With women’s health centers facing closures, and counties lacking hospitals, it can be difficult to find obstetric and gynecological care in the river corridor.

The River Reporter spoke to local experts to learn what accessing women’s health care looks like in a rural area, some of the challenges associated with OBGYN facilities, and some successes.

Additional reporting provided by Patrick Kelly and Liam Mayo.

Lack of workforce

Of the many challenges that come with accessing women’s health care in a rural area, one pressing issue is a lack of workforce in maternal care.

Dr. Erin McFadden, chief medical officer of The Wright Center, said that Wayne and Pike counties are “in dire need of specialist obstetricians and gynaecologists.”

The Wright Center location in Hawley, PA is one of the few medical facilities in Wayne County that provides reproductive care, including pelvic and breast exams, pap smears, STD/STI testing and birth control. 

“I lived in the northern tier of Wayne County. I wouldn’t know where I was going to deliver my baby.” McFadden said.

Lisa Davis, director of the Pennsylvania Office of Rural Health, echoed McFadden’s sentiments, stating that it is hard to recruit both primary care and midwives across the state.

“Two-thirds of the primary care physicians in the state practice in the four most populated counties in the state, [is] mostly down in the southeast,” she explained. “In any community, you need to have at least two OB/GYNs, and without that, it means that the burden falls on just one provider to address all of the births in that community.”

Cost

Part of the reason there is a shortage of labor and delivery care workers in the area, according to McFadden, is because of “malpractice and the fear of the lack of tort reform in the state of Pennsylvania, and one lawsuit would permanently ruin your ability to practice medicine for the rest of your life and would financially bankrupt you.” 

One example of a malpractice lawsuit ruled against a hospital was Vaccaro v. Scranton Quincy Hospital, which resulted in a $19.3 million settlement for Charles and Marissa Vaccaro, who alleged that a late cesarean section caused their newborn to sustain brain damage. Scranton Quincy Hospital still exists, but it is now known as the Moses Taylor Hospital.

McFadden said she has seen these lawsuits drive away OB/GYN specialists in northeastern Pennsylvania.

Davis expressed similar views, adding that providing labor and delivery services can be expensive for a hospital due to high medical malpractice costs, since “you’re dealing not with just one life but multiple lives.”

Besides malpractice coverage, providing these services can also be expensive because hospitals need to have a certain volume of deliveries to cover the cost of that service, Davis added. An OB/GYN, a neonatologist, an anesthesiologist are all examples of roles needed during delivery that can be costly. 

According to independent health researcher KFF in 2023, four in 10 births were covered by Medicaid. In Pennsylvania specifically, that number was 35 percent. In New York, it was 49 percent. The One Big Beautiful Bill, signed into law in July 2025, will reduce federal funding for Medicaid by $1 trillion over the next 10 years. 

“When we continue to cut Medicaid, we are excluding individuals in our community from necessary life-sustaining health care.” McFadden said.

Transportation

Living in a rural area means the closest facility providing maternal care can be far away. For example, while Pike County, PA does have Maternal and Family Health Services (MFHS) at various locations, the locations are not able to perform deliveries. Instead, residents of Pike County must go to Wayne Memorial Hospital in Honesdale, PA to deliver a child. Pike County currently does not and has never had its own dedicated hospital.

Dingman Township, which is the most densely populated area of Pike County, is just shy of over an hour away from Wayne Memorial Hospital.

”If you live 45, 50 minutes away and you don’t have transportation, who is providing you that perinatal care?” McFadden said.

Davis commented that in rural Pennsylvania, road conditions during winter months can make it more difficult to find transportation options, especially because rural areas often do not have public transportation.

The dangers of giving birth

“You’re less likely to seek out medical care or prevention care if it’s inconvenient.” Sullivan 180 CEO Denise Frangipane said. The program is based in Sullivan County, NY.

Lisa Davis, director of the Pennsylvania Office of Rural Health, explained that in northwestern Pennsylvania, there has been an increase in roadside deliveries.

“We know of a kitchen table birth that took place, and also just more recently a birth that took place in the back seat of a car that was parked in a business,” she said.

Risks associated with giving birth include perineal tears, abnormal heart rate of the child, water breaking early, excessive bleeding and more. These circumstances are something health care providers can often assist with. 

Maternal mortality rates in the U.S.—meaning the death of a woman while pregnant or after terminating a pregnancy—were 17.9 per 100,000 births in 2024, according to the Centers for Disease Control and Prevention. 

While that is a decrease from the previous year’s 18.9 rate, KFF notes that when compared to mortality rates of similar countries (such as Canada, Belgium or Australia) it is significantly higher. The average mortality rate of other countries in 2023 is 5.1, compared to 18.9 in the U.S.

According to the World Health Organization, maternal deaths can be prevented by providing access to contraception, safe abortion care, and quality post-abortion care. Most maternal deaths are preventable.

The closest Planned Parenthood to Wayne County is in Wilkes-Barre, 50 miles or more away. In Sullivan County, the closest Planned Parenthood location is in Newburgh, on average also 50 miles away.

Successes

Though providing OB/GYN services can be pricey, Davis commended Wayne Memorial for finding a workaround. Since the OB/GYN specialists are employees of the health center overall, the medical malpractice insurance is paid for by the federal government, meaning it is at no cost to the hospital. 

Davis also added that Wayne Memorial has mobile units, which can be a helpful resource for those who do not have transportation. Wayne Memorial currently has a mobile mammogram unit, which provides breast cancer screenings for residents in Wayne and Pike counties as it travels between health care center locations.

Dr. Erin McFadden, chief medical officer of the Wright Center,  said that at all Wright Center locations, including the one in Hawley, physicians “encourage everyone in our community between the ages of 40 and 65 to have an annual mammogram to identify breast cancer.” 

Wayne and Pike counties also provide free transportation for medical visits covered by Medicaid. 

The Rural Health Transformation Plan, which is a “five-year, $50 billion initiative to stabilize and to transform rural health care” according to Davis, may also be used to help improve maternal health care. The program was offered to all 50 states, and all states applied and received funds out of a $200 million maximum per year. This year, Pennsylvania received $130 million. 

Garnet Health Doctors CEO Jerry Dunlavey told the River Reporter that New York’s plan for the federal money includes funding maternal health care.

In New York, Garnet Health Medical Center has recently opened a new OB/GYN practice, just a month after Crystal Run Healthcare, one of the few dedicated OB/GYN clinics in the county, closed its doors. 

“As of July 1st, that program is up and running. In the first month alone, we saw over 250 patient visits, we welcomed over 20 babies to this world, which is really, really kind of cool.” Dunlavey said. 

Assemblywoman Paula Kay (D-100) said that after Crystal Run closed its practice in Sullivan County, she was “thrilled” to see Garnet step up.

Kay said that using capital discretionary monies, $250,000 would be donated to Garnet Health to redo and modernize the OB/GYN facility. 

“Patients and staff alike deserve to have the most modern conveniences and offices—an office that’s welcoming, an office that’s modern, as I said—has everything that the providers need to have the best care for their patients.” Kay said.