Telemedicine provides abortion access for rural women in states where the procedure is restricted or banned

Graph by the Society of Family Planning (click to enlarge)

Women living in rural areas with abortion-restrictive state laws are using telehealth and doctors in other states to access abortion medications. State shield laws currently protect out-of-state medical professionals who prescribe abortion medications, but that protection may not remain a guarantee.

Asynchronous telemedicine abortion medication provision rates "were higher in states with abortion restrictions and poorer counties far from clinics," reports Rachael Robertson of MedPage Today. "Of the 118,338 medication abortion pill packs Aid Access provided over a 15-month period, 84% went to states with near-total restrictions or bans on telemedicine abortion," reported Abigail Aiken, PhD, at the University of Texas, in the Journal of the American Medical Association.

When the U.S. Supreme Court overturned Roe v. Wade in 2022, some states followed the decision with abortion bans; however, if the bans were meant to stop abortions, they had limited success. Robertson writes, "Some data suggest that abortion rates remained steady despite these challenges."

Aiken's research points to medication abortions and the shield law as a reason abortion rates remained level, even in states with the most stringent restrictions. Aiken explains, "One plausible contributor is the rise of online asynchronous telemedicine abortion services -- particularly those operating under shield laws, which allow U.S.-licensed clinicians to provide abortion medications to patients in ban states with protection from legal liability."

"Before Roe was overturned, telehealth only accounted for 4% of abortions; that has increased to 25% as of December 2024, and disproportionately to ban states, according to Society of Family Planning data," Robertson adds.

Shield law protections will be tested by a Texas lawsuit "against a New York physician operating a nonprofit delivering telemedicine abortion," Robertson reports. "In the past, states tended to honor and assist other states' law enforcement, but the post-Roe era is different."

Military doctors try to replace therapy for PTSD with 'combat cocktails.' The practice has been linked to suicide risk.

Veterans are 50% more likely to commit suicide than civilian 
adults. (Medication-Induced Suicide Prevention graphic)

Although there is no data to support the practice, many military doctors prescribe "combat cocktails" to veterans with Post- traumatic stress disorder. "The practice, known as 'polypharmacy,' can tranquilize patients to the point of numbness, cause weight gain and increase suicidal thoughts when it involves pharmaceuticals that target the central nervous system," report Shalini Ramachandran and Betsy McKay of The Wall Street Journal. Because roughly a third of military veterans live in rural areas, the post-combat treatment may have a disproportionate impact on rural families and communities.

Medical guidelines for the Department of Veterans Affairs don't recommend giving patients simultaneous mixes of psychiatric medications, and the Food and Drug Administration warns against the practice. And yet, "prescribing cocktails of such drugs is one of the VA’s most common treatments for veterans with PTSD (post-traumatic stress disorder)," the Journal reports. "And the number of veterans on multiple psychiatric drugs is a growing concern at the agency."

Polypharmacy definitions vary, but "the VA defines it as taking five or more medications at the same time," Ramachandran and McKay explain. A growing number of VA physicians and researchers believes such dosing can have disastrous results, because powerful drugs can interact with patients' nervous systems and each other in unpredictable ways.

While talk therapy is considered the best PTSD treatment, therapists are often in short supply, so medical providers have turned to medicine to treat PTSD symptoms. "Nearly 60% of VA patients with PTSD were taking two or more central nervous system drugs at the same time in 2019," the Journal reports. "The VA declined requests from The Wall Street Journal to provide more recent polypharmacy numbers for veterans in its care."

Given that suicide rates among veterans are much higher than those of civilian adults, how the VA treats PTSD is under scrutiny from Congress, advocacy groups and veterans. "Studies by VA researchers link the simultaneous use of multiple psychiatric drugs to suicide risk among veterans," Ramachandran and McKay write. "Yet the agency has been slow to mandate changes."

Analysis: Rural Coloradans feel ignored and 'looked down on.' A policy expert looks at how and why.

