Reproductive Access Can Be Difficult in Rural Areas

"Rural women are twice as likely to die from pregnancy complications than women in large metropolitan areas, federal data shows," Sarah Melotte reports for The Daily Yonder. The lack of pregnancy and childbirth care in rural hospitals, especially for high-risk cases, contributes to the problem. And rural women of color and their babies face even worse odds. Stories out of Montana, Nebraska and Texas illustrate the overall trend, made more worrisome fears that that eroding abortion rights will increase the number of high-risk pregnancies. Montana State University sociologist Maggie Thorsen told Melotte that the U.S. is already "the only industrialized country in the world that has a growing maternal mortality rate."

Fewer than half of the nation's rural counties had obstetric services in 2019, a Commonwealth Fund study found. Many hospitals have shuttered them (a trend the pandemic has accelerated), citing expense, lack of personnel, and declining rural birthrates. "Women unable to reach obstetrics units in time to give birth can end up delivering in an emergency room en route to the desired hospital. This can have deadly consequences for individuals with high-risk pregnancies," Melotte reports. "Common complications associated with these births include hemorrhaging, preterm birth, and preeclampsia."

A recent study of Montana maternity deserts illustrates the trend. Thorsen and others found that pregnant Montanans drove an average of 42 minutes from home to give birth, but that trips of several hours were not unusual. About 44% of the state's population lives in rural areas, more than twice the national average, Melotte reports. About half of its counties are maternity-care deserts, and 10% of the state's population—some 93,000 people—live in those deserts.

Native American women in Montana have even higher rates of complications or death in childbirth. Indigenous women (who tend to live in rural areas) are less likely to live within an hour's drive of high-level obstetric services than white women; not many Indian Health Services hospitals in the state provide such services, Thorsen told Melotte.

A story from Nebraska highlights other facets of the issue. Emergency help can be hard to access in rural areas. One rural woman who had preeclampsia called an ambulance, but it took so long to get there that she ended up giving birth in the ambulance, assisted by an EMT who had never delivered a baby, Addie Costello reports for the Flatwater Free Press. Local primary-care physicians can provide some obstetric services, but many are retiring, and not enough doctors are replacing them.