Iowa facing maternal health crisis

By Dr. Robert O'Connor and Dr. Amy Ferguson

Like the rest of the United States, Iowa is facing a maternal health crisis. The maternal mortality rate in Iowa has almost doubled in recent years and significant racial disparities exist. Black mothers in Iowa have a pregnancy-related maternal mortality over six times higher than their white counterparts.

But Iowa lawmakers have the chance to pass legislation that could reduce maternal mortality rates and improve outcomes for mothers. Extending the Medicaid postpartum coverage period from the current 60 days to a full 12 months is the simplest and most targeted way to ensure that new mothers can get the care they need to help keep them and their baby healthy.

Medicaid is key to improving

maternal health outcomes and

addressing disparities in outcomes

With four out of every 10 births in Iowa covered by Medicaid, the state’s public health insurance program plays a critical role in making sure Iowans have access to the high-quality care that they need. Currently Medicaid eligibility changes 60 days after the mother gives birth. Eligibility drops from 375% of the federal poverty level to 138% of federal poverty level and many women lose insurance coverage.

As physicians who care for new mothers and newborns in our community, we have seen first-hand the importance of ensuring our patients have access to care, especially during the postpartum period (which the CDC defines as the full 12 months after giving birth). By assuring continuity of care during an extremely vulnerable time, Iowa has the opportunity to improve the health of mothers and set their children on a healthy trajectory.

Twelve months of postpartum care

is rooted in clinical evidence

This policy change is in line with clinical evidence and can keep moms and babies healthy. Some of the most dangerous pregnancy-related complications may not surface until weeks or months after delivery. In fact, Iowa’s Maternal Mortality Review Committee reported that most maternal deaths (56%) occurred postpartum, and formally recommended expanding Medicaid coverage for one year postpartum.

Congress established the arbitrary 60-day postpartum period for Medicaid coverage in 1986. We know now that preventable pregnancy-related deaths occur throughout the first year after giving birth and continuing coverage to 12 months postpartum is rooted in clinical evidence. It is time our policies change to reflect the research. Continuing postpartum coverage ensures coverage during this vulnerable time. It will provide coverage for moms without other options and prevent potentially deadly disruptions in accessing proper care.

Extending coverage

helps all Iowans

An investment in moms today is an investment in the future of our state. These moms are caring for and raising our future leaders. We know that healthy babies need healthy moms. Studies show that maternal health directly influences the health of children.

We also know that healthy women make for healthy economies. Healthy women can be more productive in the workforce.

Women account for 75 percent of our health care workforce, making them central to overall population health. Women also provide most of the informal care in homes and communities from child rearing to caring for the sick and elderly.

By supporting the health of new moms in our state, we are helping our families, communities, and our economy thrive.

Our budget reflects our values as Iowans. Each year, Iowa lawmakers make intentional funding decisions based on their values and priorities. Iowans want policymakers to make sure that new mothers can get the care they need to help keep them and their baby healthy. Iowa currently has a budget surplus, and while the pandemic has created considerable economic uncertainty, the funding to extend Medicaid coverage is currently available.

As Iowans who care about new moms and babies, please encourage our legislators to join policymakers in over a dozen states (both red and blue) in varying stages of pursuing the extension of postpartum coverage. Moms can’t wait.

Dr. Robert O’Connor is an obstetrics and gynecology pediatric hospitalist and newborn nursery director Dr. Amy Ferguson is a UnityPoint Clinic OB/GYN — Fort Dodge UnityPoint Health — Blank Children’s Hospital


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