White women in rural America are dying at accelerated rates; new memoir explores why this group 'feels forgotten'

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"A New Divide in American Death" was a Washington Post headline in 2016. The article's research pointed to an only partially explained reality: "The most extreme changes in mortality have occurred among white women, who are far more likely than their grandmothers to be smokers, suffer from obesity or drink themselves to death," Joel Achenbach and Dan Keating wrote. "The statistics show decaying health for all white women since 2000. The trend was most dramatic for women in the more rural areas."

But why? Sometimes it takes a story rather than a study to show us. Journalist and author Monica Potts grew up in Clinton, Arkansas, a town of about 2,500. She left to pursue her dreams, but her best friend, Darci, stayed in Clinton. In an interview with NPR Host Scott Detrow, Potts discusses the two women's contrasting stories in her new book, The Forgotten Girls: A Memoir Of Friendship And Lost Promise In Rural America.

Detrow: Two best friends start with the same dream but grow up to live very different lives. It's the story at the heart of a new memoir about getting out of a small town and the crushing pressures to stay in it. . . .So you're the one who, as it were, got out. But let's start with this - your friend Darci didn't. Tell us about Darci, and tell us about when the two of you were really young, the type of dreams you shared.
Potts: Darci and I met when we were really young, like, 5 or 6. From that moment on, we were almost sisters. We grew up in a small town in the Ozark Mountains. . . . It's a strong evangelical community. When we were little, we would look through an old atlas and dream about getting away when we were older to a big place. . . . When we were older, we dreamed about going to concerts and listening to bands we liked instead of the country music we heard everywhere.
Detrow: Just focusing in on that marriage message, you also write about the hypocrisy and the confusion about, your life is about getting married; your life is about finding a husband; your life is about having children. And yet, if you have sex before marriage and if you get pregnant, that's a terrible, terrible decision - and just trying to make sense of all of these conflicting messages as a teenager.
Potts: Yeah. Well, it's a terrible decision, but the path to redemption is through the church.
Detrow: At the expense of your education in many examples, right?
Potts: Yeah.
Detrow: You write about people dropping out of high school their sophomore or junior year, even, and getting married once they become pregnant.
Potts: At the expense of your education and whatever else you might have wanted for your life. Your life becomes about being a mother, and everything else you might have wanted becomes subsumed by that.
Detrow: So you go to college. You begin a career as a journalist. Darci drops out of college relatively early. She stays in and around Clinton. She's in a series of abusive relationships. . . .has drug problems. . . but you ultimately reconnected as adults.
Potts: I was working as a journalist, and I had started to read a series of studies about white women with the least amounts of education - were losing years of life expectancy compared to the generation before. That felt very personal to me. . . .That group of women was similar to the girls that I had grown up with, and I wanted to report what was happening and across rural America. . . .While I was [in Clinton] in April 2015, Darci reached out to me for the first time . . . . We met up. . . . I told her the kind of book I wanted to write. . . And she said, well, maybe you should just write about me. From there, we started to talk more about her life.
Potts: We spent a lot of time together over the next few years.
Detrow: And she really struggled in those interactions with you.
Potts: It was really up and down, and it was often painful to watch. . . . But she thought that if her story might help other people, then it would be worth it.
Detrow: And what do you think the big picture lessons are?
Potts: I've spent about five years thinking about this. . . One of the things in rural America is this perception of scarcity. I think it's easy for people here to believe that they've been forgotten, that there's no help for them, that there are no options. . . . or life outside of the church and motherhood and marriage for girls is. . . .They're just not connected to those options. I think the first place to start would be expanding those worlds and connecting people to the broader world . . . . giving people the freedom to become who they are and who they need to be.
Detrow: Over the period where you began reporting this book and writing this book, you decided to move back there yourself. Why?
Potts: There was a moment when I started to come home in my mid-30s. . . . I just realized how beautiful this place was to me. I have really deep roots here. . . . And there are things about this place I love - the wildness, the mountains, the rivers, and some of the culture. I felt I needed to close the loop before I could move on with my adulthood and experience this place anew and with fresh adult eyes.