by Tom Snee

A new Tippie College of Business study of hospitals in Iowa finds that when a rural county loses its last labor and delivery unit, fewer expectant mothers who live there get adequate pre-natal care, even though that care is still available.

One of the study co-authors said the findings are another demonstration of the challenges facing rural hospitals and the communities that rely on them for care, especially patients who are enrolled in Medicaid.

“Our study reflects continuing problems in our maternal health system in general, and in rural areas in particular,” said Tom Gruca, professor of marketing in the Tippie College of Business. “It suggests a breakdown of maternal health care in rural areas.”

Adequate pre-natal care is vital to mothers and babies. When mothers do not get adequate pre-natal care, their babies face an array of possible health complications, including a higher likelihood of low birth weight and death, Gruca said.

He worked with Stephanie Radke and Laurel Smiens of the University of Iowa Hospitals and Clinics and Kelly Ryckman of the University of Indiana School of Public Health. The research team looked at the impact of the closure of seven labor and delivery units in 2018 and 2019 at rural hospitals in Iowa where pre-natal care continued to be available. The hospitals were in Hardin, Osceola, Clayton, Emmett, Lucas, Hamilton, and Van Buren counties and were the only labor and delivery unit in those counties before the closure.

The study found that 18 percent of expectant mothers were making an inadequate number of pre-natal care visits to a doctor in those hospitals before the closing. Following the closing, that number increased to 22 percent.

“And 18 percent is not a great number to begin with,” Gruca said.

All women in rural counties where the only labor and delivery unit closed have a 24% higher likelihood of having inadequate prenatal care compared to those in counties that still have a unit. For women enrolled in Medicaid, the difference is even more pronounced, with a 38 percent higher likelihood of receiving inadequate pre-natal care.

Although the study did not find out why fewer expectant mothers sought adequate pre-natal care, the researchers speculated that many of them may have thought their local hospital dropped all maternity services when the labor and delivery unit was closed. They said access to adequate pre-natal care was complicated by the fact that not all health care providers in the affected counties accept every form of insurance, especially Medicaid.

Gruca said one possible solution to helping expectant mothers would be the establishment of a central source of information they can access to find health care professionals who provide the care they need and accept the insurance they have. Currently, no such resource exists.

The paper, “Closure of labor and delivery units in rural counties is associated with reduced adequacy of prenatal care, even when prenatal care remains available,” was published in the Journal of Rural Health.

MEDIA CONTACT: Tom Snee, 319-384-0010 (o); 319-541-8434 (c); tom-snee@uiowa.edu