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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The Missouri Legislature has approved a law to stop its Medicaid program, known as MO HealthNet, from paying Planned Parenthood for medical services for Medicaid patients.

The decision follows a court ruling which found not reimbursing Planned Parenthood through Medicaid goes against Missouri's constitution.

Emily Wales, president and CEO of Planned Parenthood Great Plains, said they have joined forces with Planned Parenthood St. Louis Region and Southwest Missouri and stand behind providing health care to those who need it. She argued the Legislature is causing confusion despite a clear decision from the highest court.

"Despite the court's repeatedly ruling that 'defunding' Planned Parenthood health centers is unconstitutional, lawmakers continue to deny critical care like birth control, cancer screenings, wellness exams and STI testing and treatment from the patients who need it," Wales stressed.

According to the Missouri Family Health Council, Planned Parenthood health centers serve nearly half of patients who rely on family planning safety net providers in the state. Planned Parenthood Great Plains and St. Louis Region Southwest Missouri will continue serving patients and is looking for alternative solutions for funding.

The new law also blocks Planned Parenthood from being a recognized provider in the state's Medicaid program. Wales pointed out it could hurt health care for people who rely on the safety net.

"There are not enough other providers in the health care safety-net system to absorb Planned Parenthood's patients," Wales pointed out. "At Planned Parenthood, we'll continue to do everything we can to serve our patients, no matter what."

Planned Parenthood Great Plains provides health care to more than 30,000 people in 13 health centers across Missouri, Arkansas, Kansas and Oklahoma. The St. Louis Region and Southwest Missouri chapter has been serving for more than 90 years.

By Mary Anne Franks for Ms. Magazine.
Broadcast version by Alex Gonzalez for Northern Rockies News Service reporting for the Ms. Magazine-Public News Service Collaboration

People end up in emergency rooms for a variety of reasons. They’re having trouble breathing. They’ve suddenly developed chest pains. They’re bleeding uncontrollably. They’ve fallen off a roof, they’ve crashed their car, they’ve overdosed, they’re suicidal, they got stabbed in a fight, they got shot by police.

Some people who need emergency services are poor, or have no insurance, or are in the country illegally, or have committed a crime. Under the federal Emergency Medical Treatment and Labor Act (EMTALA), they are all entitled to receive emergency care. This law is based on a simple principle: Hospitals shouldn’t be allowed to let people die based on who they are, how much they can pay, or what they have done.

On April 24, the Supreme Court will hear oral arguments in Moyle v. U.S., a case that will determine whether individual states are allowed to exclude a single group from this basic protection: pregnant women. The state of Idaho claims that it has the right to forbid pregnant women and girls—and only pregnant women and girls—from receiving emergency care that could save their lives.

How, and why, would a state want to do this?

First, the how: In 2022, the Supreme Court ruled in Dobbs that forced childbirth does not violate the Constitution. This allowed Idaho’s 2020 “Defense of Life Act,” a draconian anti-abortion law, to go into effect. According to the law, anyone who performs an abortion faces imprisonment of up to five years in prison. Healthcare professionals who perform abortions will also have their professional licenses suspended or revoked permanently.

This puts the state law directly in conflict with federal emergency care law. EMTALA requires Medicare-funded hospitals (which most hospitals are) to provide medically necessary stabilizing treatment to any patient with an “emergency medical condition.” An emergency medical condition is one that, in the absence of immediate medical attention, is likely to cause “serious impairment to bodily functions,” “serious dysfunction of any bodily organ,” or otherwise puts the health of the patient “in serious jeopardy.”

Pregnancy complications are a common reason for emergency care visits, and the medically necessary stabilizing treatment necessary to prevent serious injury or death to women and girls experiencing those complications sometimes includes the termination of the pregnancy.

Given that an abortion is sometimes the only medical treatment that will prevent death or serious bodily injury to women, a more accurate title for Idaho’s abortion law would be the “Let Women Die Act.” But as seen in the majority decision in Dobbs and the arguments propounded recently by the Alliance Defending Freedom in the mifepristone access case, forced birth proponents are rarely candid about their necropolitical agenda. Defenders of Idaho’s law instead feign outrage at the suggestion that the law will kill women, pointing to the law’s exception for abortions performed by a physician who “determined, in his good faith medical judgment and based on the facts known to the physician at the time, that the abortion was necessary to prevent the death of the pregnant woman.”

Idaho insists that the law’s exception for abortions necessary to save the life of the mother means that there is no conflict between it and federal law. But as the Department of Justice pointed out when it sued to stop the Idaho law from being enforced with regard to EMTALA’s requirements, federal law requires emergency medical care necessary to prevent serious injury, not just death. The federal law does not authorize the withholding of essential medical treatment to patients who are only close to, but have not yet arrived, at death’s door.

What is more, as countless medical professionals have attested, the line between serious bodily injury or death is rarely precise. It is often difficult, if not impossible, to predict the exact moment that a serious medical condition becomes a life-threatening one.

As the National Women’s Law Center detailed in its amicus brief in the case, “No clinical bright line defines when a patient’s condition crosses the lines of this continuum. At what point does the condition of a pregnant woman with a uterine hemorrhage deteriorate from health-threatening to the point that an abortion is ‘necessary’ to prevent death? When is it certain she will die but for medical intervention? How many blood units does she have to lose? One? Two? Five? How fast does she have to be bleeding?”

The recognition that serious bodily injury and death are so closely related as to be nearly indistinguishable has long been reflected in U.S. law. At common law, a person could be convicted of murder not only if he intended to kill but also if he intended to inflict “grievous bodily injury.” The law of self-defense generally allows a person to use deadly force when facing an imminent threat of death or serious bodily harm, not only to herself but to others.

Significantly, Idaho’s self-defense law specifies that a person is not required to wait for the danger to become fully apparent before acting: “The defense of self or of another does not require a person to wait until he or she ascertains whether the danger is apparent or real. A person confronted with such danger has a clear right to act upon appearances such as would influence the action of a reasonable person.”

Unless, of course, the person in danger is a pregnant woman.


Mary Anne Franks wrote this article for Ms. Magazine.

The U.S. Supreme Court is set to hear oral arguments today in a case about whether patients have access to emergency room abortions in states banning the procedure.

Idaho v. United States could determine if providers can perform medically necessary abortions for women experiencing complications under decades-old rules known as the Emergency Medical Treatment and Labor Act.

Dr. Polly Wiltz, a second-year emergency medicine resident at University Hospitals in Cleveland, said she is worried about her ability to care for patients who need abortions, if protections end.

"We are putting ourselves at risk for allowing legislators -- allowing people who do not have medical training -- to pick and choose which procedures, which life-stabilizing treatments and medications can and cannot be applied in the emergency department," Wiltz pointed out. "It's infringing on patient rights."

The Center for American Progress said pregnant patients with severe complications who are denied abortions could develop severe sepsis requiring limb amputation, uncontrollable uterine hemorrhage requiring hysterectomy, kidney failure requiring lifelong dialysis, hypoxic brain injury and other severe conditions.

Wiltz added most of the patients with pregnancy complications coming into the hospital lack access to routine OBGYN-related care.

"Regarding pregnancy related complaints, I see first trimester pregnant patients every single day," Wiltz noted. "In my shift, I have caught ectopic pregnancies that have ruptured."

Hospitals made up 33% of the facilities providing abortions in 2020, according to data from the Pew Research Center. Last fall, a majority of Ohio voters chose to approve a constitutional amendment, "Issue 1," establishing a statewide right to abortion and reproductive care in the aftermath of the Roe versus Wade decision.


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