Des Moines clinic receives $2 million federal grant to improve maternal health outcomes

Primary Health Care, the Des Moines-based safety net health care provider, has received a $2 million federal grant to invest in maternal health care and address disparities among vulnerable populations.

Officials with the nonprofit community health center say the two-year grant, which was part of more than $65 million handed out by the Biden Administration to health centers across the country, will help providers improve maternal health outcomes by investing in care coordination and increasing access to needed services.

The money comes as Iowa's maternal mortality rate has more than doubled between 1999 and 2019.

"This program is aimed at helping any maternal health patient that comes through our doors," said Marissa Conrad, spokesperson for Primary Health Care.

Of the 35 federally-funded health centers that received funding from the U.S. Health Resources and Services Administration, Primary Health Care was the only health center in Iowa to receive a grant, Conrad said.

The funding is part of federal officials' larger effort to address poor maternal health outcomes among populations who are at highest risk for complications, including those without health insurance coverage or women of color.

Federal officials say studies have shown black and indigenous women are three times more likely to die of pregnancy-related causes than white women in the U.S.

As a federally qualified health center, the majority of Primary Health Care's patients fall under that umbrella, Conrad said.

The health center saw more than 40,000 patients in 2021. Of those, 67% identified as a racial or ethnic minority and 47% were cared for in a language other than English. About 40% of its patients identified as Hispanic.

Among the pregnant patients the health center cared for in 2021, 46% were uninsured and 40% were on Medicaid, Conrad said.

Primary Health Care to hire new staff, offer more care coordination

As part of the grant, Primary Health Care will hire medical care coordinators, called community health workers, as an extra set of eyes on the patient, said Megan Sloat, a certified nurse midwife with the health care center.

These four new staff members will serve as liaisons for patients' medical and social services needs, connecting them with community services and otherwise work to address the reasons they may miss appointments.

That work includes connecting patients to the health center's behavioral health consultants who screen women for perinatal mood disorders like depression and anxiety.

The clinic's community health workers will also give more education and offer more attention to patients' medical needs, especially those with high-risk pregnancies. For example, if a woman is diabetic, the coordinator will ensure the patient knows how to monitor their blood sugars and otherwise manage their condition, Sloat said.

"Every clinic around the country, especially post-COVID, it feels like there’s less time and more risk," Sloat said. "The more education and attention we can give to people, the better."

The grant will also allow Primary Health Care to increase telehealth services and to offer in-house ultrasounds, reducing the amount of time patients need to travel to other clinics. Sloat said the health center's midwives will be trained to offer ultrasounds.

Iowa's maternal mortality on the rise

Federal health data shows Iowa had 30 maternal deaths between 2018 and 2021, or a maternal mortality rate of 20.2 maternal deaths per 100,000 live births.

Maternal mortality accounts for all deaths that take place during birth and up to a year later. Iowa's maternal deaths include delivery-related complications, such as post-partum hemorrhage, as well as other deaths not specifically related to pregnancy, such as car accidents.

Iowa's maternal mortality rate has been on the rise in the past 20 years, with increases more profound among communities of color nationally, according to a new study published in JAMA. Researchers found maternal deaths per 100,000 births more than doubled in that time period, increasing from 10 in 1999 to nearly 22 in 2019.

Rates across the United States more than doubled between 1999 and 2019. The study found those rates were more significant among Black, Native American and Native Alaskan women.

In Iowa, the maternal death rate among American Indian and Alaska Native populations rose from 26.5 to 139. Rates among Black women decreased from 26 to 24.3, but the study noted high death counts during that 20-year period.

By comparison, Iowa's white population saw an increase from 8.3 deaths per 100,000 births in 1999 to 17.6 deaths in 2019.

Researchers have found that pregnancy complications and other poor health outcomes among women in rural states like Iowa are tied to a lack of access to pregnancy-related care.

A new report from March of Dimes found more than 41% of Iowa women live in counties where they face a high to very high vulnerability to adverse outcomes because they lack that access to care.

The report found 10.6% of women received inadequate prenatal care during their pregnancy, including regular screenings that are often key in reducing risk for complications.

Researchers also found, both in Iowa and across the country, that women of color were more likely to receive sufficient care due to challenges like a lack of reliable transportation or poor housing conditions.

Health center to hire new nurse midwife at Marshalltown clinic

Primary Health Care also plans to hire a certified nurse midwife to practice at its Marshalltown clinic. Sloat said the health care center is hoping to improve access to prenatal and postpartum care to women in that county and the surrounding area, an issue that is in part tied to that area's lack of labor and delivery services.

The county's sole hospital-based labor and delivery unit, located in Marshalltown, permanently shut its doors in 2019. Hospital officials at the hospital cited declining birth rates and a shortage of health care providers as the reason for the closure.

Primary Health Care won't offer labor and delivery services at Marshalltown with the hire of a new midwife, Sloat said. However, the new provider will allow the clinic to expand prenatal service and offer a pathway for women to access affordable labor and delivery services through its partnership with the hospital in Ames, about 42 miles from Marshalltown.

"By seeing us in Marshalltown, we make a pathway to affordability," Sloat said. "If you’re uninsured or undocumented, you can’t get services anywhere. Part of the mission is that we’ll see you regardless of your ability to pay. So if we can get patients on our pathway to delivery, we do all of the management of where you’re going to have the baby and how going to get there financially."

Marshalltown's closure is among the 41 labor and delivery units across the state — but mostly in rural parts of Iowa — that have permanently shut down since 2000. Only about 40% of Iowa counties had a birthing center in 2021, experts estimate.

A recent study from the University of Iowa found that labor and delivery closures resulted in more pregnant women missing prenatal appointments.

The study, published in the Journal of Rural Health, found women seeking prenatal visits dropped from 83% to 79% in seven counties where the sole hospital closed its labor and delivery unit. Women on Medicaid were more likely to miss appointments, researchers found.

About a third of Iowa counties are classified as maternity care deserts, meaning they don't have an OB-GYN or a birthing center, according to the March of Dimes report. In some cases, women in those areas travel 40 miles to reach the nearest birthing hospital.

Michaela Ramm covers health care for the Des Moines Register. She can be reached at mramm@registermedia.com, at (319) 339-7354 or on Twitter at @Michaela_Ramm

This article originally appeared on Des Moines Register: Primary Health Care awarded $2 million federal maternal health grant