Pregnant in rural America: Fear, stigma, and barriers to care

VINTON COUNTY, OHIO — Overcoming substance use disorder while pregnant is hard enough—couple that with traveling over an hour to the nearest hospital via a rideshare service for prenatal care appointments and to give birth and you’re looking at a particularly stressful pregnancy. But that’s what Janette did.

In maternity care deserts, such as this one in rural Ohio, it’s normal for the nearest hospital to be a long drive away. Additionally, those who live in maternity care deserts are more likely to be dealing with poverty or substance use disorder, according to our 2022 report Nowhere to Go: Maternity Care Deserts Across the U.S.

Just like 12.8% of residents of Vinton County—the least populated county in the state, with around 13,000 residents—Janette lives below the poverty line. “It's hard to make a living here,” she says. “I live off a [welfare benefit] check because I'm not able to work because of my car wrecks. It’s a struggle.”

Without a license or a car, Janette relied on the rideshare service Care a Lot to take her to doctor appointments in Gallipolis, the closest hospital offering obstetric care. She had to reschedule a few times due to no cars being available.

 “Prenatal care is a major disparity in this county,” says Ciara Fox, Vinton County Health Commissioner. “Access to care in general is. We have no healthcare facilities that are hospital wide. So if you’re a resident of Vinton County and you’re a mom or an expecting mom, you have to go out of the county to receive prenatal care.”

Unfortunately, things just seem to be getting worse for moms and babies in rural America. Our maternity care deserts report shows that as a country we’re going in the wrong direction and an already severe situation is getting worse.

“You see these women struggling, whether it’s not having transportation to go to their OB appointments, not having food to feed their family, not having adequate housing, and you know there’s more out there and you know there could be so much for them that we just don’t have here in the community,” says Lindsey Jeffers, March of Dimes Community Health Worker.

Janette faced additional barriers throughout her pregnancy. She was taking a medication to help treat opioid dependence and addiction and had difficulty getting her prescriptions filled due to medical professionals treating her differently because of her circumstances. When her usual pharmacy refused to fill her prescription, Janette had to find another pharmacy that had her medication in stock and was willing to serve her—which was a 35-minute drive.

To make matters worse, after Selena was born, she was transported via helicopter to a NICU in Columbus—about two hours away—where she spent a week. Janette and her boyfriend took turns going to visit her using the same car service.

“It just takes it out of you,” Janette adds. “All these questions, and all the ‘I hopes’…'I hope we can get a way back and I hope we can get her home when she’s released.’”

When Selena was finally ready to leave the NICU, Janette’s boyfriend, via Care a Lot, went to bring her home. “When she came through that front door it was the happiest feeling in the world,” Janette recalls. “There's nothing wrong with her—she's healthy and we don't have to worry anymore.”

But having a healthy baby wasn’t the end of the family’s problems. “We struggle trying to get help and we struggle trying to get what she needs half the time,” she adds. “It's not always easy to ask for help. I was embarrassed to get help from anyone. I try to be independent, but I had to have help—or else.”

Inadequate access to maternity care in the U.S. is just another way in which so many women have been forgotten about. We must do more to turn the maternal and infant health crisis around, especially in rural America.