The first time my partner visited my parents, he exclaimed, “WHAT is that smell?” It was manure. Though surrounded by the beautiful background of the Blue Ridge Mountains, the lovely stench of the Shenandoah Valley is one highlight of living in the same county that ranks 3rd in the country for poultry production. This agricultural image may contribute to the perception that rural America is all white men on tractors farming, but my experience growing up in various parts of the Blue Ridge Mountains and Appalachian region has shown me rural America is far more diverse and multifaceted. Rural areas encompass a mix of racial, cultural and economic backgrounds, with communities ranging from Indigenous and immigrant populations to farming families and remote workers. Yet, as rural areas continue to evolve, the healthcare system has failed to keep up, especially for women.
After graduating from college, I moved to a rural “high needs” Health Physician Shortage Area (HPSA) county in southwestern Virginia, where it took me an entire year to secure a new patient primary care visit – a delay that is particularly harmful to people seeking reproductive care. Access to OB/GYN care is similarly limited, with only 6% of obstetricians-gynecologists practicing in rural areas. As a result, many rural women rely on already overburdened primary care or family medicine physicians for routine gynecologic checkups or family planning services – or forgo care entirely.
Rural women are also enrolled in Medicaid and Medicare at higher rates than their metropolitan counterparts, with rural practices treating up to four times as many Medicare patients as metropolitan practices. Yet despite this need, rural hospitals face persistent challenges in recruiting and retaining staff, often lacking the resources to compete with urban centers. Two out of every three of the nation’s primary care Health Physician Shortage Areas (HPSAs) are in rural or partially rural areas, forcing residents to travel an average of 39 miles to a hospital.
Rural residents simply do not have access to doctors.
Women in rural areas face numerous barriers to equitable and comprehensive care. For many, the combination of geographic isolation, economic barriers and systemic neglect means that care is difficult to afford and nearly impossible to access. These systemic barriers have tangible consequences for rural women’s health, such as:
- Higher rates of chronic conditions such as diabetes, heart disease and obesity, often due to limited access to preventative care, healthy food and exercise opportunities;
- Lower odds of being vaccinated against HPV, lower screening rates for cervical and breast cancer and higher incidence and mortality rates for cervical cancer than women in non-metro areas;
- Substance Use Disorder (SUD) is prevalent in rural areas, with women having higher rates of heavy alcohol consumption as well as drug overdose-related deaths; and
- Rural women report more unintended pregnancies while also suffering from higher rates of severe maternal mortality and morbidity, infant mortality rates and two-thirds live in maternity care deserts with little to no access to prenatal or birthing care. One-half of rural women drive more than 30 minutes to reach an obstetrics hospital.
Cultural and social barriers also play a significant role in shaping rural women’s health experiences. In tight-knit rural communities, seeking care can feel like a public announcement, and women often delay addressing sensitive health concerns due to fear of judgment or gossip. As a teenager, my limited options for OB/GYN care highlighted these challenges. One of the few local offices was run by a friend’s parents, which made seeking care there profoundly uncomfortable. Turning to my primary care doctor was not any more comfortable, as she was one of my mom’s childhood best friends, and I had known her my whole life. Thankfully, I was seeking contraceptive and gynecological care with the support and knowledge of my parents, and they could help me navigate finding a provider. Otherwise, the fear of my providers knowing every aspect of my personal life would have prevented me from receiving care.
Fear of judgment, transportation burdens and limited specialty providers are just a few barriers rural women face in navigating the health landscape. Yet, these barriers only magnify and become more daunting when accessing reproductive care.
Stay tuned as I share more about the reproductive health landscape of my hometown and the barriers affecting rural women’s reproductive health experiences in my next blog, Miles, Mountains, and Barriers: The Hidden Reproductive Health Crisis in Appalachia.
