenthood Southeast, in an interview before the ruling. "If Georgia wants to be a state that says it's really supporting families and those who give birth, we have a lot of work to do."
Questions about impact on births
The country's highest court on Friday overturned the landmark Roe v. Wade ruling that for five decades had ensured the right to an abortion nationwide. The matter is now in the hands of the states.
A federal court is expected to quickly uphold Georgia's 2019 "heartbeat" law — which bars most abortions after about six weeks of pregnancy, before most women know they're pregnant — and dismiss a legal challenge filed by several abortion providers.
Some anti-abortion advocates in Georgia argue abortion rights supporters are overreacting to the potential fallout from a wide-ranging ban on the procedure.
"They've got their hair on fire about everything," Martha Zoller, executive director of the Georgia Life Alliance, said in an interview before the decision was released. "You would think that what we're trying to do is to deny women medical care. That's not the case at all."
It is unclear how many more births Georgia can expect once abortion rights are rolled back.
Many of the state's abortion clinics, however, are expected to close — or at least drastically shift what they do — as a result.
That doesn't mean that Georgia women will stop seeking out or having abortions.
Initial data from Texas, which implemented a similar six-week ban last September, found that the number of legal abortions performed in the state fell by about half in the months after the law was implemented.
But later studies showed that most Texas women wound up terminating their pregnancies by other means, either traveling to a clinic in another state for the procedure or ordering abortion pills through the internet. In the end, the state's abortion rate fell by only about 10%, according to University of Texas at Austin researchers.
The Supreme Court's decision Friday in Dobbs v. Jackson Women's Health Organization could make it even harder for Georgians to secure an abortion. Some 26 states, particularly across the South and Midwest, are "certain or likely" to ban the procedure, according to the Guttmacher Institute. The abortion rights research organization estimates that a Georgian's average driving distance to an abortion clinic will increase more than tenfold, from 17 miles to 203 miles.
Abortion opponents say they're eager to revisit Senate Bill 456, a proposal that would ban women from receiving an abortion pill through the mail, when the Legislature reconvenes in January. The measure failed to pass the General Assembly earlier this year.
Poor and Black women likely most affected
The women expected to be the most affected by the ruling are those who don't have the money to travel or the ability to secure child care or time off from work to receive the procedure.
Nationally, three-quarters of the women who seek abortions are poor or low-income and 59% are already mothers, according to Guttmacher statistics.
Nearly two-thirds of those who received legal abortions in Georgia in 2019 were Black and 58% were in their 20s, according to Kaiser Family Foundation data.
Decreased access to abortions could have a profound impact on families, including on finances. A major University of California, San Francisco study that followed women who were denied abortions and went on to give birth found an increase in household poverty lasting four years relative to those who received the procedure.
One 2021 study from the University of Colorado Boulder found that a national abortion ban would lead to a 33% increase in deaths in Black expectant mothers.
Policy debates likely to heat up
In the nearly two months since a draft of the Dobbs decision was leaked, many of Georgia's top GOP leaders have remained tight-lipped about their plans for any additional abortion statutes, even as they've celebrated the possibility of the end of Roe. Most have given no specifics beyond their desire to see the "heartbeat" law fully implemented.
While some conservative candidates running in competitive primary battles last month called for even stricter abortion bans, Republican insiders under the Gold Dome see that as unlikely for now given the narrow margins by which the heartbeat law was passed in 2019.
Many Republican officeholders have taken a wait-and-see approach to the state's social safety net, indicating they're open to making changes to address any additional needs that may stem from the Dobbs decision.
"There may be some additional things that we can certainly look at, but I believe we have a really robust plan for taking care" of women before, during and after pregnancy and her child, Newton, who's also an emergency physician, said before Friday's Supreme Court ruling.
Newton and Zoller pointed to actions taken by the Legislature in recent years making it easier to adopt and foster children; creating paid family leave for state workers; and removing red tape for so-called maternity supportive housing residences, homes where needy women can stay while they're pregnant and up to 18 months postpartum.
Abortion rights advocates and some who work in women's health say that the state hasn't done nearly enough.
Many believe that Georgia should start by joining the 38 other states that have expanded Medicaid under the Affordable Care Act to cover Georgians who are too poor to afford private insurance but don't qualify for public assistance. That's in part because a woman's health prior to pregnancy is a major determining factor in how they'll do while pregnant and after they have their baby.
Georgia in 2022 had an uninsured rate of 15.9%, far higher than the national average of 10.4%. And as of 2017, one in five women of child-bearing age were uninsured in Georgia, according to the Kaiser Family Foundation. Both are among the highest rates in the country.
A 2020 study from the journal Women's Health Issues found that Medicaid expansion was "significantly associated" with lower maternal mortality and better health outcomes compared with states that didn't expand, particularly among Black mothers.
Gov. Brian Kemp and other GOP leaders in Georgia aren't interested in a full expansion — they're instead pursuing a narrower "waiver" with the federal government.
But lawmakers this year did opt to expand Medicaid for lower-income mothers earning at or below 220% of the federal poverty level, which translates to about $60,000 for a family of four, for up to a year post-partum.
The move, which required years of behind-the-scenes work, was widely praised, including by nonprofits that work with low-income women.
Jemea Dorsey, CEO of the Center for Black Women's Wellness, an Atlanta nonprofit that seeks to improve the health and well-being of underserved Black women, said her organization was "elated" by the development. Refusing to expand Medicaid, she said, tends to "exacerbate inequalities."
Dorsey would like legislators to do more to address rural hospital closures and to integrate more doulas and midwives into Georgia's health care system. Research shows the latter could help cut down on maternal mortality rates for Black women.
Half of Georgia's 159 counties don't have an OBGYN, and hospitals that are struggling financially often eliminate their obstetric services first.
"If we're saying that we care about babies, we've got to care about the very people who birth the babies," said Dorsey before Friday's ruling.
Fox, of the Georgia Budget and Policy Institute, said the state needs to devote more resources to expanding child care options and paid parental leave.
"Three weeks is certainly not enough to even recover from child birth. Clearly that is a very gendered perspective on birthing recovery," Fox said, referring to the three weeks of benefits cleared for state workers last year. Fox said that 12 to 16 weeks of paid leave would be more ideal.
Georgia's GOP leaders are unlikely to do so any time soon — the impact of the current program is still being studied, and party leaders are generally wary of mandates, especially on the private sector.
Others want to see more emphasis on contraception and sex education for students to better help prevent pregnancies. A 2015 CDC report showed that more than two-thirds of Georgia schools failed to teach all of the recommended sexual education topics.
