“It’s been a great pleasure to come back and serve only ten miles from where I grew up,” Dr. Emily Boevers said during an August 22 panel discussion at the Democratic National Convention in Chicago. “And it’s my joy to take care of women every day, and women of all ages, and women of many different circumstances.”
But the Waverly-based obstetrician/gynecologist painted a troubling picture of how abortion restrictions harm rural health care access in many ways, putting lives at risk—and not only for those seeking to terminate a pregnancy.
“RURAL HEALTH CARE IS VERY COMPLICATED”
Boevers is the only full-time OB/GYN working in Bremer County, and has been among the Iowa physicians most willing to speak out against the state’s near-total abortion ban. She is also founder and president of the political action committee Iowans for Health Liberty, which seeks to elect Iowa candidates who support reproductive freedom.
She was speaking in Chicago as part of a DNC Rural Council panel, moderated by former U.S. Senator Heidi Heitkamp of North Dakota. Heitkamp emphasized during her opening remarks that the federal Farm Bill is not the only important issue for rural America. She noted that the health care sector is often the largest employer in rural communities. In addition, providing quality health care is an economic issue, because people don’t want to live and work in an area where health care is not accessible.
Boevers wanted the audience to understand that “Rural health care is very complicated.” Whereas people living in densely-populated areas may live within 20 to 30 minutes of multiple health care providers, people in rural areas routinely drive an hour or more to a clinic, with no other options in their area.
She noted that 33 percent of Iowa counties have no labor and delivery services, while 97 out of 99 counties “are technically health professional shortage areas.” Rural residents of other states face similar conditions, she said. “That’s just a way of life in rural America.”
The biggest problem with what Boevers called “hostility in medicine” is that restricting people’s access to health care “risks all sorts of everyday health-care situations becoming life-threatening emergencies. And that is why it is so important that our government stay out of that patient-physician relationship, and allow patients to exercise their own decisions.”
“THE LAST THING ANYONE WANTS TO DO IS CALL THE GOVERNOR”
One of the other speakers on the DNC Rural Council panel was Marilyn Lands, who won a special election for an Alabama House seat in March. She campaigned on an abortion rights platform and filmed a tv ad with Alyssa, an Alabama resident who had to travel 500 miles to obtain an abortion after learning that the baby she was carrying had a non-survivable condition.
Heitkamp asked Lands about that commercial. Lands explained that she learned about Alyssa from a special by journalist Diane Sawyer, who profiled families affected by abortion bans. The story resonated with her because Lands had a nearly identical experience 20 years earlier. She was carrying a much-wanted pregnancy but learned the fetus had a chromosomal abnormality that was incompatible with life.
Alyssa had “a horrific experience” traveling to a faraway clinic. But Lands was able to receive medical care in her own community, with her doctor in her hospital and a support network nearby. “The fact that in 20 years we’ve gone so far backwards, it’s just obscene,” she told the DNC audience.
After Lands shared her story, Boevers advocated for “pushing back on this idea that a late term or a third trimester abortion is commonplace. These are highly desired children for people that have been planning, that have been building a nursery, they have have been stocking a closet and putting blankets and cribs.”
As a witness to these “heartbreaking developments,” Boevers said, “I have wept in exam rooms with patients sharing that news. And the last thing anyone wants to do is call the governor.”
ABORTION BANS “PUT WOMEN’S LIVES AT RISK”
Several minutes later, Boevers explained how abortion restrictions “continue to put women’s lives at risk even in situations where they are not seeking to and their pregnancy.”
For instance, many first- or second-trimester complications can be life-threatening, such as early rupture of membranes resulting in septic infections, or a chronic abruption that leads to excessive bleeding. (Bleeding Heartland profiled women who had experienced such complications after Iowa Republicans enacted a 20-week abortion ban in 2017.)