Colorado ranchers asked the state’s wildlife commission to delay wolf releases in 2024. 
Their petition was denied. (Photo by Hyoung Chang, Getty Images via The Conversation CC)

In a tale as old as the American West, farming and ranching Coloradans resent being ignored and dismissed as "dumb" by city folk. "Many rural Coloradans, especially in agricultural communities, feel looked down on by their urban counterparts," writes policy scholar Kayla Gabehart for The Conversation. "One cattle rancher I spoke to put it plainly: 'It’s an attitude. . .We are the idiots. . .We are the dumb farmers . . . We don’t really matter.'"

To help understand attitudes and cultural differences between rural and urban Coloradans, she began by looking at each group's response to certain policies. Gabehart explains, "A designated day to forgo eating meat. . . and the ongoing wolf reintroduction. . . .These policies, while specific to Colorado, are symptoms of something larger. Namely, an ever-urbanizing, globalized world that rural, agricultural citizens feel is leaving them behind."

The "MeatOut Day" was declared by Colorado's governor as a way to draw attention to the health and environmental impacts of farming food animals by abstaining from a day of eating meat. The day received minimal attention from more urban Coloradans, but those from rural areas were incensed. Gabehart writes, "Neighbors in Elbert County promptly responded with outrage, flying banners and flags declaring their support for agriculture and a carnivorous diet. . . . There are nearly 36,000 cattle in Elbert County. This is relatively typical of a rural Colorado county."

Wolves were hunted into extinction in Colorado during the 1940s. And yet, in 2020, urban voters, who were by geography unlikely to encounter or be economically impacted by wolves, voted for wolf reintroduction. "Rural residents voted decidedly against the initiative. Despite much legislative and grassroots action to oppose it, wolves were reintroduced in December 2023," Gabehart adds. "Several cattle have since been killed by wolves."

"Rural residents in Colorado have told me they feel excluded. This is not new or exclusive to Colorado, but a story as old as America itself,” Gabehart explains. The American caste system "is entirely constructed and designed by the American upper class to intentionally exploit resentment of working-class white people. . . .The result is what sociologist Michael M. Bell calls a 'spatial patriarchy' that characterizes rural America as dumb, incapable, racist, poor and degraded."

When it comes to who American rural voters support, maybe part of it is tied to which candidate mirrors some of the resentment and isolation of rural living. "Rural communities have the distinct feeling that urban America doesn’t care whether they fail or flourish," Gabehart writes. "Nearly 70% of rural voters supported Trump in the 2024 presidential election. He won 93% of rural counties. Rural Americans feel left behind, and for them, Trump might be their last hope."

Some residents in rural Mason, Tenn., don't want a migrant detention center in their town, but it's coming anyway

At times, the town meeting devolved into the mayor, left,
shouting at citizens. (YouTube, WREG, Memphis, Tenn.)

Despite raucous pushback from residents and activists during a recent town meeting in Mason, Tenn., the evening ended with the mayor and council members approving agreements to transition the town's closed prison into a migrant detention facility managed by a private company.

"The first vote of the meeting resulted in approval for a contract with CoreCivic to resume operating the facility, which was closed in 2021," Adrian Sainz of The Associated Press reports.  "The second vote was to approve an agreement with Immigration and Customs Enforcement."

Eddie Noeman, Mason's mayor, who emigrated from Egypt, saw reopening the facility as a way to boost the town's lagging economy. "Noeman said he wanted to bring jobs and economic development to the town," Sainz explains. "With a population of about 1,300, Mason is located about 40 miles northeast of Memphis. When it was open, the prison was the town’s largest employer."

Before the start of the contentious meeting, Mason board member Virginia Rivers said she was not in favor of the town being connected to an ICE facility. She told Sainz, "I don’t like what ICE stands for, how they treat the people.” 

Once the contracts were approved, CoreCivic released a statement touting all the benefits the center will contribute to the town, such as good-paying jobs and tax generation.

