Before the First Prenatal Visit: Why Maternal Health in Georgia Starts Years Earlier

We often talk about maternal health as if it starts with a positive pregnancy test. The data keep telling us otherwise.

A new study in CDC’s journal Preventing Chronic Disease is a good example. Researchers looked at births across 1,374 U.S. counties from 2020 to 2024. They asked a simple question: does living where primary care is hard to reach affect the health a woman brings into pregnancy?

The answer was yes. But that’s not the whole story, and the rest matters most for Georgia.

What the new CDC study found

The researchers compared counties designated as primary care Health Professional Shortage Areas with counties that have more providers. In shortage areas, women who gave birth were more likely to enter pregnancy with obesity and chronic hypertension. After adjusting for other factors, the link was strongest for obesity.

The study also found that Black women who gave birth had higher rates of every chronic condition measured than White women. The disparity held regardless of how close primary care was. In the authors’ words, geographic access to primary care “did not attenuate racial disparities” in these conditions.

That second finding deserves attention. Opening more clinics is necessary, but it isn’t enough. A woman’s blood pressure and weight before pregnancy take shape over years. Food, stress, income, transportation, and whether anyone was checking in along the way all play a part. A first prenatal visit can’t undo all of that in a few months.

Why this hits the South, and rural Georgia, hardest

The study’s maps show primary care shortage areas concentrated in the South and Midwest. Georgia knows this pattern well. Many of our rural counties have few primary care providers, long drives to the nearest hospital, and fewer places to deliver a baby than they once had.

When care is far away, prevention usually slips first. People skip routine blood pressure checks. A conversation about blood sugar never happens. Women arrive at pregnancy with conditions that were never caught, or were caught and never followed up.

None of this is a failure of personal responsibility. It’s a system that hasn’t put support where people live.

What I saw on Georgia’s back roads

From 1998 to 2000, I led Georgia’s State Office of Rural Health at the Department of Community Health. Before that, I spent four years at the University of Georgia working on community and economic development across the state. In both jobs, I spent a lot of time in rural hospitals. In many of those towns, the hospital was the largest employer. It was where babies were born and the first stop when something went wrong.

At least 13 of the hospitals I visited are no longer there. Medicaid cuts played a major role in their closure.

When a rural hospital or clinic closes, mothers and babies feel it. First, a woman who once had a doctor down the road may now drive an hour or more to deliver. Every checkup after the baby comes, the ones that catch high blood pressure or rising blood sugar, becomes that much harder to get to.

The damage doesn’t stop at the hospital door. We also lose vital economic development. Early in my career, I learned that a hospital often makes a rural town’s economic development plan believable. Families think twice about moving to a town without a doctor. Employers hesitate to open where their workers can’t get care. Young people who grow up there leave and don’t come back. When we lose a hospital or a clinic, we lose people’s ability and their desire to live there.

That’s how health care deserts form. Geography alone doesn’t create them. We are creating them, one closure at a time, and every closure makes the next one more likely.

The shortage areas on the CDC study’s maps aren’t only places where providers are scarce. They show where those losses have already added up.

The year after birth is a window, not an afterthought.

Pregnancy does something rare: it brings many women into regular contact with the health system, often for the first time in years. That’s an opportunity. Too often, it ends abruptly after the last postpartum checkup.

CDC reports that more than 80% of pregnancy-related deaths are preventable, and that these deaths can happen up to a year after pregnancy. CDC’s earlier national analysis found that about one in three pregnancy-related deaths happened between one week and one year after delivery. Those are the weeks and months after the hospital stay, when many new mothers are home, exhausted, and focused on the baby rather than themselves.

Two conditions in this study make the point. Chronic hypertension raises the stakes for complications during and after pregnancy. And gestational diabetes, which many women develop during pregnancy, raises a woman’s risk of type 2 diabetes later in life. The year after birth is the natural time to follow up on both, if someone is there to make sure it happens.

What sustained prevention looks like

If we take the study’s findings seriously, the answer isn’t one more appointment. It’s steady support that reaches women where they are, before, during, and after pregnancy:

Before pregnancy: everyday help with healthy eating, physical activity, and blood pressure for women of reproductive age, especially in shortage areas.

During pregnancy: strong links between prenatal care and community resources. After birth: a full year of support that covers physical recovery, sleep, nutrition, mood, and follow-up on conditions like gestational diabetes and high blood pressure.

This kind of support has to be permanent community infrastructure. Treating it as a short-term grant or a line item that can be cut in a lean year won’t work. Maternal health progress is real, but it isn’t self-sustaining. New mothers build trust locally, over time, before a crisis.

Where ProVention fits: HALT360 Postpartum Care

At ProVention Health Foundation, we built the HALT360 Postpartum Care program for that critical first year after birth. It covers four core skills:

Heal and get stronger the safe way: guidance on physical recovery after delivery. Notice mood changes and know what to do: helping new parents spot warning signs early and know where to turn for help. Sleep and eat well with a newborn: practical routines for the hardest months. Check for diabetes risk after pregnancy: follow-up for women who had gestational diabetes.

The program runs on HALT360, a single app that works on any device and is backed by trained coaches. For a new mother in a rural county two hours from her OB, that means support at home on her own schedule. Partners don’t have to add staff to deliver it.

Postpartum Care is designed for OB/GYN offices, doula groups, and Medicaid maternal health programs. It also connects with our Hypertension and CDC-recognized Diabetes Prevention programs. A mother whose blood pressure or blood sugar needs attention after birth can keep getting support well beyond the first year.

The bottom line

This CDC study shows that maternal health is shaped long before delivery day and long after it. Geography matters, but access to a clinic alone won’t close the gaps. What closes them is prevention that reaches women in their own communities and stays there.

We don’t have to keep creating deserts. When a hospital or clinic is gone, the community still needs care. Prevention that reaches women at home can help a town hold on while it rebuilds what it lost. It only works if we treat it as permanent community infrastructure, not a line item to cut when budgets get tight.

Georgia’s mothers deserve that support in every county, not just those near a hospital.

To bring HALT360 Postpartum Care to your clinic, health department, or maternal health program, contact us about a partnership.

Sources

Boulet S, Costley L, Stanhope K. Geographic Access to Primary Care and Racial and Ethnic Disparities in the Prevalence of Maternal Chronic Conditions 2020–2024. Prev Chronic Dis 2026;23:260235. https://www.cdc.gov/pcd/issues/2026/26_0235.htm CDC. Preventing Pregnancy-Related Deaths. https://www.cdc.gov/maternal-mortality/preventing-pregnancy-related-deaths/index.html CDC. Vital Signs: Pregnancy-Related Deaths, United States, 2011–2015. MMWR, May 10, 2019. https://www.cdc.gov/mmwr/volumes/68/wr/mm6818e1.htm