Doctors commonly treat those medical situations “with the with the same abortion care that is provided to women who want to terminate their pregnancy,” Boevers said. “But instead it’s abortion care in an emergency. And what these laws do—laws in Iowa, laws in Idaho, laws in Florida and North Dakota—is they tie one hand behind the back of all of our health care providers, forcing us to fit into a box that the legislature has laid out before we can provide standard of care medicine to our patients.”
Thinking about how far rural residents may have traveled to see a doctor, Boevers reminded the audience that these patients may have other children at home, or caregiver responsibilities for a parent. They may have a farm to harvest. “And we’re talking about risking people’s lives in an emergent situation. These are rural health care issues, and especially in our rural states, where transport to other hospitals is so challenging, people may languish for hours or days waiting for treatment and risking their lives.”
“A LOT OF THOSE STATES ARE GOING TO GET LEFT BEHIND”
Heitkamp turned the discussion to voter backlash against abortion bans since the U.S. Supreme Court overturned Roe v. Wade in 2022. Panelist Tammi Kromenaker (who ran the only abortion clinic in North Dakota before moving the facility to Minnesota) reminded the audience that abortion rights have won every time the issue has been before voters. Eleven states have abortion-related measures on the November 5, 2024 ballot.
Boevers pointed out that Iowa is one of the states where citizens cannot put constitutional measures on the ballot. “And a lot of those states are going to get left behind.”
She went on to say, “it’s wonderful that some of these states are codifying this right, but this was the whole benefit of Roe. This is the whole benefit of Roe, is that we had a federal protection for this federal right, and we did not have geographic inequality in our country.” That’s why Boevers feels it’s “so important” to have presidential and vice presidential candidates who “are loudly and openly supporting access to reproductive health care.”
“WE NEED TO PRIORITIZE RURAL HEALTH”
Heitkamp asked the panelists to share their ideas on what the DNC Rural Caucus could do to help doctors in their work.
Jocelyn Frye, who is president of the National Partnership for Women & Families, encouraged people to share their personal stories, which can help combat “narrow perceptions” of who seeks abortions. She added that for rural communities, it’s important to reinforce that “health care is not just one issue. It’s a whole ecosystem.” The U.S. Supreme Court’s Dobbs decision has “just devastated not only abortion access, it has devastated access to health care, period, in many communities.” Some diseases or conditions may be treated with mifepristone, a common abortion medication, and access to that medicine is threatened.
Kromenaker encouraged people to support independent abortion clinics, which generally have fewer resources than Planned Parenthood facilities. She also called for ending the stigma and secrecy around abortion by talking about the issue with family and friends.
Boevers cited the “tremendous health care crisis and shortage” in Iowa, which has been 51st out of 51 (the states plus Washington, DC) in terms of OB/GYNs per capita. That doesn’t only affect pregnant patients. “I’m not just an obstetric care provider. I’m also a gynecologist. I’m primary care for women.” Her patients get cancer. They need a wide range of health care: colonoscopies, mammograms, hypertension management. “I’m there to take care of a whole community, and when OB/GYN don’t feel safe practicing in a state, those services lack.”
In her final remarks on the panel, Boevers highlighted that Iowa has had the highest increase in cancer cases in recent years. As others have speculated, she suggested environmental pollutants and agricultural chemicals are playing a role in this trend. “We need to as a country really prioritize rural health from the person perspective, from an environmental perspective, and from a health care workforce perspective,” Boevers concluded, drawing applause from the audience.
Watch the whole DNC Rural Council panel here. The other panelists were National Partnership for Women & Families president Jocelyn Frye, Tammi Kromenaker of Red River Women’s Clinic, and Alabama State Representative Marilyn Lands.
The rural health care and abortion rights discussion continues for about 45 minutes. Beginning at the 46:30 mark of this video, you can watch former Iowa Governor Tom Vilsack and former First Lady Christie Vilsack discuss Biden administration policies that have benefited rural America.
Top photo was provided by Dr. Emily Boevers and published with permission.