Without help, the rural maternal care crisis will only get worse, and 'more women and babies will die unnecessarily'

Over the past decade, many rural hospitals have struggled to stay afloat, but even among the surviving hospitals, labor and delivery services have been cut, which forces mothers to travel and increases pregnancy dangers. Dave Muoio of Fierce Healthcare reports, "Over half of the country's rural hospitals aren't offering labor and delivery services, according to a new report from the Center for Healthcare Quality. The center wrote that over 200 rural hospitals across the U.S. stopped delivering babies in the past decade. As of this month, 55% of rural hospitals don't offer these services, and in 10 states, more than two-thirds don't."

Why obstetrical care is getting axed in rural areas comes down to costs. "CHQPR noted that it can be financially difficult for hospitals to staff for 24/7 maternity care and that private and Medicare payments often fail to break even," Muoio writes. "Per hospital cost reports for 2022, over a third of rural hospitals that still provide maternity care logged an overall loss on patient care services. . . . Within 12 states, more than half of rural maternity care hospitals posted patient care losses."

CHQPR graph

The lack of care can prove deadly for mothers and babies. Muoio writes, "The sparse availability of maternity care hospitals forces pregnant women to travel further for a delivery and incur a higher risk of complications and death for the mother and baby alike, the center wrote. Whereas travel time to a hospital with labor and delivery services is often under 20 minutes for those in urban areas, in rural areas, 'the travel time is likely to be at least 30 minutes, and it is often 40 minutes or more,' according to the report."

Stemming the tide of closures will require approaches that work for more remote health care systems. "Any strategy to bolster the rural maternity workforce will also require targeted clinician training," Muoio reports. "To address the financial roadblock, CHQPR urged employers to put pressure on their health insurance plans' to demonstrate that they are paying adequate amounts to cover the cost of maternity care services. Similarly, states should require Medicaid plans to pay adequate amounts for maternity care services.'"

"It is not an exaggeration to say that rural maternity care is in a state of crisis, and a crisis demands immediate action," the CHQPR report said. "Every day that steps are not taken to implement the changes in workforce recruitment and payments described above increases the likelihood that more women and babies will die unnecessarily."

Opinion: Recruiting physicians to rural areas needs to show what communities offer, which goes far beyond money

Rural medicine is often more about relationships than diagnoses,
which is a hard concept to incentivize. (UIC photo)

Student loan reductions and payoffs have not enticed enough graduating doctors to move into rural areas. But when medical providers experience working in less populated places, they often find smaller communities have so much more to offer, writes Arjun V.K. Sharma in his essay for Undark. "Strategies to attract doctors to rural areas can take many forms, but it is hard to imagine any being successful without the doctor seeing the benefits of the community in which they reside."

Government officials, public policy writers and community planners would do well to look at what it takes for a resident to opt to live in a rural location. Sharma explains: "Often, it is interminably fraught — already hard work is made harder, significant others are uprooted, and certain city comforts and sensibilities may be sacrificed. Physicians, then, must rely on forces internally summoned — autonomy, altruism, competence — to propel them forward. These qualities are harder to define and measure, which make them difficult to meaningfully pin to any reward."

"When I left the city for work in a rural hospital, I put those virtues to the test. I was unsettled, initially wading through the steady stream of 'hellos,' 'good mornings,' and 'good nights' from passersby in the corridor, and unsure of how to interact with psychiatric patients who ran a café near their small ward to ease their transition to the world outside," Sharma writes. "And I was uneasy, at times, with the care we provided — even if patients were appreciative of what they received. The same decisions we fashioned in the city — to get antibiotics delivered at home or to get a surgeon to clear out an abscess — came together with fewer resources, and with doctors stretched hundreds of miles apart."

Rural settings offer a space where all people intermingle and get to know each other. And the closeness of being together while all others are miles away "lent a power to something decidedly tangible. Interactions with patients had an unflinching honesty and tenderness about them," Sharma adds. "One morning, an older man with anxiety was referred from the emergency department to a senior physician. They ran into each other at the grocery store and at local hockey games; living down the street, the physician would often check in on him."