Overall, CoreCivic has a darker reputation in Tennessee. Sainz reports, "The company has spent more than $4.4 million to settle about 80 lawsuits and out-of-court complaints alleging mistreatment — including at least 22 inmate deaths — at four Tennessee prisons and two jails from 2016 through September 2024."

Quick hits: More bacon; thriving town-owned grocery store; shocking fertilizer prices; drones for rural duties?

Five-month-old pigs from the latest breeding line Smithfield 
has developed. (Smithfield Foods photo via WSJ)

Just like lots of people, pork companies would like more bacon. For pigs to produce more bacon, they need bigger bellies, a trait pork industry breeders have been developing for years. "Today, slaughtered hogs weigh about 285 pounds on average, a 30-pound increase since the late 1990s," reports Patrick Thomas of The Wall Street Journal. "The increase in hog weight coincided with the explosion in popularity of bacon as more than just a breakfast item." With bacon in demand and razor-thin profit margins, the pork industry is using breeding programs to "build a better pig." 

St. Paul, Kansas, hadn't had a local grocery store for more than two decades, but in 2005, the town's new mayor challenged his community to use municipal support to plan and build a grocery store. St. Paul residents embraced the challenge and the St. Paul Area Community Development Corporation stepped in to help with planning and financial legwork, reports Kansas State University. In 2008, the St. Paul Supermarket opened, and it continues to thrive as a town-supported grocery store. Its motto is "the friendly store." Read its success blueprint here.

Fertilizer costs are high in the currency of corn. (Krista Swanson, National Corn Growers Association )

With alarmingly high fertilizer costs and falling commodity prices, U.S. farmers are grappling with how to stay afloat in today's market. "Farmers are in the middle of calling input suppliers to get quotes for fall fertilizer, and the prices are shocking," reports Tyne Morgan of Farm Journal. "The corn price to fertilizer price ratio on inputs such as phosphate is now the highest on record, and as corn prices continue to slide, it’s creating financial hurt on farmers. . . . An unnamed farmer asked U.S. Farm Report, 'How are we going to survive at these prices?'" 

After severe storms damaged crops and farming equipment across Nebraska, the state used drones to help mitigate the aftermath. "Using drones to help with disaster response shows the role they now play in the state’s economy, after years of investment and research from the state government," reports Chris Teale of Route Fifty. "Officials in the state are looking at ways drones can be used, especially to help those in rural areas. Delivery of food, medical supplies and other resources is one use case receiving a lot of attention."

A Maine roadway.
(C. Banks photo)

Among all the states, Maine remains one of the most rural and wild. "Greater Portland, Lewiston, Auburn, Bangor, and other populous areas make up just a small slice of Maine’s pie," writes Chris Sedenka in his opinion for WBLM radio in Portland, Maine. "It’s fascinating just how much of the state remains truly remote and untouched. . . . We still have territories named T2R9, you’re not going to find that in every state. . . . According to the data, Maine’s rural population makes up 61.5% of the total. That is an absolutely huge number. . . .The majority of the state is basically just pine trees and wildlife."

Living a long life could partially depend on geography. Some counties just seem to support populations who keep on keeping on. 

The map above shows which U.S. counties have an overall life expectancy above 80 years.
(Map via Brilliant Maps)

Illinois publisher closes newspapers in five states, leaving some towns as 'news deserts'

The Brookings Register was the area's last local news source. 

Update: "Recently shuttered newspapers across Wyoming and South Dakota are set to publish again, after buyers stepped up within days to prevent the rural communities from becoming 'news deserts,' where little or no local media remains," reports Sarah Raza of The Associated Press. 

As of last week, 31 communities in the Midwest and the West no longer have a newspaper. "News Media Corp., which owns local newspapers across five states, said it will close 14 operations in Wyoming, seven in Illinois, five in Arizona, four in South Dakota and one in Nebraska," report Sarah Raza and Jack Dura of The Associated Press.

