Faced with a sharp rise in maternal mortality rates, Iowa health experts will share in a $10 million federal grant to study and improve maternal health outcomes in the state.
Under the five-year grant, University of Iowa Health Care will work with the Iowa Department of Public Health to study the root causes of maternal mortality rates and implement strategies to prevent these deaths.
The rate of maternal death in Iowa has almost doubled in recent years, said Dr. Stephen Hunter, principal investigator on the grant and vice chairman for the department of obstetrics at the UI.
Maternal mortality in Iowa reached 39 between 2015 and 2018, according to the UI. The previous three years saw 20 total deaths.
The World Health Organization defines maternal mortality as the death of a woman while pregnant or within 42 days of termination of pregnancy from a cause related to the pregnancy.
Iowa is one of nine states to receive the State Maternal Health Innovation Program grant from the Health Resources and Services Administration, under the U.S. Department of Health and Human Services.
The project’s team includes staff at the Iowa Public Health Department as well as UI faculty in the departments of obstetrics and gynecology and epidemiology.
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For the first year, the team plans to collect and analyze data from every hospital in Iowa, Hunter said. In the following four years, Hunter said, researchers will create and implement programs aimed at reducing maternal mortality.
Grantees are tasked with creating programs that will continue beyond the five-year grant.
“There has to be some mechanism of sustainability built in,” Hunter said.
While the data researchers uncover will ultimately guide the program development, Hunter said they have some preliminary goals based on the current barriers to maternal health care access.
Health care professionals are seeing an increased prevalence of comorbidities — experiencing multiple chronic conditions simultaneously — among patients.
“You take a lot of very sick people and put them in an environment where there’s not a lot of access to care, and that’s a recipe for disaster,” Hunter said.
Iowa has a rate of 1.49 of obstetrician-gynecologists per 10,000 women — the second lowest in the country, just ahead of Arkansas.
The shortage hits women in rural areas the hardest, experts say, particularly if they live in counties without a labor and delivery unit.
Since 2000, 34 of Iowa’s 118 community hospitals have shut down their labor and delivery units, meaning women living in those service areas must travel elsewhere for prenatal care and to give birth.
The latest closure occurred in September in Marshalltown’s hospital — the first Level II hospital unit closure in Iowa, Hunter said.
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“That’s concerning,” Hunter said. “That leaves big maternal health care deserts within our state if we lose these hospitals, and I don’t see much hope that it’s going to slow down much.”
These closures also put extra pressure on hospitals that keep labor and delivery services, including the UI Hospitals and Clinics. Hunter said so far this year, the hospital has seen a 19 percent increase in deliveries over a year ago.
The driving factor for these closures are finances, specifically Medicaid reimbursement for obstetrics. Hunter said in some cases, hospitals are losing almost $1 million a year delivering babies who are insured under Medicaid.
Rural hospitals are unable to absorb that loss the way larger hospitals can, he said.
The low reimbursement, coupled with the fact that hospitals have to hire doctors above market rate to recruit them to rural areas, has driven hospital leadership to close these units.
To address this, researchers under the State Maternal Health Innovation Program grant will consider solutions through expanding telemedicine and implementing obstetric training programs in rural health care settings.
However, Hunter said change also will take an effort on the part of policy makers. He encouraged patients to reach out to lawmakers to help preserve access to maternal services, particularly in rural areas.
“This is not a Republican or a Democrat problem,” he said. “This is mothers dying. It transcends every party line.”
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