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Report finds a third of Iowa counties are maternity care deserts

Iowa Public Radio | By Natalie Krebs

Published August 1, 2023 at 10:24 AM CDT

A March of Dimes report found one-third of Iowa counties are maternity care deserts.

A third of Iowa’s 99 counties are maternity care deserts, meaning they have no OB/GYNs and no birthing hospitals or birthing centers, according to a new report by the non-profit March of Dimes.

The report found 33 counties fit this definition, marking an increase in the number of rural hospitals that are no longer offering labor and delivery services.

The loss of maternity services correlates with negative birthing outcomes, said Jessica Dill, the manager of centralized developments with the March of Dimes.

"Preterm birth, issues related to birth, maternal morbidity rates go up when families have to drive more than 30 minutes to get to a care provider," she said.

The report found hospitals offering birthing services dropped 6.7% between 2019 and 2020. Insufficient Medicaid reimbursement rates are a big factor in why many rural hospitals continue to shutter their labor and delivery units, she said.

"Hospitals can't afford to stay open in places where the majority of families are coming to them with just Medicaid and not private care insurance," Dill said.

More than 40% of Iowa births in 2021 were Medicaid-funded, ranging from 67% in Buena Vista County to 18% in Dallas County.

The report also measured the availability of family planning services in Iowa counties, finding that 41.4% of Iowa women live in counties with very high or high vulnerability to "adverse outcomes" from a lack of services, such as an unexpected pregnancy, preterm birth and anxiety and depression.

Dill said many counties that lack maternity care services do have access to family planning services, but said overall many women are traveling further for reproductive care.

The report concludes one way to help fill in some of the gaps is to increase telehealth services, especially for Medicaid patients.

"Access to telehealth services have been proven to not replace, but help supplement and give families access to care in those maternity care deserts," Dill said.