ACOG Issues Committee Opinion on Rural Women's Health Disparities

March 9, 2009

The American College of Obstetricians and Gynecologists has issued a committee opinion on the health disparities faced by rural women in the United States, highlighting problems of access to care (with emphasis on access to reproductive health) and encouraging physicians to become involved in efforts to reduce and eliminate these problems. The organization explains that “lack of access to adequate women’s health care puts rural women in the US at a greatly increased risk of poor health outcomes compared with women in urban areas.”

In summarizing the issue for ACOG’s press release, Alan G. Waxman, MD, chair of ACOG’s Committee on Health Care for Underserved Women, stated that although “rural communities are home to 17% of all females 15 and older in the US, and 18% of all US births take place there… nearly one-third of rural women live in counties with no ob-gyn at all.”

Committee member Eliza Buyers, MD also remarked:

“When compared with their urban counterparts, US rural women experience higher rates of cervical cancer, and they receive fewer preventive screenings such as mammograms, Pap tests, and colorectal screening. They are also less likely to have received at least one family planning service in the past year and have an increased risk of receiving inadequate, late, or no prenatal care. Without enough health care facilities and clinicians to provide basic women’s health care, these women are at a higher risk of developing problems that could be prevented.

Their reproductive health care is also in jeopardy. Many of the least-populated communities do not have publicly funded family planning clinics, severely limiting a woman’s contraceptive options.”

Among the recommendations to physicians in the opinion (which is unfortunately not freely available online):

  • Collaborate with maternal-child and rural health agencies in your state to identify the health needs of rural women and barriers to care. Share your professional expertise as a member of an advisory committee or task force focused on improving the health of rural women.
  • Partner with family physicians and other women’s primary care providers to ensure that appropriate consultation and training are available for practitioners in rural areas.
  • Conduct further research to understand acceptable conditions for performance of vaginal birth after cesarean delivery in rural areas and to study the effect of vaginal birth after cesarean delivery policies on access to care for rural women.
  • Advocate for increased access to contraceptive methods and emergency contraception.
  • Advocate for availability of safe, legal, and accessible abortion services.
  • Rural health disparities are only partially due to lack of health care services. Rural communities have disparities in education, employment, and poverty that also should be addressed.

While I’m happy to see ACOG encouraging action, these are large problems that are unlikely to be solved by simply telling providers to do more – federal solutions encouraging providers to go to rural areas (such as medical school loan forgiveness) and systemic change are likely needed. For additional discussion of rural health issues, see the Rural Women’s Health Project and the National Rural Health Association.

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