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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A majority of South Dakotans have voted to maintain a strict abortion ban but other factors are shifting the landscape for reproductive care in the state.

Of the 10 states voting on abortion during the 2024 election, South Dakota was one of three to keep a ban in place.

Kim Floren, director of the Justice through Empowerment Network, which provides financial assistance to people seeking abortions, said the state's view on the issue is not new but concern is growing over how the federal government may affect reproductive rights.

"I'm feeling the panic from people who are in areas that maybe haven't experienced what we've experienced as far as barriers go," Floren noted. "The reality is that we as a community can figure out how to take care of one another."

The Justice through Empowerment Network provides assistance with travel and transportation, child care, lodging, interpreters, birth control and medical procedure funding. Floren pointed out the organization supports 30 to 40 people per month. The final tally for Amendment G, which would have established a right to abortion in the state's constitution, was 41% for and 59% against.

South Dakotans voted in 2006 and 2008 against near-total abortion bans but Floren stressed since then, President-elect Donald Trump's first term made people feel "emboldened to be more vocal." Still, she acknowledged his second term will begin in a different context than his first.

"Before Dobbs, we did not have all of these reliable, safe websites where you can order abortion pills from and have them sent to your house for extremely cheap," Floren observed. "In some ways, access here has gotten better."

Floren added Gov. Tim Walz of Minnesota will return to his post after running for vice president on the Democratic ticket. Walz in 2023 signed a bill protecting patients who travel to Minnesota for abortion care and their providers from legal penalties in other states.


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It is now up to Wisconsin Supreme Court justices to decide the fate of an abortion law from the mid-1800s.

A circuit court determined last year an 1849 law does not apply to "medically consented" abortions in Wisconsin. The high court heard arguments Monday about whether a 1985 state law overrides the older one, allowing abortions before the point at which a fetus could survive outside the womb.

Jenny Higgins, professor of obstetrics and gynecology at the University of Wisconsin-Madison, said while the impact of this case is critically important, even if the 1849 law is determined to be unenforceable, returning to the status quo would mean a dire landscape for abortion access.

"Even though abortion is technically available at clinics in Wisconsin right now, it's heavily restricted," Higgins explained. "Because of insurance and Medicaid prohibitions, people have to pay out-of-pocket for a service that should be covered by insurance."

The 1849 law, which was brought to light after Roe v. Wade was overturned by the U.S. Supreme Court, prompted a statewide freeze on abortion services for more than a year. Higgins noted if Wisconsin's high court rules the law still applies today, the state would be looking at another abortion freeze.

Abortion access disproportionately affects those who are already the most marginalized, Higgins pointed out. She noted while people from all walks of life may find themselves needing abortion care, factors like poverty and racism make it much harder for some to achieve reproductive autonomy, compared to those with more economic and social resources.

"Those effects make it much harder for folks to be able to access contraceptive care, be in relationships that are stable and healthy and communicative, to be able to see past the end of the day into one's future if you are, again, mostly focused on your own economic scarcity or figuring out how to feed your kids, or figuring out how not to get evicted," Higgins outlined.

The 1976 Hyde Amendment, established three years after Roe v. Wade, prohibits the use of federal funds for abortion. Higgins hopes federal lawmakers will focus more on this amendment when considering the barriers to abortion care.


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Strong reactions are pouring in from both sides as Missouri voters made history by adding abortion rights to the state constitution.

The decision to pass Amendment 3, the "Right to Reproductive Freedom Initiative," makes Missouri the first state to overturn a near-total statewide abortion ban. Advocates and opponents are now gearing up for future battles.

Jamie Morris, executive director and general counsel of the Missouri Catholic Conference in Jefferson City, said he is disappointed with the passage of the amendment but emphasized his organization's pride in the conference's efforts, despite limited resources, and vowed the fight is not over.

"From the church's perspective, win or lose, we were going to continue to advocate for policy to help address the needs of women to help them choose life to begin with," Morris explained. "So that not only you're dealing with, necessarily, the supply of abortion, but also the demand."

In addition to abortion rights, Amendment 3 protects access to contraception and reproductive health services.

Meanwhile, pro-choice advocates in Missouri including Planned Parenthood and the ACLU are celebrating the passage of the amendment, while filing a lawsuit to block some restrictions, including parental consent for minors and continued regulatory oversight of abortion services.

Maggie Olivia, senior policy manager for the advocacy group Abortion Action Missouri, applauded the vote.

"I could not be more proud of the first steps that we are taking together as Missourians to dismantle the decades of political infringements on our access to abortion and, frankly, all reproductive care," Olivia stressed.

Missouri was among nine states with abortion rights measures on the 2024 general election ballot. Amendment 3 takes effect Dec. 5.


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