Going Rural: The Case for Access to Reproductive Health Care

Throughout the world, women and girls in rural areas disproportionately experience exclusion and poverty. Less availability of basic services such as education, health care, water, sanitation, and electricity is a problem for many rural communities, and women and girls in these settings frequently encounter additional structural, economic and social barriers that impact their lives across different areas, from education to health.

Next week, women’s groups, governments, and United Nations (UN) agencies will come together for the sixty-second session of the Commission on the Status of Women (CSW62), the largest UN gathering focused on achieving gender equality and women’s human rights. This year’s Commission will focus on “challenges and opportunities in achieving gender equality and the empowerment of rural women and girls.” The theme is urgent.

Women and girls in both urban and rural areas face similar challenges when it comes to realizing gender equality and the full enjoyment of their human rights. However, those in rural areas often come up against added pressures and more pronounced barriers, particularly in regard to their sexual and reproductive health and rights. The limited availability of quality health facilities and services, the lack of essential infrastructure, and the overall shortage of health workers in rural areas, for example, mean that rural women and girls have to travel longer distances to access care. They commonly face limited transportation options and high travel costs, as well as concerns about travel safety and the cultural acceptability of travel for women.

Rural women make up more than a quarter of the world’s population and face similar obstacles in developed and developing countries. In the United States, women living in rural areas have to travel substantially more than their urban counterparts to access abortion services. More than 40 percent of women in rural areas have to travel between 50 and 100 miles to access care, while another 30 percent have to travel more than 100 miles. This stands in stark contrast to the numbers for women living in urban areas, at 7 and 3.8 percent, respectively. In addition, research shows that 87 percent of US counties had no abortion provider while obstetricians–gynecologists in rural areas were significantly less likely to perform abortions than those in urban settings. When combined with waiting periods and other restrictions on access to abortion, the barriers to accessing abortion care for rural women are significantly harder to overcome.

Higher rates of poverty and limited health insurance exacerbate disparities in access to health care for rural populations by putting the services that do exist out of financial reach for many. The International Labour Organization estimates that 56 percent of the world’s rural population lack health insurance, in contrast to 22 percent of those in urban areas. Poverty and scarce financial resources means that almost two-thirds of people in rural areas cannot access health care, compared to a third of those in rural areas. The problem is often even more acute for women and girls in rural areas, since they often have lower incomes and less control over household finances that men.

In many countries, rural women’s ability to make decisions about their own health care is restricted. These women frequently report that they have less freedom to decide whether or not to seek health care than their urban counterparts, with those decisions being at least partially or completely up to their husbands.

Finally, discriminatory attitudes towards women and girls from rural areas can drive them away from care or greatly affect the quality of care they receive, if they are able to access it at all. For indigenous women and girls who live in rural areas, historic marginalization, forced displacement, and economic exploitationcombined with discrimination due to their rural residency, their sex, and their ethnicityresults in additional struggles. Indigenous women often experience disempowerment and discrimination, as well as language barriers and indifference in health care settings. In many rural areas, unwanted pregnancy, prevalence of sexual abuse, and child and maternal mortality rates are higher among indigenous than non-indigenous groups.

All of these barriers affect how women and girls in rural areas utilize sexual and reproductive health care services, as well as their health outcomes. Adolescent girls in rural areas are three times more likely to become pregnant and up to twice more likely to become child brides than their urban peers. At the same time, rates of modern contraceptive use, use of prenatal and postnatal care, and skilled attendance during delivery are much lower in rural areas, while rates of maternal mortality across the globe are on average two and a half times higher. Simply put, rural women and girls are dying for lack of access to quality sexual and reproductive health care.

Despite the barriers they face, women and girls in rural areas are driving transformative change and progress for gender equality, women’s human rights, and sustainable development. Governments must support them with policies that respect, protect, and fulfill women’s and girls’ human rightsincluding their sexual and reproductive health and rightsand that enhance their autonomy and ability to make decisions in every aspect of their lives.

As countries work to implement the Sustainable Development Goals, rural women and girls must not be left behind. The International Women’s Health Coalition (IWHC), along with a broad coalition of partners, is advocating for the Commission to not only recognize rural women’s and girls’ sexual and reproductive rights, but also commit to ensuring they have the information, means, and agency to make those rights a reality.

Governments should commit to investing in public health systems in rural areas, as well as developing specific programs that guarantee universal access to comprehensive sexual and reproductive health care services and information. That includes providing comprehensive sexuality education to all adolescents and young people, in and out of school, in order to equip women and girls in rural areas with the knowledge they need to make decisions about their bodies, health, and lives; negotiate healthy sexual and social relationships; and begin to challenge and change gender norms.

Read our full list of priorities in our statement to the UN Economic and Social Council (ECOSOC).

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