Citizens of Lake View, Iowa, protest recent abortion bans at the Statehouse in Des Moines, Iowa. If the U.S. Supreme Court overturns Roe v. Wade many states currently under the GOP leadership would see a pathway to complete or near-complete abortion bans. Experts worry it could lead to even more burden on rural maternity and emergency wards. (AP Photo/Charlie Neibergall, File)

Already strained rural obstetrics units could find themselves dealing with even more maternity cases if the U.S. Supreme Court overturns Roe v. Wade

The court is expected to make a decision on a challenge to Roe v. Wade at the end of June, or the beginning of July. In May, a leaked draft opinion suggested that the Court is poised to overturn the 1973 Roe v. Wade case that established abortion rights protections nationwide. If the case is overruled, it could lead to abortion bans in nearly half of the country’s states.

The resulting pregnancies, experts said, could add to the problems rural communities are experiencing when it comes to quality maternity care in their areas.

“We are already under-staffed and under-resourced for deliveries in rural areas,” said Brock Slabach, COO of the National Rural Health Association. “We have maternity deserts in rural areas all over the country. If, as expected, Roe is overturned, we could have real capacity issues with many more live births.”

In Michigan, he said, officials anticipate between 8,000 and 20,000 additional live births per year.

“That could overwhelm a lot of hospitals,” he said. “Let me be clear — the maternity care crisis is already here. I don’t want to say that it’s going to get bad. It’s already bad, but we are going to have to do a lot to… beef up our resources to be able to accommodate the volume of people that are going to be delivering if Roe is overturned.”

According to the Commonwealth Fund, rural hospitals are closing their obstetric (OB) units, leaving fewer than half of the country’s rural counties with those services. With fewer OB units, rural women are facing longer travel times to get to a hospital that can deliver their babies. The OB unit closures also mean increases in births outside hospitals, births in hospitals without obstetrics care, and preterm births — all of which put both mother and child at risk.

Katy Backes Kozhimannil, professor at the University of Minnesota School of Public Health and director of the University of Minnesota Rural Health Research Center, said restricted access to abortion services would affect miscarriages and reproductive health as well.

“These services will be needed by rural residents, increasingly, at a time when rural hospitals are closing obstetric units, and rural emergency departments are ill-equipped to support emergency births and other obstetric care emergencies,” she said. 

“Beyond the walls of the clinic or hospital, further restrictions on reproductive health care in rural communities carry important risks for pregnant people and families, who bear the burden of suffering when needed health care is not available.”

Already maternal sickness and mortality is higher for rural residents, she said. Those rates would likely increase if access to abortions is restricted. The impact would most be felt by marginalized communities within rural areas, she said.

According to the U.S. Government Accountability Office (GAO), the more rural an area is, the higher the rate of deaths among pregnant women. The GAO found that rural areas with small urban clusters saw 19.8 maternal deaths per every 100,000 live births, where rural areas with no urban clusters saw 23.8 deaths. In comparison, large metropolitan areas with over 1 million residents saw 14.6 deaths per every 100,000 live births, while small and mid-sized metropolitan areas saw 16.2 deaths.

Greater disparities exist by race and ethnicity, the Centers for Disease Control and Prevention (CDC) found. Black women in rural counties had 59.3 deaths per 100,000 live births, compared to 19.7 for white women in those same counties.

“Rural communities where a majority of people are Black or Indigenous already suffer higher rates of premature death, and these are the same communities where access to rural maternity care is declining most rapidly,” Kozhimannil said. “Lack of access to abortion care and other reproductive health care services is likely to amplify risk of severe maternal morbidity and mortality among those who are already at greatest risk: rural residents who are Black or Indigenous. 

The impact would also be felt in emergency departments, she said, that would likely see increases in births, miscarriages, and the complications that could result from illegal abortions.

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