Forty-five years ago, the Supreme Court ruled in Roe v. Wade that women have a legal right to privacy, and that includes the personal decision to end a pregnancy. Yet numerous laws and regulations have made it increasingly difficult for women to access not only abortion but also the full range of reproductive health care, including affordable contraception, quality maternal health care and basic preventive care.

We see more and more stories of women forced to drive hours for abortion care because it is not available in their communities. You can’t pick up the paper or turn on the news without seeing another political attack on women’s health or an overall indifference to building a health care system with women in mind. Along with an alarming trend of reduced access to maternal care, particularly in rural areas, this highlights the challenges many women face in accessing high-quality, affordable care right here in Maine.

Decreased funding and limited access to quality care mean the U.S. now has the highest maternal mortality rate among developed countries. Over 60 percent of these deaths are preventable. Some of these women might still be alive if they had better access to preventive care to manage their high blood pressure, weight or diabetes.

These risks are exacerbated in rural counties, where maternal mortality rates are higher and maternal health care is disappearing.

From 2004 to 2014, 9 percent of all rural U.S. counties lost access to hospital obstetric services, and more than 45 percent are now without a single local hospital where women can get prenatal care and deliver babies. Calais Regional Hospital is the latest to close its obstetric and gynecological unit, meaning that women in northern Washington County must now drive more than an hour to Machias for prenatal care and delivery.

The birth control pill has been available to American women for more than 50 years and remains the most popular form of contraception. Yet women face unprecedented attacks on access to birth control including threats to providers, insurance coverage and federal funding. Key health programs like Title X (federal family planning funding), Medicaid, Medicare, and the Affordable Care Act all disproportionately serve and benefit women. But as these programs come under attack, it is women and especially women of color and low-income people who disproportionately pay the price.

And nearly half a century later, access to abortion remains limited, especially for women in rural areas. There are only three public abortion providers in Maine, and more than half of Maine women live in a county without access to an abortion provider.

Restricted access to abortion simply compounds an already challenging environment for women to receive the care they need when they need it. Roe v. Wade may have guaranteed a right to a medical procedure, but without providers in rural areas and affordable access, the right becomes one in name only.

Abortion is the only medical procedure singled out in Maine law with provider restrictions. Today, nurse practitioners and other advanced care professionals are willing and able to provide the service in areas with no other provider, but this outdated law prohibits them, thus denying women the ability to access care in their hometown, their county or even within a few hours’ drive.

There’s no medical reason for this, and women’s health is harmed by this fundamental lack of access. Numerous health organizations, including the World Health Organization, the American College of Obstetricians and Gynecologists and the American Public Health Association, have called for a change, as have local women’s health care providers, the Maine Medical Association and the Maine State Nurse Practitioners Association.

Over the last year, we have seen a groundswell of people demand a health care system that better meets the needs of people. It bears noting that women represented the majority of this movement. We saw women in record numbers stand up to protect the Affordable Care Act and Planned Parenthood, the nation’s leading women’s health care provider. And now we need to channel that energy to ensure that women’s health isn’t sidelined but centered in the discussion.

Because Maine has two options.

We can regress to a health system that overlooks women’s needs and limits access to women’s reproductive health care, including abortion and maternal care.

Or we can progress toward a system that meets women’s needs with better outcomes, integrated women’s health providers and improved access to the full range of reproductive health care: contraception, abortion and maternal health.

The choice is ours.

Nicole Clegg is vice president of public policy for the Planned Parenthood Maine Action Fund and Planned Parenthood of Northern New England

in Maine.

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