Even before Roe v. Wade was overturned, abortion care lagged behind in rural communities

Filmmaker Emma Dessau grew up in urban New Jersey with access to sex education and Planned Parenthood, and an understanding that Roe v. Wade was a sacred law. When Dobbs v. Jackson overturned abortion as a constitutional right in 2022, Dessau followed in the steps of others — taking to the streets, posting on social media and donating to charities, she writes for The Daily Yonder.

When she met Caitlin Gaffin, co-founder of Holler Health Justice in West Virginia, she realized Roe was never enough for many rural communities.

Dessau began producing a documentary about Holler Health Justice in 2018. That year — before Roe was overturned — the West Virginia legislature removed Medicaid coverage for abortions, in a state where nearly 30% of people use Medicaid for health care.

"The protection of Roe didn’t make abortion affordable or accessible in West Virginia. It didn’t increase the number of safe clinics in remote hollers or expand the availability of sex education resources," Dessau writes. "After Roe fell, Holler Health Justice adjusted to the new harrowing reality, but its core mission remained the same."

The film underscores the reality of anti-abortion sentiments in the wake of Dobbs v. Jackson. Abortion clinics disappeared due to budget cuts while Crisis Pregnancy Centers popped up, intercepting funding from low-income families and creating abstinence-only sex education programs.

"The mission of Holler Health Justice is not to prove that mutual aid is a replacement for the health and safety services provided by state and federal governments," Dessau writes. "Rather, its work is borne from a tradition of everyday people filling in the gaps when their homes and lives are seen as sources to extract and divest from, not invest in."

Babies delivered at rural hospitals can receive specialized neonatal care through a unique telehealth program

A newborn baby's care team can get live, immediate help
from a neonatologist with TeleICN. (Dartmouth photo)

A pregnancy delivery in a rural hospital far away from specialized care poses significant risks for a baby born with complex needs. In Vermont and New Hampshire, Dartmouth Health created TeleICN, a unique telehealth program that connects rural medical providers to neonatologists who can help manage a baby's health during and after delivery, reports Christopher Cheney for Healthleaders.

As more rural hospitals have cut services to save money, many have shuttered their labor and delivery units. In the case of an emergency delivery, EMS will take a pregnant patient to the nearest emergency department, where a rural care team can "connect to the TeleICN program using an iPad or making a phone call," Cheney explains.

Tapping into TeleICN is similar to using FaceTime. The program allows a neonatologist to "talk with the local teams, look at the baby via video, and work with the mom and their family members to make decisions about the next steps in care for babies," Cheney reports. TeleICN can "connect local care teams to a neonatologist virtually on a 24/7 basis, and it serves 16 rural hospitals in New Hampshire and Vermont."

Katelyn Darling, a director at Dartmouth Health, shared the varying levels of care TeleICN often provides, saying, "Sometimes, they know a mom in labor is on the way to their hospital, and they want us to help them prep the care room. Sometimes, they want us in the background to support them. Sometimes, they want us on the frontline making decisions about care."

Because the TeleICN has been so successful, Dartmouth expanded its virtual obstetrics care with its new TeleMFM program. Cheney explains, "The focus is on high-risk obstetrics care and fetal-maternal medicine services, with the goal of reducing the need for patients to travel long distances. … Patients can go to a clinic associated with a rural hospital and get connected to a TeleMFM provider."

Jessica Clem, TeleICN's medical director, told Healthleaders, "What we are trying to do is provide equitable care in New Hampshire and Vermont, particularly for rural communities."

Analysis: Rural women are more likely to face domestic violence or be killed by an intimate partner

Physical and social isolation can keep abused women from 
asking for help. (Getty Images photo via Conversaiton CC)

Not only are rural women more likely to face violence or be killed by a partner, they also face fewer intervention options and stigmas that discourage them from asking for help. Regional acceptance of violence against women, social and physical isolation, and gun ownership can all be contributing factors.

"I analyzed aggregate 1992 to 2005 National Crime Victimization Survey data, and this data conclusively shows that rural women across the U.S. report physical and sexual violence at higher rates than those in more densely populated areas," explains rural violence expert Walter S. DeKeseredy for The Conversation.

While many people may think rural living is safer, for many women, it's often the opposite. "Rural women in the U.S. are more likely to be killed by their current or former male partners compared to their urban and suburban counterparts," DeKeseredy writes. "A study looking at data from 2005 to 2017 across 16 states, for example, found that female homicide rates are higher in rural places."