Sharma writes. "A connection to a rural identity could be bought with incentives, or it could be learned. . . . It could be lived through simple and heartfelt things: a teary 'thank you,' a firm handshake, or the question, over and again, from patients of your plans to stay. These gestures don’t absolve the system of its responsibility to make positive reforms. But they affirm value and purpose of work that, whittled down by staffing shortages and burnout, can still impact lives our society willfully neglects."

New leadership and dedicated volunteers helped this small Appalachian town 'persevere' after almost losing its charter

Pound, Virginia is slowing rebounding.
(Photo by Megan Schnabel, Cardinal News)

Despite personal battles and an embezzlement scandal, the town of Pound in Wise County, Virginia, is still a town, which for some people is a shocker. "In early 2022, the town, pop. 877 and falling, was facing an existential crisis, brought on by years of infighting and dysfunction, reports Megan Schnabel of Cardinal News in southwest Virginia. "A top General Assembly member — the region's own delegate — had threatened that the state would yank the town's charter. He was tired of seeing stories in the local news about how town council members couldn't get along, about fiscal improprieties, polluted water, misplaced drugs and guns in the police department."

The news that Pound might cease to exist moved some townspeople to buckle down, fight for what was good in the town, and fix past mistakes. "Leabern Kennedy was elected to the town council in 2021 on a platform of changing the status quo, is now the vice mayor and a driving force behind Pound's revitalization," Schnabel writes. Kennedy told Schnabel: "I think we have shocked the world because I don't think anyone expected us to come back. I'm OK with that."

Map by Robert Lunsford,
Cardinal News

Part of Pound's recovery included leadership changes, with elected and hired officials working together. "The town has chosen a new mayor and replaced half its council members. It paid off almost $9,000 in debt and hired a part-time clerk-treasurer," Schnabel reports. Cindy Mullins, a Pound police officer who was hired in 2021, told Schnabel, "So it's going to take some time to pull back out of this and to really fully function again. . . . It goes back to the trust of the people, the trust of the community and other communities at large to be able to look at us and respect us."

The town's budget is small, and every penny counts as town leaders work to set finances right alongside developing tourist attractions along the scenic Pound River. Debbie Hale, a town volunteer, has worked on grant applications. "Hale won a grant to buy four GRIT Freedom Chairs, which look something like a cross between a mountain bike and a wheelchair and allow people with limited mobility to explore off-road. . . . Pound is still dealing with some issues that send up red flags for state and federal grant programs. . . . One problem is capacity. . . . Another challenge: the town’s fiscal history."

"One source of help during the turmoil, and still today, was the Virginia Municipal League. Its executive director, Michelle Gowdy, spoke on Pound’s behalf during legislative hearings over the town’s future," Schnabel writes. "She and her team have helped Pound’s leaders get trained on budgeting, Freedom of Information Act compliance and other municipal matters. . . ."

Chestnut trees were possibly on the cusp of revival, but a lab error undermined that project; future success is unclear

Few chestnuts ever reach maturity.
(Graphic by Adam Dixon, Ambrook Research)

A blight-resistant American chestnut seems a long way off despite years of dedicated scientific research and work to revive it.

The first epic chestnut loss goes back to the early 1900s when a deadly fungus, Cryphonectria parasitica, wiped out "5 billion trees and their 2 billion tons of biomass," reports Lela Nargi of Ambrook Research. But scientists at the State University of New York's College of Environmental Science and Forestry had been working to develop a genetically altered chestnut that could survive the blight, and their work showed progress until a lab blunder set the entire project into a tailspin.

Nargi explains, "This past December, SUNY admitted a major error with a variant known as Darling 58. This caused its research and financial partner, The American Chestnut Foundation, to pull its support of D58. . . ."

Not all chestnut tree supporters agree that genetic modification is the path to the trees' revival, but despite the controversy, SUNY put its first trees in the soil in 2006 and, by 2019, filed a petition with the Department of Agriculture to have D58 deregulated.

Things looked to be going well until the lab gaffe was aired. Nargi reports, "SUNY had goofed up variations of its breeding line. Instead of using D58 to pollinate trees in its research plots, it had accidentally used D54. . . .TACF withdrew its support of the petition and the trees themselves, saying they'd already noticed 'disappointing performance results.'"

