Health greatly affects how women are able to show up in both work and life. When women in Iowa face barriers to receiving the health care they need, they struggle to thrive in many other aspects of their lives. 

The Fearless team held our second Fearless Focus of the year on June 19, focusing on the barriers to health care women face in Iowa and how we can solve them.

The speakers included: 

Dr. Wanakee Carr, obstetrician-gynecologist, the Iowa Clinic

Tara Geddes, chief nursing officer, Floyd Valley Healthcare

Nichole Nidey, assistant professor, Department of Epidemiology, University of Iowa College of Public Health

Christina Schark, executive director, Southern Iowa Mental Health Center

Here are five takeaways from the event. You can watch the full event at fearlessbr.com/past-events. 

Iowa ranks last in the U.S. for the number of OB-GYN doctors per capita

Because there are a number of compounding factors making recruitment of obstetrician-gynecologists more difficult, the issue is only getting worse. 

In 2024, the state of Iowa enacted one of the most restrictive abortion bans in the country, causing some medical doctors to choose more friendly states in which to practice. 

“If you’re someone who plans to provide abortion care, you’re not going to want to come to Iowa to practice. You’re going to choose someplace more friendly to practice where you know you can provide that care if it’s needed,” Carr said. “If you’re not from Iowa, if this state is not friendly to practicing medicine without politics involved, people are going to be less likely to come.” 

Nidey echoed that students and trainees are also choosing to study elsewhere due to Iowa’s reproductive laws.

“If we can get trainees to come here to our programs, we can hopefully be more likely to keep them here in the state of Iowa,” she said. “But if our training programs are not able to provide educational experiences for all aspects of maternal care, it’s going to be really hard for us to get those really good trainees into our state and then to later stay.” 

Geddes said that patient volume and finances make it difficult to recruit OB-GYN providers in rural communities. It leaves them with fewer providers trained to manage more complex health issues for women.

“Our family practice doctors will do the OB care for our low-risk patients here, but that doesn’t mean that those high-risk patients aren’t showing up in our ERs. We have to make sure staff are prepared for those emergencies that come up that we don’t see on a regular basis,” she said. 

Expanding options for who can provide care is important

Schark explained that while the mental health field has always struggled with maintaining its workforce, Iowa has expanded who can provide care, leading to more patients getting the help they need. Community-based workers are able to address immediate crises. 

“When I first started in mental health back in 2001, it really was just the licensed therapist that did the bulk of the treatment. In the last 20 years or so, we’ve gotten a lot more creative about the ways we can use different types of staff,” she said. “For example, now we employ quite a few community case managers who go to a person’s house. Sometimes, we get really almost the same results as you would if a person did see a therapist.” 

Schark also pointed to Iowa’s mobile crisis team as an option that could help more women.

“To dispatch the mobile crisis team, anyone can dial 988 to reach the mobile crisis provider for your county,” she said. “What has happened is women who feel like they can’t leave because they’re caretakers, they cannot come to our crisis unit. This has really helped with some of those barriers for women especially who feel like they can’t leave their families.” 

Rural communities have less access to health care than metro areas

Over 40 maternal centers in Iowa have closed over the last two decades, many of them in rural communities. Geddes explained that many people have to travel further than before to get the health care they need, especially specialty and maternal care. 

“We were recognizing that there were a lot of closures in neighboring counties, and we were at a point where we were losing some of our [patient] volume in OB,” Geddes said. “When you start losing volume, it’s hard to recruit physicians and be able to keep those competencies and skills and be able to do that in a safe manner. It’s also hard to recruit nursing staff into that.”

In 2024, Floyd Valley Healthcare invested in expanding its birthing unit to help defy the trend. Geddes said it’s also a long-term investment as women are often the primary decision-makers in families and if they have quality maternal care they’re more likely to continue their family’s care with that health care entity.  

Carr said struggling revenue and retaining senior leaders is also making it difficult to get young doctors into rural communities. When providers are more sparse in rural areas, those practicing often experience burnout.

“They’re caring for so many patients that they can’t keep going at that rate,” Carr said. “So they choose to leave the state or move to a more metro area where they have more support or they’re taking less calls or where they don’t have to see an overwhelming number of patients in a day.” 

Women tend to neglect their mental health for the sake of their families

Women tend to be the household managers for the rest of their family, which can often lead to them neglecting their own care. 

The stigma around mental health can often make it seem less important of an issue to disrupt the family dynamic over, Schark said. 

“We are the caretakers for everybody in our family,” Schark said. “I’m the one that makes sure even the dog gets to where they need to be. So if we’re the ones that are feeling weak or sad or depressed, sometimes there’s just not time in the day for women to take care of themselves.” 

She encouraged women to provide themselves the same care they would expect for their loved ones.

It’s more difficult for some groups of women to access quality health care

Nidey leads the Empower Project at the University of Iowa, which is a patient-centered collaborative of over 20 pregnant women with substance-use disorders. Her work studies how these women are able to access care in Iowa. 

“In a recent study, my team called every licensed substance use treatment center in the state of Iowa, and when we called these centers, nearly half of them never answered the phone. So imagine if you called 911, and nobody picked up half the time,” Nidey said. 

Carr also spoke about the disproportionate maternal mortality rate for women of color in Iowa, which is higher than the national rate. Black women are six times more likely to die in childbirth than white women. Medicaid cuts expand the issue. 

“If you don’t have insurance, you’re less likely to seek care,” Carr said. “People don’t realize 40% of birthing women in the state use Medicaid.”  

It’s difficult for women with substance abuse issues to get pregnancy care, as well, explained Nidey. Providers often don’t understand substance use and what medications are safe to use during pregnancy. Stigma makes it even worse. 

“A recent study that our team did found women who reported stigma and discrimination during their prenatal care and their substance abuse treatment were two to three times more likely to disengage from their substance use treatment and two to three times more likely to return to use and overdose in the first six months postpartum,” Nidey said.