By Liz Carey for The Daily Yonder.
Broadcast version by Mike Moen for Prairie News Service for the Public News Service/Daily Yonder Collaboration

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.

Liz Carey wrote this article for The Daily Yonder.


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Vending machines commonly found in workplace break rooms generally contain soft drinks or snacks but one machine in Indianapolis dispenses unconventional items at the turn of a knob.

The Plan B morning-after pill, pregnancy tests and condoms are displayed in a clear glass case inside a colorful blue and orange dispenser. The items provide easy access to protection against an unwanted pregnancy and are free of charge.

Melissa Gruver, organizing director of the feminist organization Indiana Task FORCE, said it operates like a traditional vending machine.

"You just push whenever you want and it falls down, and you reach your hand through the little door and you pull it out, take it with you," Gruver explained.

A 2022 Indiana Department of Health Termination Report indicated 9,600 pregnancies were aborted, with Marion County recording the highest number of unwanted pregnancies. The report also noted the average age of a woman in Indiana who sought an abortion was 27, and 67% of all terminated pregnancies occurred within four to eight weeks of conception.

The state's contentious near-total abortion ban, which was upheld by the Indiana Supreme Court last year, has stoked fears lawmakers may begin restricting a woman's choice of birth control.

Indiana Task FORCE and reproductive health groups All-Options and the Midwest Access Coalition want the emergency contraceptive vending machine to serve as a gathering spot for community conversations on reproductive rights and sexual health.

"We've long been organizing our communities to bring about reproductive justice, which we didn't have before and we definitely don't have it now," Gruver pointed out. "But what we know to be true is that there are more of us that want access to reproductive care than those that try to stop it. We're excited to continue to work to meet this need now, and to organize for a better community."

Gruver hopes to have one dispenser in every Indiana region in the future to add to the single machine currently in an eastside Indianapolis grocery store. She added some universities in the state already have vending machines offering similar contraception products but users have to purchase the items.

This story is based on original reporting by Mary Claire Molloy for Mirror Indy.


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