Clinicians and public health experts worry the pandemic, staffing shortages and increased abortion restrictions will further erode reproductive care access.
BANGOR, Maine — All the reasons people in this rural region seek reproductive care — and the barriers they must overcome in accessing it — were on full display from the moment the first patient stepped into this clinic nestled amid towering evergreens.
Mabel Wadsworth Center is an island of integrated care in this rural community, where state reports show there is one primary care physician for every 1,300 residents and one psychiatrist for every 14,000. Its mission is to provide full-spectrum reproductive care, telegraphed by the art lining the walls: colorful renderings of uteruses and vaginas and black-and-white images of the bellies of women who have given birth, had miscarriages, abortions and stillbirths.
Amid disappearing maternity wards as rural hospitals struggle to stay afloat, some experts view more fully integrating reproductive care into primary medicine as a way to expand care and improve patient outcomes. “What I had been told, or what I had seen, was only OB-GYNs or nurse-midwives really provide this type of care, then I went to medical school and my world was totally opened up in realizing that family doctors are providing this care all across the country,” Lee said, stressing that she was speaking from her professional experience and not on behalf of her institution.
A small group of “antis” regularly pickets the clinic, where patients spoke on the condition of anonymity out of concern for their safety. Many of the small-town family medicine doctors who work on “clinic days” when abortions are performed travel from more than 75 miles away and don’t broadcast their work at Mabel Wadsworth in their home communities, which are more conservative than Bangor. Here, storefront window displays in downtown show support for abortion rights.
The study said rural communities with more African American and low-income families have suffered more rapid loss of maternity wards than have other rural communities. More than half of the nation’s Black population lives in the South, which experienced “If you’re going to be treating women and doing gynecological care, you can’t dismiss women,” she said, describing her struggles while waiting to be seen. The high school graduate who works two jobs said one doctor told her, “‘You’re just not managing your anxiety.’ ”
“We’re a very small organization, and we can’t always meet all the demand there is. That’s been something the pandemic has shown us,” Strout-Bentes said, noting the clinic cared for 2,782 people last year and that there is a waiting list for primary care services.
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