While newspapers have closed all around the United States, when a rural area loses its only local news source, the void is unlikely to be replaced by another paper or online publication. "The U.S. has lost over one-third of its print newspapers and two-thirds of its newspaper journalists since 2004," Raza and Dura explain. "NMC’s closure affects longtime newspapers that were often the primary source of news in numerous small towns, worsening the problem of news deserts in rural areas."

The company's CEO, J.J. Tompkins, listed the current financial woes of the news industry alongside a failed bid to sell the company as the reason for the sudden closures. "Hundreds of employees were terminated immediately, and Tompkins wrote that the company will make 'reasonable efforts to pay you all remaining compensation you have earned,'" Raza and Dura write. Even upper management at many of the papers told AP they did not see the closure coming.

The Brookings Register in South Dakota was the town's last news source. The town's mayor said "the closure of his town’s newspaper 'absolutely' leaves a big hole in the community," AP reports. "He liked the newspaper’s commentary for fostering conversations. The reporters did a great job telling readers what was going on in Brookings, a city of about 25,000 people." 

Boar's Head plant in tiny Jarratt, Va., will reopen soon, but the company's poor sanitation record remains a concern

Boar's Head positions itself as an upscale
company, but state inspections show many problems.

Boar's Head deli meat indefinitely closed its Jarratt, Virginia, plant last September after 10 people died and dozens were hospitalized after eating listeria-tainted liverwurst from the facility. The plant, which was the major employer in the small town of 600 residents, is now slated for reopening. But a closer look at other Boar's Head facilities reveals a troubling pattern.

Jonel Aleccia of The Associated Press reports, "Boar's Head plants in Arkansas, Indiana and elsewhere in Virginia have been flagged for the same kinds of sanitation problems that led to the outbreak, with the most recent report in June."

Inspections since the beginning of 2025 report problems with "meat and fat residue left on equipment and walls, drains blocked with meat products, beaded condensation on ceilings and floors, overflowing trash cans, and staff who didn’t wear protective hairnets and plastic aprons — or wash their hands," Aleccia reports. Similar conditions were repeatedly reported at the Jarratt plant prior to the nationwide listeria outbreak.

Recent inspection findings from Boar’s Head sites in Forrest City, Arkansas, New Castle, Indiana, and Petersburg, Virginia, "surprised outside food safety advocates who said that factory conditions should have improved," Aleccia explains. Instead, the reports "raise new questions about the company’s promises to address systemic problems."

Barbara Kowalcyk, who directs a food safety and nutrition security center at George Washington University, told Aleccia, "What jumped out to me is there is an organizational culture issue that needs to be changed. . . .Usually that culture has to start at the top.” 

Company officials refused to talk to the AP about the recent inspections, Aleccia reported.

Meanwhile, the USDA has lifted its forced suspension of the Jarratt facility, and the company is hiring for positions at the plant.

Emergency departments in some rural areas don't have 24/7 on-site physician coverage

A hospital in Ekalaka, Mont., sits at the intersection of two dirt roads. 
(Photo by Arielle Zionts, KFF Health News) 

Many rural emergency rooms are no longer run by attending physicians, but instead depend on care by nurse practitioners and physician assistants. "A recent study found that in 2022, at least 7.4% of emergency departments across the U.S. did not have an attending physician on-site 24/7," reports Arielle Zionts for KFF Health News. "More than 90% were in low-volume or critical access hospitals — a federal designation for small, rural hospitals."

The 2022 report represents "82% of hospitals that responded to a survey sent to all emergency departments in the country, except those operated by the federal government," Zionts writes. "The study is the first of its kind, so there isn’t proof that such staffing arrangements are increasing, said Carlos Camargo, the lead author and a professor of emergency medicine at Harvard Medical School."

The idea of an emergency department without a doctor on staff remains controversial, and not all states allow it. "Some doctors and their professional associations say physicians’ extensive training leads to better care, and that some hospitals are just trying to save money by not employing them," Zionts explains. Indiana, Virginia, and South Carolina have passed laws that require all their EDs to have a 24/7 physician on-site.