Besides using genetic modification trees to bring back the chestnut, two other methods are in the works. "The American Chestnut Cooperators' Foundation seeks to breed resistance into 100 percent American chestnut trees," Nargi adds. "Another, undertaken by the American Chestnut Foundation, is a backcross in which American chestnuts are cross-bred repeatedly with Chinese chestnuts to impart the latter's blight tolerance into a hybrid tree." All the methods have problems, and while millions of wild chestnuts exist, few will reach maturity.

Donald Davis, author of The American Chestnut, told Nargi: "Even people who used to be fans of the American chestnut would say it had its chance, it had its place in history. They say now we need to move on to species that are going to be more likely to survive in new environmental conditions."

Some of the best rural discourse happens 'on the front porch.' Reimagine Rural series features book authors.

This week Tony Pipa from Reimagine Rural and Brent Orrell of the American Enterprise Institute kicked off their new "on the front porch" conversations with authors of recent books on rural America.

The first discussion was with Nick Jacobs of Colby College, whose recent book with Dan Shea, The Rural Voter: The Politics of Place and the Disuniting of America, uses comprehensive data to examine how the deep sense of civic pride among rural citizens collides with increasingly nationalized policy and political concerns. Watch the YouTube recording here.

Future "Front Porch" sessions are on:

• Thursday, February 8, 2 p.m. ET with Kathryn Edin and Timothy Nelson, authors of The Injustice of Place: Uncovering the Legacy of Poverty in America with Luke Shaefer, in-person & online at Brookings.
• Thursday, April 4, at 10 a.m. ET with Elizabeth Currid-Halkett, author of The Overlooked Americans: The Resilience of our Rural Towns and What it Means for our Country, in-person & online. Location TBA.

To hear more about struggles and triumphs in rural America, give Brookings' podcast, "Reimagine Rural" a listen. The podcast features Pipa traveling through rural America -- from Shamokin, Pennslyvania, to Thomas and Davis, West Virginia, and across to Globe, Arizona. Pipa explores small-town challenges with residents who are living it. Throughout these conversations, Pipa examines the ways rural residents are reinventing their towns.

In 1985-2014, suicide rates were highest among workers in lumber, wood and furniture; metal fabrication; and mining

Workers in several rural-oriented industries were found to have the highest suicide rates, in what the authors say is the first study of suicide rates by industry using nationally representative data.

The study looked at 1,943 suicides over 29 years, from 1985 to 2014. It found that age-adjusted suicide rates were highest in the furniture, lumber, and wood industry group (29.3 suicides per 100,000 population), the fabricated-metal industry (26.3 per 100,000), and mining (25.8). Railroading had the lowest rate (5.5), then education, banking, hospitals, and entertainment and recreation. 

Lines extending from numbers indicate possible maximum rates, due to
sample size. (Study graph, adapted by The Rural Blog; click to enlarge)

Most workers in the high-ranking industries are men, which may partially explain their rank. "Male-dominated industries often come with intense pressure, competition, and societal expectations that can significantly impact the mental health of individuals working within them," the authors write. "Male-dominated industries often involve high-stress jobs, long working hours, low pay, and limited work-life balance, all of which can contribute to chronic stress and mental-health problems."

The study, published in the Archives of Suicide Research, was conducted by Ahmed Arif and three other researchers at the University of North Carolina at Charlotte. They note, "Suicide rates in the working-age U.S. population have increased by over 40% in the last two decades," with the latest annual total 48,000. "Between 1999 and 2017, the age-adjusted suicide rate increased from 10.5 to 14.0 per 100,000 population. Although suicide may be linked with characteristics of workplaces and their industries, few studies have reported industry-level suicide rates."

Why study such rates? "Characteristics of the workplace may affect suicide risk," the authors write. "Researchers have identified job stress, low job satisfaction, bullying and harassment, lack of support and resources, poor management practices, and job insecurity as some of the risk factors for suicide linked with the workplace." Also, "There is evidence that workplace suicide prevention is effective."

