The American College of Obstetricians and Gynecologists (ACOG) has issued a press release decrying the lack of access for rural women in the U.S. of adequate women's health care. The lack of access, ACOG says, puts these women at "a greatly increased risk of poor health outcomes compared with women in urban areas." ACOG says that its Committee Opinion lists contributing factors as physician shortage in rural areas, limited resources at small community hospitals, and patient factors such as lack of insurance or the need to travel long distances to receive care.

"Rural communities are home to 17% of all females 15 and older in the U.S., and 18% of all U.S. births take place there," said Alan G. Waxman, MD, chair of ACOG's Committee on Health Care for Underserved Women. "Unfortunately, nearly one-third of rural women live in counties with no ob-gyn at all. Location is a serious health disadvantage for these women."

According to the press release, rural women are more likely to have a cesarean delivery, low-birth-weight infant, and neonatal and postneonatal mortality and are less likely to be offered a vaginal birth after cesarean. In addition, racial and ethnic disparities in health care may also be amplified in rural settings.

"When compared with their urban counterparts, U.S. 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," said Eliza Buyers, MD, a committee member who helped develop the document. "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," Dr. Buyers continued. "Many of the least-populated communities do not have publicly funded family planning clinics, severely limiting a woman's contraceptive options."

The Committee Opinion suggests ways in which ob-gyns can help increase access to women's health services in nonurban areas including collaboration with state maternal-child and rural health agencies to identify health needs of rural women and barriers to care.

"Ob-gyns have the ability to help improve health care for rural women," Dr. Waxman said. "ACOG encourages ob-gyns to get involved in the process because every woman deserves to be cared for, no matter where she lives."

The Committee Opinion #429 "Health Disparities for Rural Women" is published in the March 2009 edition of Obstetrics & Gynecology.

Adapted from a press release from ACOG, www.acog.org.

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