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Iowa wins major federal grant to improve maternal health care

University of Iowa Obstetrics and Gynecology team
Date: Tuesday, October 1, 2019

Maternal medicine experts with University of Iowa Health Care, in partnership with the Iowa Department of Public Health (IDPH), have received a five-year, $10 million grant from the Health Resources & Services Administration (HRSA) to improve maternal health outcomes in the state.

Iowa is one of nine states to receive a State Maternal Health Innovation Program grant from HRSA. The award will be used to create and implement innovative strategies to address disparities in maternal health and improve maternal health outcomes, with a particular emphasis on preventing and reducing maternal death and severe maternal illness.

Stephen Hunter, MD, PhD, UI professor of obstetrics and gynecology and vice chair for obstetrics and co-director of the Iowa Statewide Perinatal Care Program, is the principal investigator on the grant, and the team includes UI faculty in the Departments of Obstetrics and Gynecology and Epidemiology, and staff at the IDPH.

“This was a true team effort which involved University of Iowa faculty and staff, and also the incredible work and help we received from IDPH,” Hunter says. “We are excited and honored to have been awarded this significant grant and we are eager to work with our partners over the next five years to truly improve health care and health outcomes for mothers in Iowa.”

A crisis in maternal health care

Iowa Department of Public Health teamLike the rest of the nation, maternal health in Iowa is experiencing a crisis. Maternal death rates are higher in the U.S. than in any other developed nation, and they are rising. In Iowa, maternal mortality has almost doubled in the three-year period 2015-2018, compared to the previous three years, up from 20 deaths to 39. In addition, Hunter says, patients are now sicker than in the past, with increasing maternal age, higher levels of obesity and related health complications, and societal problems such as substance abuse and mental health, all playing a role. To compound these problems, access to care is diminishing and the provider workforce is shrinking. Iowa has seen more than 30 labor and delivery units in critical access hospitals close since the year 2000, and Iowa has the lowest number of obstetricians per capita in the country, according to the American College of Obstetricians and Gynecologists.

These problems are also receiving increased attention from all levels of state government. In June, Gov. Kim Reynolds’ office organized a maternal health round-table, and the Iowa Department of Public Health recently held an OB summit, where Hunter and his colleagues and partners kicked off discussions about plans to identify, analyze, and address the major issues affecting maternal health in the state.

“These are national problems, but in rural states like Iowa, access to care is really becoming a crisis,” Hunter says. “The first year of the grant will involve collecting and analyzing data to identify primary problems and develop a ‘game plan’ to address those issues.”

To help address the shortages of qualified obstetrical providers across the state, the team will aim to establish new educational and training programs for providers who want to practice in rural areas. These training programs could include a rural track OB-GYN residency position, where the graduating OB/GYN physician would commit to work in a rural area of need; a nurse-midwifery training program; and obstetric fellowship training for family medicine doctors.

The team will also use the grant to create new systems for delivering quality care to make access less of an issue, including expanding telehealth services. They also plan to improve education of providers delivering prenatal care and help local hospitals be better prepared and equipped to provide obstetric and prenatal care.

Hunter credits the decades-long collaboration between the UI and the IDPH on the Statewide Perinatal Care Program as one of the reasons Iowa was successful in obtaining one of these grants. “It illustrates our capabilities as a strong, collaborative team capable of addressing this type of statewide issue,” he says.