Many graduating high school students are considering alternatives to college for job training

Some students seek to avoid college because of cost vs.
labor mismatches. (Photo by Nathan Dumloa, Unsplash)

For three generations, going to college and earning a 4-year degree was the coveted path to a rewarding career with a higher income. But the American belief in the "college for all model" has changed, writes Douglas Belkin in an essay for The Wall Street Journal. "So how did one of the crown jewels of American society squander so much confidence so quickly?"

It began with federal student loans to almost any 18-year-old high school graduate, which had a seismic change on higher education enrollment. "Cash and prestige saturated college campuses while alternatives like vocational and technical schools withered," Belkin explains. "Between 1965 and 2011, university enrollment increased nearly fourfold to 21 million as the earning differential between high school and college graduates expanded."

"For middle-class Americans, college made sense as long as a degree generated a large enough wage premium to make the rising cost of the investment worthwhile," Belvin writes. "As that premium became less consistent, the risks of going to college grew and confidence in college as an institution declined."

A college education "is among the largest investments most Americans will make," Belkin adds. The "math doesn't work for a growing number of families. The percentage of students who enrolled in college after graduating high school fell from 70% in 2016 to 62% in 2022. . . . A poll published in 2022 asked parents if they would rather their child attend a four-year college or a three-year apprenticeship that would train them for a job and pay them while they learned. Nearly half of parents whose child had graduated from college chose the apprenticeship."

Changes are also showing up in the workplace. Belkin writes: "In what has been called the 'degree reset,' the federal government and several states eliminated the degree requirements for many government jobs."

Thieves took most print copies of rural weekly with story on alleged rape at police chief's home; increased story's reach

UPDATE, Jan. 20: Mike Wiggins tells the International Society of Weekly Newspaper Editors, "The thief returned all of the stolen newspapers to our office Thursday night, confessed to the crime and was cited for petty theft this morning." The Plaindealer reports that it is not disclosing the thief's relationship to the sexual-assault case, and "The theft was not connected in any way to the three defendants in the case, their families or the Ouray Police Department."

Front page of the latest Ouray County Plaindealer

By Corey Hutchins
Inside the News in Colorado

This week, a front-page story appeared in the small and mighty Ouray County Plaindealer about a 17-year-old girl’s allegations of being raped by teenagers at the home of a police chief.

What happened next? Papers started disappearing from newspaper boxes around the county, said the paper’s owners, Erin McIntyre and Mike Wiggins.

Here’s more from a note to readers in an email Thursday: "All of our newspaper racks in Ouray and all but one rack in Ridgway were hit by a thief who stole all the newspapers. From what we know so far, it seems this person put in four quarters and took all the papers at these racks. It’s pretty clear that someone didn’t want the community to read the news this week. … Whoever did this does not understand that stealing newspapers doesn’t stop a story. We’re not going to stop doing our job, which is to shine light on important issues in our community and keep you informed. This person is not going to shut down the freedom of the press by stealing a few hundred newspapers. Our community won’t stand for it and we won’t, either."

McIntyre also said the young newspaper publishers were working with a printing plant in Montrose to get another press run published on Thursday. “I'll leave it up to you to draw your own conclusions on which story they didn’t want you to read,” she wrote. Online, a backlash was surging.

When news of the alleged newspaper thefts hit social media Thursday afternoon, Colorado journalists began sharing a link to the online version of the rape allegations story, including an editor at the Colorado Sun, Denver Post staffers, prominent Denver TV anchor Kyle Clark, and others. (The Plaindealer made the story free to read on its website; other stories are not.) The Post ran details of the rape allegations, naming two suspects; the story led with news of the stolen papers.

Ouray County (Wikipedia map)

Clark also included a broadcast segment about it on his "Next" show Thursday evening, indicating the sexual assault story was the news someone was trying to suppress. “We have a link to the article at the Next section of 9News.com,” Clark told his audience Thursday evening. “I recommend you read it if for no other reason [than] that because somebody doesn’t want you to see it.”

If that was the case, the pilfered periodicals produced a classic Streisand effect. The online version prominently displayed mugshots of the three young men arrested for suspected sexual assault, including the Ouray police chief’s stepson; the front-page print story did not.

