The Health Care Gaps in Rural America: Maternity Services vs. Abortion Access
For many women living in rural parts of the U.S., the struggle to access basic maternity care has overshadowed the ongoing debates about abortion access. In communities like Baker City, Oregon, where maternity wards continue to close, women are increasingly focused on the need for safe and accessible options to give birth rather than the availability of abortion services.
Shyanne McCoy, a 23-year-old from Baker City, Oregon, found herself making a two-hour drive to Boise, Idaho, when her local hospital closed its maternity ward. With symptoms of preeclampsia, McCoy knew she needed more comprehensive care than her small-town hospital could offer. Unfortunately, she was forced to make this lengthy trip away from home to receive the critical attention she needed as her pregnancy progressed.
“I couldn’t risk going anywhere but a larger hospital when I needed urgent care,” McCoy recalled. “I spent the last week of my pregnancy in Boise because I knew that was the safest option for me and my baby.”
For McCoy and many rural women, this situation reflects a larger and growing concern: the lack of accessible maternity care. With rural hospitals continuing to close or limit their services, including obstetrics, many women find themselves needing to travel long distances for basic medical needs, a problem that’s quickly becoming more pressing than the availability of abortion services in these regions.
Rural Communities Grapple with Maternity Care Shortages
Across the U.S., rural areas have faced hospital closures that leave pregnant women with limited options for maternity care. A study published in JAMA in December 2024 found that 52% of rural hospitals had eliminated obstetrics care by 2022. The ripple effect of these closures is felt most acutely by young women, who are already more likely to need obstetric care during pregnancy.
These closures are not an isolated issue in one state or county. The trend is impacting rural communities nationwide, where hospitals struggle with funding, workforce shortages, and low patient volume. For women like McCoy, the primary concern isn’t about abortion access, but rather how to get the maternal care they need to safely deliver their babies.
While Oregon is one of the most progressive states in the country when it comes to abortion access, residents in its rural areas have made it clear that expanding abortion services is not the priority for them right now. Oregon’s government provides comprehensive abortion services, including access through its Medicaid system. Yet, even in this state, there has been significant pushback in rural areas against efforts to increase abortion access, with many voters and local leaders advocating for more investment in maternal health services instead.
State Rep. Christine Goodwin, a Republican from a district in southwestern Oregon, called it an example of urban lawmakers imposing their needs on rural communities. Her concern was that any efforts to expand abortion access in her district would be met with strong opposition, especially if it came at the expense of improving maternity care.
Health Care Priorities: Maternal Health Over Abortion Access
As the political and social divide over abortion access continues to grow, many rural women argue that expanding maternal health services should take precedence over abortion. A proposed bill in Oregon aimed to introduce two mobile reproductive health care clinics to rural areas, which would provide both abortion and general reproductive health services. However, after significant opposition, including from leaders in Baker County, the bill was amended, and abortion services were removed from the proposal.
Paige Witham, 27, a member of the Baker County health care steering committee, expressed the sentiment of many rural residents when she said, “If you expanded rural access to abortions before you extended access to maternal health care, you would have an uprising on your hands.”
Witham’s perspective is shared by many in her community. For women like her, who recently gave birth to an infant, the focus is firmly on improving the care they can access during pregnancy and childbirth, not on increasing abortion access. Without access to local maternity care, women in rural areas are forced to make significant sacrifices, like leaving their families and jobs behind for extended periods, to receive the care they need at distant hospitals.
A Lack of Obstetrics Care and Its Consequences
The lack of obstetrics care in rural areas poses serious risks to maternal and infant health. Research shows that the longer the distance between a pregnant woman and the hospital where she can receive care, the greater the likelihood of complications, including preterm birth and low birth weight. The study found that babies born far from obstetrics care were more likely to need neonatal intensive care unit (NICU) services, which can be expensive and life-saving.
In rural Oregon, many communities have lost or reduced access to these critical services. This has created a gap in the health care system that has left women feeling neglected and underserved. While the state’s urban areas have been a focus of abortion access expansion, it is clear that for many rural women, the more urgent concern is securing the maternity services they need to carry and deliver their babies safely.
Rural Women’s Health Care Needs Must Be Addressed
As the political landscape continues to shift, lawmakers in rural areas are calling for more focused attention on the real issues faced by women in these communities. The discussion around expanding abortion access is important, but it is becoming increasingly clear that, for many rural women, the immediate priority is ensuring that they have the support and resources they need to safely navigate their pregnancies and childbirth.
In rural Oregon and beyond, the health care needs of women are not one-size-fits-all. Advocates for rural women’s health are urging lawmakers to prioritize access to obstetric care as much as—or more than—the expansion of abortion services. The conversation is evolving, but one thing is clear: without addressing the maternal health crisis in rural America, many women will continue to face unnecessary risks to their health and that of their children.
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