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Kentucky lacking in prenatal care as more could need it post-Roe

Restrictions on abortion will mean more pregnancies carried to term, and more need for prenatal care.
John Ted Dagatano
Restrictions on abortion will mean more pregnancies carried to term, and more need for prenatal care.

While abortions are still accessible right now in Kentucky, the U.S. Supreme Court decision to overturn Roe v. Wade could ultimately mean less abortion care in the state. 

Kentucky’s Cabinet for Health and Family Services reported there were more than 4,100 abortions in the state in 2020, and more than 51,000 live births, according to March of Dimes

If a total ban goes through, more people will be forced to bring pregnancies to term in Kentucky, a state where it’s statistically more dangerous to be pregnant.

A lack of OB-GYNS

Part of the problem is a lack of obstetrics and gynecological doctors. Data paints a bleak portrait of prenatal care in the state, which may be worse in rural areas.  

Data from the U.S. Health Resources and Services Administration show more than half of Kentucky’s 120 counties had no dedicated OB-GYN in 2020 and 2021. It’s a problem throughout many rural communities, with around half of U.S. counties having no OB-GYN in 2016.  

Dr. Anne Banfield is medical director of Obstetrics and Gynecology at St. Mary’s Hospital in Maryland. A few months ago, she was practicing in rural West Virginia and saw first-hand how hard it was for people to get the health care they needed.

“We have a lot of mothers in our country who are suffering, because potentially in many cases, there are breakdowns in the prenatal care system,” she said. 

A report by the U.S. Department of Health and Human Services found that Kentucky was short of the number of the OB-GYNS it needed as of a few years ago and that the situation was expected to get worse in the next decade.

Family doctors often provide prenatal care in rural areas, but the American Board of Family Medicine found only about 8% in Kentucky do. That’s lower than every bordering state – Indiana, Illinois, Ohio, Virginia, West Virginia, Missouri and Tennessee – in which around 12% of family doctors do prenatal care.

People may also get some prenatal care services at other places like local health departments. But the presence of doctors is not the only barrier.

Melissa Eggen is a Ph.D. student at the University of Louisville and a senior policy analyst at the Commonwealth Institute of Kentucky. 

She said there are other factors that can prevent people from accessing prenatal care, like a lack of insurance or systemic racism in health care. 

“A woman may have seen her provider, and that provider may have expressed something that she perceived as being racist,” Eggen said. “And she may not want to come to that provider any longer, she may not trust that provider, she may stop using prenatal care altogether.”

Dangerous outcomes

Kentucky has a higher maternal mortality rate than many other states. The Centers for Disease Control and Prevention reports that between 2018 and 2020, Kentucky’s rate was higher than the nationwide average at nearly 40 deaths per 100,000 live births. That’s double the nationwide rate. 

Banfield, the doctor who worked in West Virginia, said even people with low-risk pregnancies should have doctor visits regularly. But in rural communities across Kentucky, comorbidities like diabetes and hypertension are more prevalent. That means the risk for a dangerous pregnancy is increased, as is the need for prenatal care.

“There’s additional surveillance that is recommended, and oftentimes that means that the number of visits that they are recommended to have can be substantially increased,” she said. 

She paints a picture of how those comorbidities can make pregnancy dangerous.

 “We may have a patient who has hypertension, and goes from having hypertension, to having preeclampsia or eclampsia and now, maternal seizures, and maternal neurologic complications associated with that,” she said. “We may have a mother who has a placenta that's inappropriately located and has bleeding outside the hospital that results in hemorrhage that is life-threatening.”

More restrictions coming

With the U.S. Supreme Court’s ruling last month, hundreds of thousands lost access to abortion in Kentucky, as the state’s trigger law went into effect. 

The law makes it a Class D felony for anyone to provide abortions in the state, except in life-threatening situations.

Providers took that to court, and abortion services resumed a week later. That fight continues, and access could again be taken away this year for people seeking services in the commonwealth. 

Abortions are still available in Kentucky for now. But those too are hard to access; the state’s only two providers are in Louisville, far from much of the state’s rural population.

Banfield said the possibility of more unplanned pregnancies being carried to term is creating a perfect storm in areas with already poor maternal outcomes, like Kentucky. 

 “The post-Roe situation, and the issues we have with maternal mortality, and the issues that we have with access to care in rural areas of the United States [...] are all coming together in a way that is going to make our situation when we are trying to fight a battle against maternal mortality 1,000 times worse,” Banfield said. 

Aprile Rickert is LPM's Southern Indiana reporter. Email Aprile at arickert@lpm.org.

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