McIntyre said Friday she hadn’t looked at how much traffic the online story generated, but she said more than $2,000 in donations had flowed in to the newsroom since they publicized the thefts. “People are angry this happened,” she said in a text message Friday morning. “Law enforcement is going to catch this person and we plan on pressing charges.” (She pointed to a 2022 state statute that makes the act of interfering with the lawful distribution of newspapers a finable offense.)

“If you hoped to silence or intimidate us,” Plaindealer co-owner Wiggins said, “you failed miserably.”

Flora and Fauna: A working mouse; this hasn't happened since 1803; 'Wicked' the amazing dog

Welsh Tidy Mouse is reporting for the night shift.
(Photo by Rodney Holbrook, Animal News Agency via WP)

A clean shed is a happy shed. At least Welsh Tidy Mouse thinks so. He has been organizing everything from nails to cable ties in 75-year-old Rodney Holbrook's outdoor shed, reports Jennifer Hassan of The Washington Post. "Most of the time, the rodent works alone, though sometimes it has accomplices, Holbrook said. In one clip, he spotted two other mice joining the nightly cleanup."

How can animals survive in an ever-warming world? Adaptation is one way, but can they do it fast enough? "Maybe," writes Brian Owens for Hakai magazine. "Research conducted over the past couple of decades has shown that evolution can occur on timescales similar to those of climate change. . . .There are things animals can do to stack their decks — and people can help."

Cicadas' vibrating noise can reach 100
 decibels. (Photo by B. Nino, Unsplash)

What genus of this insect is exclusive to North America, spends 99.5% of its life underground and becomes one of nature's loudest bugs once it emerges above ground? Magicicada -- also known as periodical cicadas. This spring, much of the eastern United States will experience a cicada extravaganza as "two cicada broods erupt in states from Virginia to Illinois come late April through June," reports Clare Marie Schneider of NPR. "Periodical cicadas have the longest known insect life cycle. . . . The last time the two broods — Brood XIX and Brood XIII — emerged simultaneously was in 1803."

With family grocery bills often topping off at more than $1,000 a month, this spring is a great time to consider growing a garden. "Because we humans developed into thriving species (well... somewhat thriving) when we learned how to grow our own food," writes Nicole Burke of Grow Yourself Podcast. "I'm about to convince you that growing some of your own food is not that hard to do." Don't have the energy or room to plant? Many plants can "breathe" life into indoor living spaces, Janece Maze and Christopher Michel of Country Living report. "The best part of houseplants? The weather's always fine."

Cartoon by Marina Wang, Hakai

How do penguins tell each other apart when they all have the same outfit on? By their spots! "African penguins develop a distinct constellation of spots on their chests, which remain the same throughout their lives," reports Marina Wang for Hakai magazine. "Zookeepers often use these spots to identify individuals. . . To find out if the birds do the same, Luigi Baciadonna, a psychologist at the University of Turin in Italy, and his colleagues designed an experimental series."

Once common in the West, the whitebark pine tree is struggling to survive. "Warmer temperatures, a fungal disease called white pine blister rust, and swarms of mountain pine beetles have killed hundreds of millions of whitebark pines across the West," reports Jim Robbins of Yale Environment360. "Wildfires are taking an increasing toll, and other conifer species are moving upslope in the rapidly changing environment, outcompeting the whitebark for nutrients and moisture."

Wicked is calm, cool and commanding.
(Photo by Stephaniellen Photography, AKC)

Wicked isn't just the name of a blockbuster musical. It's also is the name of a rock-star-quality dog. "Meet Wicked, a three-year-old Doberman Pinscher who clinched the win for the American Kennel Club's 2023 Working Group competition last month," reports Liz Langley of National Geographic. "Exactly the opposite of what her name might suggest, Wicked has a calm but commanding presence. Even when she won Best of Breed earlier in the day, which put her in the Working Group competition, Wicked seemed to be a crowd favorite — every ounce of her compact, muscular body brimmed with energy."

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Rural is full of diversity. Trees in Muncy, Penn., pop. 2, 500 (Photo by Venti Views, Unsplash)

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