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'There's just not any here:' A look at eastern Kentucky's maternity health deserts

At a downtown Lexington rally to mark the two-year anniversary of the Supreme Court's Dobbs decision, University of Louisville medical student Shriya Dodwani said Kentucky's near-total ban on abortions runs counter to requirements by the Accreditation Council for Graduate Medical Education.
John McGary
/
WEKU
At a downtown Lexington rally to mark the two-year anniversary of the Supreme Court's Dobbs decision, University of Louisville medical student Shriya Dodwani, left, said Kentucky's near-total ban on abortions runs counter to requirements by the Accreditation Council for Graduate Medical Education.

“Estill Medical. This is Madisyn. How may I help you?”

It’s a few minutes before lunch at Estill Medical Clinic, in Irvine. The practice is owned by nurse practitioner and Estill native Donna Isfort. It offers many services, but, like every other medical facility in the county, no OB/GYN.

“Many, many of my patients at least have to travel anywhere from 30 minutes to 60, 70, minutes just to get to obstetrical care. There's just not any here. We have no nurse midwives. Here we, I do family practice, so I do a lot of women's health at my clinic, but not prenatal care.

Estill County does have a hospital, but a spokesman for Marcum and Wallace says not counting unplanned births in the ER, they haven’t delivered babies since 1986.

“Okay, give me just a second and let me get you over to her nurse, and I'll see if she can help you.”

According to a 2023 report by the March of Dimes, women living in what some call “maternity care deserts” like Estill and several nearby counties must travel more than twice as far to get the care they need. Multiple studies conclude that greater distance puts women, expectant and otherwise, at greater risk. Isfort says she and her staff work closely with the Estill County Health Department to provide the help they can and out-of-county referrals for services they can’t provide.

Some think Kentucky’s maternity care deserts may spread.

At the June 24th rally in downtown Lexington to mark the two-year anniversary of the Supreme Court’s toppling of Roe V. Wade, second-year medical student Shriya Dodwani painted a bleak picture.

“The Accreditation Council for Graduate Medical Education requires that OB/GYN residents have access to abortion training. This isn't about politics. It's about ensuring that we have the comprehensive skills needed to provide the best possible care for our patients. Without this training in Kentucky, we're left with no choice but to leave and pursue our education elsewhere.”

In a recent survey of students at Kentucky’s three medical universities, 62 percent of respondents said they’re considering finishing elsewhere because of the state’s near-total abortion ban.

A week later, University of Kentucky Healthcare officials unveiled a plan that could help some women in rural areas. The outreach division of UK Women’s Health OBGYN announced they’d add services at 19 new sites, several in eastern Kentucky. Dr. Emily DeFranco is chair of UK HealthCare’s Department of Obstetrics and Gynecology. She says they’re also expanding telehealth services.

“We'll send a sonographer with an ultrasound machine to the site, and they'll perform the ultrasound and then virtually, by telemedicine, the physician who is in Lexington is able to view the images from the ultrasound, and then have a video conference with the patient on that site and counsel her about the findings.”

That sort of outreach could eliminate some of the long trips many women must make for routine care. There’s another program, funded in part by Medicaid and tobacco settlement dollars, that helps expectant and new mothers: HANDS, which stands for Health Access Nurturing Development Services. It’s available to all women during pregnancy through a child’s third birthday. At the Estill health department, Teresa Talbott is the ongoing home visitor, dropping in weekly with 15 to 20 families per year for the last 17 years.

“We're not coming in to look at your home. We're not coming, you know, to tell you what to do. We're just coming in and giving you the information and helping you along with it.”

One woman she’s helping now is Whitney Bingham, who happens to be the health department’s WIC program coordinator. Talbott, who Bingham calls TT, is assisting her and her two-year-old son through challenges ranging from potty training to car seat installations.

“When TT left my house for the last visit, Aceson, that's my son, he was at the door and he did not want her to leave, like he never wants her to leave. So, you know, that's a good thing.”

Still, Bingham says when it’s time for her to leave for an OB-GYN visit, she makes the hour-long drive to Lexington.

The Cabinet for Health and Family Services declined our request for an interview with the state Department for Public Health’s director of women’s health.

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John McGary is a Lexington native and Navy veteran with three decades of radio, television and newspaper experience.
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