(Editor's note: Earlier versions of this column changed Iowa Gov. Kim Reynolds quote from "pro-life" to "anti-abortion." The text of the quote has been corrected. Note added 11:30 a.m. on Aug. 23, 2019.)
In a state where the dominant party is championing the rights of fetuses, the lives of their mothers’ have never been in more danger.
“I’m proud to lead the most pro-life state in the country and remain firm in my belief that all human life is precious,” said Gov. Kim Reynolds in February of 2019.
At the time Gov. Reynolds made those comments, the maternal death rate for Iowa mothers was 17.9 per 100,000 live births. Maternal deaths are defined as deaths of a mother “due to complications of pregnancy, labor, delivery, or puerperium” in the weeks following the birth. And in Iowa alone the maternal mortality rate is higher than any other developed country. Except for our own country, of course, where the national average is 26.4 deaths per 100,000. The Iowa Department of Health reports rates of maternal deaths in the state have doubled in the past decade. National research shows 30 percent of these deaths are avoidable and could be prevented with qualified professionals, and better access to care. But solving the issue of saving the lives of mothers is a complicated issue that lies at the intersection of culture, health care policy, and politics.
In September, Marshalltown will lose their obstetrics unit. In a news release, Unity Point stated the closure is due to declining birthrates and a lack of qualified health care professionals willing to move to the town. They declined to comment on the specifics of the closure and how it is affecting women in the area. But Joel Greer, the mayor of Marshalltown, says the issue is more complex. Medicaid is a huge issue, he says. A 2014 study by the American College of Obstetricians and Gynecologists found that women in rural areas are poorer and more likely to rely on Medicaid. Yet, Medicaid reimbursements for OBGYNs are lower than commercial insurance. Leaving hospitals to fill the gaps in cost. And they can’t.
The Governor’s office denies that the privatized Medicaid program contributes to the problem, but the money tells a different story. Former Gov. Terry Branstad’s 2017 $1.7 billion health and human services appropriations bill discontinued the federal Medicaid family planning network waiver. Giving up about $3 million in federal funding. The state used the funds to create a family planning network, leading to the closure of Planned Parenthood clinics across the state, further compounding the health care crisis. Closing clinics doesn’t save babies, it just endangers mothers, by making it impossible for them to find care.
It’s not just Marshalltown, thirty-four OB units have closed across the state since 2000. “If it’s that bad for Marshalltown, a town of almost 30,000” said Bill Menner of the Iowa Rural Health Association, “imagine how hard it is for a smaller town.”
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Menner adds that while Medicaid pay outs are a huge problem, that’s only part of the picture. A huge challenge for Iowa is recruiting health care workers. “There is an opportunity here to talk about solutions to recruit qualified doctors, nurses, and well, everyone, even veterinarians,” said Menner. He mentioned possible solutions like loan forgiveness programs, which Iowa participates in, the problem is, so do bigger cities.
Declining birthrates are also a problem, but how can you convince someone to move to a rural area and have a baby there when there are no services? And why is the health and safety of our families and issue of a hospital’s bottom line?
And it’s not just Iowa. States like Minnesota, Wisconsin, and others are experiencing the same crisis of care, leaving vulnerable mothers at a loss. Less than one half of rural women live within a 30-minute drive of a hospital that offers perinatal services. 87.6 percent of rural women live within a 60-minute drive. Rural women are the most likely to not seek out care because of the cost and distance involved. What that means is women who are worried about their children, scared and in a crisis, have a long way to travel for help.
Here is what all of those statistics and policy debates actually mean: “I was scared. I didn’t have bleeding with my first pregnancy. I cried pretty much the whole way there,” Jamie Huster, told the Sioux City Journal in 2018 about her 80-mile drive to the nearest hospital during pregnancy health care. My own mother had to be airlifted to a Sioux Falls hospital, when she collapsed from pre-eclampsie at a home in Akron, Iowa during her pregnancy with my younger brother.
Doctors, hospitals, politicians, city leaders — everyone agrees there is a crisis. But the policy puzzle to solving it often feels like getting punched in the face by the hand that bandages your wounds.
Sen. Chuck Grassley, a champion of rural health, has offered a lot of policy solutions such as telehealth and fixing prescription prices, and vital support for rural hospitals. But he’s also advocated rolling back key aspects of Medicaid expansion and defunding Planned Parenthood, which offers family planning services. None of his solutions mandate coverage for preexisting conditions, including maternity services. It’s like trying to walk forward by stepping on your own feet.
It would be wrong to make this issue about who loves women and babies more. After all, this problem is, simply put a mess: one that deals with population loss in rural areas, the state of our nation’s health care, and insurance. But something needs to happen.
Unity Point, which owns the hospital in Marshalltown declined to answer questions about the closure. “I don’t have any knowledge of that,” said Pat Garrett, the press officer for the Governor’s office, when told of the maternal care crisis in the state. The Iowa Department of Health and Human Services forwarded a news release about the hospitals but didn’t respond to follow up calls and emails about what’s being done to address the crisis. In the political silence and denials, Iowans are losing hospitals and mothers are losing access to care at a time when maternal deaths are on the rise.
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And while politicians grandstand over protecting fetuses and families, the realities that face their mothers are lost.
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