Friend, imagine this: You or someone you love just found out that they’re pregnant. Immediately, one wonders, “What are my next steps?” So naturally, you begin to search online for your nearest physician, only to find out that the nearest maternity ward has closed down and you have to travel nearly 50 miles for care. Now what?
There are currently over two million women, right now, living in maternity care deserts -- counties, often in rural areas, where there are no hospitals or birthing centers that help with pregnancy, and there are no doctors who specialize in pregnancy care -- and 19 million women living in contraception deserts.[1] So, if I’m doing the math right, this means that over 21 million women have little to no access to doctors that could provide contraception, doctors who can answer questions about reproductive health, provide information about abortion services, and are living without reasonable access to health centers that offers a full range of reproductive care methods. The harsh impacts of limited access to maternity care, the closure of maternity wards, strict or prohibited abortion laws, racial and socioeconomic injustices, and the consequences on pregnant women and their babies collectively form a complex and nuanced crisis in our healthcare system that leaves vulnerable populations at high risk.
A study published in 2019 found that people living in rural areas faced a 9% higher risk of maternal health issues and deaths compared to those living in urban areas. It's important to note that women of color, irrespective of where they live, had at least a 33% higher likelihood of experiencing these negative outcomes compared to white women.[2][3] This is especially concerning because, as we already know, whether they live in cities or rural areas and regardless of how much money they have (i.e. Serena Williams) [4], Black women lose their lives at 3 to 4 times more than the rate of white women due to maternity-related causes, independent of age, economic background, or education.[5] This is not okay.
We cannot ignore the racist history, intentionally placed barriers to informed family planning and lack of access to reproductive healthcare, that has left permanent scars on the communities of Black people, Indigenous tribes, and communities of color.[6] Unsurprisingly, as with maternal mortality rates, Black, Indigenous and other people of color bear a disproportionate burden of maternal mental health conditions, including postpartum depression. So on top of maternity care deserts, the racial disparities in maternal mental health is exacerbated in many small cities and rural communities with postpartum depression at a rate of 40 percent greater in Latina mothers and 80 percent greater in Black mothers compared to their white counterparts.
It is essential to confront this history, include it in our advocacy, and recognize the ongoing trauma that is being perpetuated everyday by some of our elected leaders. These groups have endured generations of systemic discrimination, from forced sterilizations to unequal access to healthcare resources.[6] Acknowledging this history is a critical step in addressing the deeply ingrained disparities that persist in healthcare today.
For all of these women, receiving maternity care, prenatal and postnatal treatment, mental health services, contraception, and abortion-care is not just about showing up to the appointment. There’s so much more to consider here: traveling long distances to receive prenatal care or give birth, which increases the risk of complications during pregnancy and delivery; childcare (finding and paying a babysitter); hotel lodging; taking time off work; and having all of this to consider even under emergency situations.
Most recently, Idaho implemented three near-total abortion bans: the first one forbids abortion after only six weeks of pregnancy, the second ban prohibits all abortions except in cases of rape, incest, or when the life of the pregnant individual is at risk, and the third ban allows family members to file lawsuits against doctors in civil court if they believe abortion care was provided.[7] They even banned teens from travelling out of state to receive abortion care, punishable by a minimum of two years in prison for anyone who assists with out of state travel.[8] Sounds familiar, huh? That’s because since 2020, we have seen copy-cat bills like this come into fruition day by day! *Coughs at Texas, who jump-started it all* Stories from women across the country tell us that limited access to abortion, a fundamental aspect of reproductive healthcare, is imperative.
Patients, like us, aren’t the only ones suffering here. The recent surge in restrictive abortion laws in various states has forced many healthcare providers to choose between their ethical commitment to patient care and the fear of legal consequences. This has led to a disturbing trend where physicians, particularly those with expertise in obstetrics and gynecology, are fleeing states with harsh abortion laws. Jessen, a recent medical school graduate who planned on returning back to her hometown in Idaho and serving as an OBGYN, states her confliction, “Do you put your desire to have a family in a safe area first, or your desire to be a full-scope provider who can provide abortion care? It's painful."[8]
We thank our legislative champions for their dedication to maternal and reproductive justice by prioritizing maternal health, the well-being of newborns, and fighting to protect our right to choose when and how we have children! In ensuring that no one gets left behind, we ask that you take your advocacy further by urging members of Congress to ensure that everyone has access to the full range of reproductive healthcare services, regardless of their geographic location. https://action.momsrising.org/sign/reproductivecaredeserts/
--Diarra, Tina, Monifa, Kristin, and the whole MomsRising.org & MamásConPoder Team
References:
[1] AP News: Rural hospitals are closing maternity wards. People are seeking options to give birth closer to home
[2] NBC News: Pregnant with no OB-GYNs around: In Idaho, maternity care became a casualty of its abortion ban
[3] Kozhimannil KB, Interrante JD, Henning-Smith C, Admon LK. Rural-Urban Differences In Severe Maternal Morbidity And Mortality In The US, 2007–15. Health Aff (Millwood). Dec 2019;38(12):2077–2085.
[4] USA Today: Serena Williams describes near-death experience she had after giving birth to daughter Olympia
[5] Tucker MJ, Berg CJ, Callaghan WM, Hsia J. The Black-White disparity in pregnancy-related mortality from 5 conditions: differences in prevalence and case-fatality rates. Am J Public Health. 2007 Feb;97(2):247-51. doi: 10.2105/AJPH.2005.072975. Epub 2006 Dec 28. PMID: 17194867; PMCID: PMC1781382.
[6] Prather C, Fuller TR, Marshall KJ, Jeffries WL 4th. The Impact of Racism on the Sexual and Reproductive Health of African American Women. J Womens Health (Larchmt). 2016 Jul;25(7):664-71. doi: 10.1089/jwh.2015.5637. Epub 2016 May 26. PMID: 27227533; PMCID: PMC4939479.
[7] Today.com: Idaho hospital closes its maternity ward, citing the state’s ‘political climate’
[8] CNN: Idaho AG sued over travel ban
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