Overturning Roe v. Wade brings challenges for women in rural Arizona

Experts worry that the U.S. Supreme Court's recent ruling that overturned Roe v. Wade, the 1973 landmark case that made abortion legal nationwide, will increase the challenges rural southern Arizona communities already face to access reproductive health care.

“We are going to see more unintended pregnancies,” said Elise Lopez, the assistant director of the Relationship Violence Program at the University of Arizona, of the ruling's impact in rural areas.

On June 24, the Court's ruling in a Mississippi case, overturning Roe, now allows states to set their own abortion laws. Thirteen states, not including Arizona, had a "trigger" law, which is one designed to take effect automatically, upon Roe being overturned.

Lara Ruggles, organizer from a national women's rights group with a branch in Tucson said she felt "abject terror" after Roe was overturned.

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"I know pretty intimately what it's like to be very broke and exist on very little income and not have insurance beyond state Medicaid and have long waitlists or not have easy access to the types of care that I needed," Ruggles said, the director of marketing and development for YWCA Southern Arizona.

She noted that she had privileges others do not have: family that she could rely on for help, living in a city with resources, and being White.

"Being really aware of how the privileges that I had made things easier for me, and yet how hard they still were made me want to do everything that I can to advocate for anyone who is in a place where they don't have those support systems."

Lopez said some challenges to accessing health care in rural areas include traveling to appointments, taking time off work for those appointments, coordinating child care, accessing contraceptives and education on contraceptive use and insurance costs.

With the most recent abortion bill signed by Gov. Doug Ducey in March, banning abortions after 15 weeks unless a woman’s life is in danger, accessing safe abortions could be more challenging for people living in rural areas, she said.

She said in rural areas where people have to travel distances for care, they will have to gauge carefully how close they are to dying as a result of lack of care and how long it takes to commute to the nearest medical facility for treatment. Rural areas often have limited options for public transportation.

“When does she decide that she is close enough to death that if she goes to a hospital seeking an abortion that she will actually get that care,” Lopez said.

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One potential solution to abortion are abortion pills, Lopez said, noting that challenges could arise if restrictions on abortion pills were put in place.

"I hope that telemedicine will be able to help people access abortion pills so that they can have an abortion at home and done safely. I think that’s really going to transform things for our rural communities," she said.

An old law could add more challenges

An Arizona anti-abortion law from 1901 could restrict abortion even more. The law, ARS13-3603, bans all abortions and punishes anyone who helps a women get an abortion with imprisonment for two to five years. There remains uncertainty whether this law will take precedence or a more recent law.

Lopez said a large concern, especially for people in rural areas, is the language in the 1901 law punishing those who help someone access an abortion. Would an Uber driver, a friend or family member who transports someone to get an abortion be punished?

This could deter people from helping each other access surgical abortions, she said.

“The fear of prison time... to access this medical care would terrorize people,” Lopez said.

Residents in rural southern Arizona communities experienced hardships in accessing basic health care, even before the overturn of Roe.

A community health worker noted that rural residents often lack the important bond between patient and physician, an effect that happens due to the constant rotation of visiting doctors.

The health worker recalled a time when her father suffered a stroke in a rural community near the border. However, because the area lacked medical equipment, a nurse had to hand pump oxygen into her father's mask for hours until he could be flown to Tucson.

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Shaq McCoy, one of the co-founders of Arizonans for Reproductive Freedom, said organizations and service providers in Arizona are figuring out how to help people access abortion services outside the state.

McCoy said areas closest to Arizona with such services would be El Centro, a city in Southern California, as well as places in Mexico and New Mexico. She noted that organizations around the country are raising money to help women pay for abortions. One such organization is Abortion Fund of Arizona.

This month, Arizonans for Reproductive Freedom worked to collect signatures to add a constitutional amendment protecting reproductive rights on Arizona ballots in November.

According to a news release published Thursday, the group fell short andcollected 175,000 signatures instead of the 356,000 signatures needed to put protections for reproductive health care on the ballot.

Now they are looking toward the 2024 election.

"Arizonans for Reproductive Freedom will continue to harness the passion of the movement to ensure the measure qualifies for the 2024 ballot," the group said in the release.

Barriers to accessing contraception in rural areas

Challenges to accessing contraception and education about effective use of contraceptives also impact people in rural areas.

Lopez highlighted that access to contraceptives, especially longer lasting contraceptives like intrauterine devices, often shortened to IUDs, is challenging in areas where there are fewer obstetrician gynecologist providers, or clinics that specialize in reproductive health.

Lopez said physical access is not the only issue but also economic access. In lower-income families, women often have to choose between paying for medicine, like birth control pills, or paying their monthly expenses.

For birth control pills to work they must be taken every day, and often at the same time every day. Lopez said that for people with less access and economic means, this can be a challenge.

According to data from the USDA Economic Research Service, the poverty rate in rural Arizona is 21.9%, compared with 12.4% in urban areas of the state.

“For many people, especially if you have less access to birth control pills, perfect use goes out the window,” she said. “It's things like skipping pills. It’s things like do I pay for my birth control this week? Do I pay for my food this week? Or do I pay for my electric this week?” Lopez said.

According to the National Institute of Health, many unintended pregnancies are a result of incorrect use of contraceptives.

Women’s rights and pro-choice groups are concerned that overturning Roe will pave the way for other restrictions like access to contraception and overturning other precedents.

State data shows that 55.9% of women who had abortions in 2020 have given birth before, a statistic which she said contradicts the argument by anti-abortion supporters that abortion is used as birth control.

Ruggles highlighted the concern would affect her personally if contraceptives were to be banned.

Ruggles, who has an IUD, said she is worried how the language in the decision to overturn Roe v. Wade could open up future attacks on IUDs and similar contraceptives which make it harder for a fertilized egg to implant in the uterus.

“The primary reason I have an IUD is because I have severe, severe pain every month during my periods,” she said, adding that unlike her IUD, pain killers did nothing to relieve her excruciating pain. She recalled in her teenage years how often she would worry that she was going to vomit or pass out from the pain.

Ruggles also noted how the overturn of Roe v. Wade will have more of a negative impact on communities with intersecting barriers.

As previously reported by The Arizona Republic, the Roe v. Wade decision could lead to increases in maternal deaths that will disproportionately affect Black and Latina women, who already have higher rates of maternal deaths.

Lopez noted that abortion rates tend to be higher in areas where there are higher rates of unintended pregnancies, which are generally higher in communities of color and in areas of lower socioeconomic status.

According to data from the Arizona Department of Health, Latinos had the highest number of abortions in 2020 at 40% compared to 35% among whites, 12% Blacks, 2% Asians and 4% Asian and Pacific Islander.

“I think we've been in a situation for years, the whole time that Roe has stood, in which abortion care and reproductive health care is much more accessible to women who have the means to travel and the means to pay for it,” Ruggles said. “That’s a racial justice issue we have not addressed.”

Coverage of southern Arizona on azcentral.com and in The Arizona Republic is funded by the nonprofit Report for America in association with The Republic.

Reach the reporter at sarah.lapidus@gannett.com.

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This article originally appeared on Arizona Republic: Overturning Roe v. Wade adds challenges for women in rural Arizona