While much of the country raged in protest or celebration on June 24 when the Supreme Court decision to overturn Roe v. Wade came down, Wilcox County was widely quiet — as was much of rural Alabama.

A woman in Wilcox County already had few options if she wanted to seek a legal and safe abortion. From the county seat of Camden, she could drive about an hour-and-a-half into Montgomery, two hours to Tuscaloosa or three hours to Jackson, Mississippi. In any case, her insurance would likely not cover the procedure.

Because of the time, money and travel barriers, some women in rural Alabama haven’t seen abortion as an accessible choice for a while, and to them, the SCOTUS decision didn’t change that.

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“When the decision to reverse Roe versus Wade came down the other day, it just seemed like there wasn't very much interest in it in my community,” Wilcox County community leader Alicia Foster said. “It's an issue for me, of course. I hate that they did that because I think that women should have the right to choose, but I just haven't found that to be a big issue here.”

Foster heads up her local Human Rights Commission for the Southern Rural Black Women’s Initiative. It’s an organization that aims to help communities across the South toward economic and social justice, and the group’s methods include ensuring access to health care.

Foster says that’s difficult, and it has been for years. Women in rural Alabama face challenges accessing any type of healthcare, not just reproductive health services.

“There's just a general lack of medical care that's available to women in this area. We don't have an OBGYN, and we don't have the specialty doctors,” Foster said. “We all have to go different places to doctors. In fact, I’m going to Montgomery in the morning for a doctor’s appointment.”

Women in rural areas face higher incidences of hypertension, diabetes and cancer than their urban counterparts. The Human Rights Watch noted in 2018 that Alabama had the highest rate of cervical cancer deaths in the nation, and Black women were affected at twice the rate of white women.

Moreover, Alabama has the nation's third-worst maternal death rate, and mothers and their babies in rural places face a barrage of health disparities. These include premature birth, low-birth weight, maternal mortality, severe maternal morbidity and increased risk of postpartum depression.

“There are so many of our women who don't have access to healthcare,” Foster said.

Where have all of the rural doctors gone?

Beyond the concerning statistics and barriers to access, there are people in the state who have been working to close the rural healthcare gap for years. One of the clearest ways to do that is increasing the number of doctors and medical services available in rural Alabama.

The University of Alabama, the University of Alabama at Birmingham and other out-of-state organizations have launched several million-dollar projects dedicated to this goal in recent months, but there are small-town doctors making contributions as well.

Dr. Brittney Anderson is one of them.

Anderson just opened her own medical practice in Demopolis, and for her, moving to rural Alabama was an intentional decision she made to ease the physician shortage in the state.

“I've always had this kind of inkling to have a private practice, to hang a shingle and be the doctor like those that I knew growing up,” Anderson said. “People need good medical care, and your ZIP code should not determine what kind of care you get.”

She grew up off of a dirt road in Prattville, but it wasn’t until she traveled to Ghana for 10 weeks that Anderson realized what a difference local medical access can make.

She was working in a clinic there when a father carried his sick child in for help. Anderson remembers hearing about how far they had to travel and how few options for medical providers there were in the area.

“That started to really plant the idea in my mind of wanting to do something to help those who have access issues. Everyone has this idea to go into medical school because they want to help people, but that was kind of the eye-opening moment for me,” Anderson said.

She came home with a plan to finish medical school and return to Ghana to practice. But she quickly recognized the significant disparities and access issues in rural areas of her home state and decided to start here.

Anderson accepted a scholarship from the Board of Medical Scholars that paid for her four years of medical school at UAB in exchange for four years of work in a rural and underserved area. Now, with the opening of her new practice, she doesn’t plan on leaving.

To treat rural patients properly, diagnose diseases early and educate people about adequate health practices, Anderson believes you have to develop relationships and trust with your community as a physician.

To fix rural problems, you have to know the people, she said.

“That's how we truly improve the number of people who are getting the screenings that they need and reducing incidents of hypertension and diabetes and things like that.”

'They need care'

Even with programs — like the one that attracted Anderson back to the state — bringing young doctors to rural Alabama, the question of how to provide rural patients with specialty care remains up in the air.

Just four months ago, expectant mothers in Demopolis had to either drive an hour into Tuscaloosa or 45 minutes into Selma to deliver, and for treatment of certain diseases and cancers, patients have no other in-state choices than traveling to Birmingham or Montgomery.

According to UAB Dr. Eric Wallace, though, the answer is simple: telemedicine.

With about 80% of rural hospitals in Alabama operating in the red, telemedicine could be the key to closing the rural healthcare gap and keeping existing hospitals in those areas open, he said.

“The death knell of many of these hospitals is: I don't have revenue, so I drop services. Then when I drop services, I don't have revenue, so I drop more services. And it keeps on until there's nothing left,” he said. “What telehealth allows us to do is to provide more services, keep more patients in those facilities.”

As the medical director of telehealth at UAB, he is working to create a network of doctors across the state that support each other and patients who face high barriers to traveling for specialized care.

So far, he has expanded the network rapidly. Prior to COVID, his team scheduled about three video appointments per day, and now, they have seen up to 1,500 patients through video visits in a day.

Essentially, patients in rural areas can go to their general practitioner’s office or sometimes even stay at home and be on a video call with a specialist like Wallace.

Whitfield Regional Hospital in Demopolis has successfully begun to use this option for infectious disease treatment, as has Russell Medical Center for oncology and Baptist Health Systems for maternal fetal medicine consultations, according to Wallace.

“We should not be putting any barriers in place of patients getting care. They need care, and there's so many barriers in getting them to care right now. Telehealth removes one,” Wallace said. “It removes the geographic barrier but still doesn't remove the economic barrier, doesn't remove the healthcare literacy barrier. But we can't just keep making excuses.”

To accomplish a plan like Wallace’s, though, Alabama would need more rural physicians to provide on-the-ground care. Alabama would need more doctors like Anderson.

“We’re at a time in medicine now that, just because there isn’t a super specialized provider in our area, doesn’t mean you can’t ring one up. Those are things that we hope to be able to do to provide telemedicine options to our patients,” Anderson said. “Like I said, I'm this crazy country doctor who’s trying and is crazy enough to think that this is going to be great.”

Hadley Hitson covers the rural South for the Montgomery Advertiser and Report for America. She can be reached at hhitson@gannett.com. 

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This article originally appeared on Montgomery Advertiser: Healthcare quality varies across rural Alabama, especially for women