Women in rural Arizona, like most women in rural America, run into obstacles as they seek comprehensive healthcare within their communities.

The issue is one of access – economic and geographical – and one of comprehensive health care, according to Leah Meyers, director of the Arizona Rural Women’s Health Network.

Comprehensive health care necessitates service that meets the needs of women from check-ups to childbirth, and beyond.

“I’ve heard so many stories from many women in rural communities who say that it’s one thing to have to get their regular check-ups, but when they’re ready to deliver their baby many times they can’t necessarily stay in their small rural communities,” Meyers said.

According to The University of Arizona Center for Rural Health Annual Report 2013-2014, Pinal County had the greatest number of federally qualified rural health centers and rural health clinics combined, totaling 10. Greenlee County had only one outlet for rural health, which was a federally qualified health center, according to the report.

Though 22.8 percent of women over the age of 18 live in rural America, nationwide only 6.4 percent of OB-GYN’s practice in rural communities, according to a 2008 report by The American College of Obstetricians and Gynecologists.

It is difficult to quantify the number of OB-GYN’s serving rural communities in Arizona. There is a CDC funded program, Well Women HealthCheck, which provides women’s health services across the state.

The Well Women HealthCheck Program does not have OB-GYN’s on site at the clinics nor are the clinics only for women. These limitations, however, do not undercut the comprehensive services provided at 24 locations across Arizona.

The program affords uninsured or underinsured, low-income rural women access to nurse practitioners who do screening, testing, referrals, and prescriptions among other assistance. To coincide with their referral service, the Well Women HealthCheck Program also provides transportation for clients as a way to confront the transportation barrier.

Services are also organized around prevention and attending to the health care needs all women regardless of their ability to pay.

“Our purpose is public health. A lot of our purpose is also prevention services,” said Kore Redden, assistant director of public health for operations. “If someone came in and said, ‘I have a lump on my breast but I have no money,’ we’re going to see that person and do the best we can for them.”

Comprehensive women’s health care is not limited to the services a nurse practitioner or clinic provides.

The absence of unrestricted avenues to fresh produce in rural communities critically impacts women’s health, according to Ivan Zacarias, a registered dietician at WIC in Casa Grande.

“There’s the fact that a lot of the rural communities we work with are food deserts,” Zacarias said. “There’s not a lot of access to fresh produce or fresh foods. We see a higher intake of processed foods.”

WIC addresses health concerns that develop in food deserts by encouraging families to fill half of their plate with veggies. WIC in Casa Grande also partners with the community food bank in Phoenix to distribute fresh produce in small towns, like Oracle and Mammoth, once a month.

Power Me A2Z, another program WIC encourages women to participate in, provides free vitamins with folic acid to women across Arizona – an important supplement to obstetric care.

In addition to fresh produce, there is also a need for sexual violence resources in rural communities. In assessment completed by the Arizona Rural Women’s Health Network, health care providers expressed the need for resources, information, and training on sexual violence.

In response, the network developed a curriculum in 2014 that includes training, presentations, and education that is tailored to meet the needs of rural communities across Arizona.

“We’re working with community health workers and other front-line heath care providers so they know and understand what the different issues are particularly around sexual violence and what they can do to help if someone wants to report,” Meyers said.

In the state of Arizona, there are only five rural locations that provide forensic exams – Kingman, Holbrook, Show Low, Springerville, and Safford. The Arizona Rural Women’s Health Network is also working in rural communities to provide forensic exam training.

Despite many health interventions in rural communities, the issue continues to be one of access and one of all-inclusive health care.

Attracting health care providers is a significant obstacle in rural communities that informs one’s access to health services and the comprehensiveness of those services. To reduce the impact of this obstacle, various health care programs offer loan forgiveness to medical professionals practicing in rural communities.

Loan forgiveness may be a way of attracting medical professionals in rural areas; but nonetheless, many health care professionals in Arizona continue to collaborate and work toward alleviating health disparities in rural communities.

“The nice thing about working in rural communities is that everybody pitches in. There’s always somebody there” said Martha Moore-Monroy, program manager at The University of Arizona Center for Rural Health. “I really love working in rural communities because there really is that strong sense of ‘we’re in this together.’”

Kassandra Manriquez is a reporter for Arizona Sonora News, a service from the School of Journalism with the University of Arizona. Contact her at [email protected]

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