Even when states require their EDs to staff a round-the-clock doctor, that doesn't make finding one easy. "In the Dakotas, more than half of emergency departments were running without 24/7 attending physician staffing," Zionts reports. In response to the regional shortage, Sioux Falls-based Sanford Health launched an emergency medicine residency to help increase its ED physician numbers.

Some rural health advocates say lawmakers need to be sure that employing full-time ED physicians 24/7 is feasible for their region before passing legislation that requires it. Zionts adds, "Camargo said some doctors say that if lawmakers are going to require 24/7 on-site physician coverage in ERs, they need to pay to help hospitals implement it."

Measles made its way back into the U.S., but new ways to prevent the disease may be on the horizon.

Illustration of infectious diseases under a microscope
(Adobe Stock)

Once thought to be eliminated in the U.S., measles has returned, leaving its unpleasant symptoms and tell-tale itchy rash in its wake. With more people contracting and spreading the disease, ways to avoid or treat it have revived. "As vaccination rates fall and infections rise, scientists are racing to develop drugs they say could prevent or treat the disease in vulnerable and unvaccinated people," reports Dominique Mosbergen of The Wall Street Journal.

A little over 20 years ago, looking for ways to treat measles wasn't a consideration, but now some biotech companies and universities are working on measles prevention without the typical MMR vaccination. Mosbergen writes, "The drugs are still a ways from becoming available to patients but could offer alternatives to people who are immunocompromised, don’t respond to the measles vaccine or are vaccine skeptics."

Not all medical professionals see new measles treatments as a positive development because they could "further drive the drop in vaccination. Nationally, 92.5% of kindergartners received the measles, mumps and rubella . . . shot in the 2024-25 school year," the Journal reports. "In 2019-20, the vaccination rate was over 95%, which is the rate encouraged by health authorities to prevent community transmission of measles."

Invivyd, one of the companies working on a new measles treatment, uses measles "antibodies that are lab-made versions that can be delivered intravenously or as an injection and boost immunity immediately," Mosbergen explains. "They could benefit newborns and immunocompromised people who can’t be vaccinated, as well as the minority of people who don’t respond to the vaccine or whose immunity has waned."

Scientists haven't studied the measles virus as much as other communicable diseases because the vaccine was so effective, but to develop new treatments, researchers have "been forced to better understand measles," Mosbergen reports. "The body’s immune response to measles, for instance, hadn’t been well understood."

'On the Front Porch' discussions return on Aug. 21. Pipa and Orrell begin with big change in northern Appalachia.

Tony Pipa (left) and Brent Orrell return on Aug. 21

After a summer of traveling to rural destinations, Tony Pipa from Reimagine Rural and Brent Orrell of the American Enterprise Institute are back 'on the front porch,' discussing the trials, successes and ongoing challenges of rural communities across the United States.

The new season dives in with Pennsylvania activist and author Tataboline Enos, who discusses her latest book, “Proudly Made: A Story of Reinvention in the Big Woods and Small Towns of the Pennsylvania Wilds.”

Set in northern Appalachia, Enos' memoir recounts the story of a region rich in public lands that was struggling to survive decades of depopulation and business decline. Through hard work, planning and collaboration, the community forged a new and brighter path forward by harnessing the spirit of the land and the people.

Enos will share details of how this community created change.

The group will share a blueprint for other rural communities looking to leverage outdoor recreation opportunities for economic development. Virtual participants can submit questions before the event via email to events@brookings.edu

Register here for the online event on Thursday, Aug. 21, at 3 p.m. E.T.

For more rural inspiration, Pipa's Reimagine Rural podcast returns for its third season beginning on Aug. 19. The podcast's first two stops are in western North Carolina, where residents and businesses are navigating post-Hurricane Helene recovery.

Season 3, Episode 1 focuses on a community working to restore outdoor recreation in Old Fort, N.C. Episode 2 explores how Canton, N.C., is maintaining its identity and resilience after multiple disasters.

New Reimagine Rural podcast episodes are released every three weeks throughout the fall and can be accessed on platforms such as Spotify and Apple.