Why rural women are more at risk for violence is a complex mix of shared misogyny, fewer witnesses, higher gun ownership rates and social stigmas. DeKeseredy writes, "In rural sections of Ohio and other states, as my research uncovered, there is common acceptance of abuse of women. In many rural areas, community norms often prohibit survivors from publicly talking about their experiences and from seeking help."

Gun ownership is more common in rural places, but it has been correlated to "intimate partner violence in rural parts of the U.S.," DeKeseredy explains. "Moreover, firearms are used in 54% of all rural domestic homicides. . . .Gun ownership can create safety concerns for social workers, many of whom work alone."

So far, efforts to prevent violence against rural women has been focused on gun control or firearm background checks. And rural libraries "have proven to be a vital resource in the struggle to end interpersonal forms of abuse of women," DeKeseredy writes. "They are more accessible in many U.S. rural communities than are shelters, public transportation and other services."

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."

New doctors are avoiding abortion ban states, new analysis shows. Restrictions may add to mutiple-care shortages.

Fewer new doctors are applying for residency in
abortion ban states. (Hush Naidoo Jade photo, Unsplash)

States with significant restrictions or bans on  abortions may be inadvertently discouraging graduating medical students from applying for residency in their state, which could exacerbate regional physician shortages. Julie Rovner and Rachana Pradhan of KFF Health News report, "According to new statistics from the Association of American Medical Colleges, for the second year in a row, students graduating from U.S. medical schools were less likely to apply this year for residency positions in states with abortion bans and other significant abortion restrictions."

State battles over abortion aren't limited to uncertainties for doctors and pregnant patients; the tensions have "also bled into the world of medical education, forcing some new doctors to factor state abortion laws into their decisions about where to begin their careers," Rovner and Pradhan write. "Fourteen states, primarily in the Midwest and South, have banned nearly all abortions. . . . A preliminary review of a new analysis by the AAMC found that the number of applicants to residency programs in states with near-total abortion bans declined by 4.2%, compared with a 0.6% drop in states where abortion remains legal."

The AAMC's analysis shows that when new doctors start avoiding certain states, those states gain fewer doctors, which adds to regional physician shortages in many specialties. KFF Health News reports, "The organization tracked a larger decrease in interest in residencies in states with abortion restrictions not only among those in specialties most likely to treat pregnant patients, like OB-GYNs and emergency room doctors, but also among aspiring doctors in other specialties."

The number of new doctors applying for OB-GYN and internal medicine residency slots in those states "dropped 6.7%, compared with a 0.4% increase in states where abortion remains legal," Rovner and Pradhan explain. "For internal medicine, the drop observed in abortion ban states was over five times as much as in states where abortion is legal."

Rural women who experience intimate partner violence face barriers when asking for and accessing help

Adobe Stock photo

While the number of U.S. domestic violence incidents peaked during the pandemic, overall numbers have remained high even as the pandemic has waned. In rural areas, many women still live in fear and face a range of traumatic issues, reports Liz Carey of The Daily Yonder. A new study found that women living in rural settings who experience intimate partner violence, or IPV, need access to more help and outside support.

The study from the University of Minnesota's Rural Health Research Center found that rural victims "face more barriers and resource limitations that could affect their health and well-being," Carey explains. "Attempts to address intimate-partner violence in rural areas should be tailored to the specific needs of the people and places in those areas, the study said."

Alyssa Fritz, who led the research team, said they "spoke with 15 state and national advocacy organizations. . . to determine what barriers rural victims face and what opportunities exist to address those challenges," Carey reports. "All respondents said rural victims lack access to services like shelters, advocacy, legal services and law enforcement. . . . If programs that address intimate partner violence exist, they are underfunded and understaffed."

For rural communities to offer support, victims need to have access to health care, which is sometimes difficult to provide in a rural setting. And women who do find care often face social stigmas for speaking out. "Nearly half of the organizations brought up a lack of privacy and confidentiality in small communities as an extra challenge that rural victims have to consider when they weigh whether or not to reach out for help or leave," Carey adds. "In other cases, attitudes and societal norms in some rural communities may justify or normalize violence and victim-blaming."

Study respondents advocated for more investment in "rural community infrastructure to ensure that IPV victims have the resources they need to leave their abusers and to heal in safety," Carey writes. "From rural housing access to affordable child care to investment in broadband internet and transportation infrastructure, providing rural IPV victims with resources, services and information is key."

Nutrition programs expanded for women and children during pandemic due to easier access; but changes are temporary

Money for fruits and vegetables is part of the
WIC program. (Photo by Rusty Watson, Unsplash)

Pandemic changes allowed more mothers to access the nutritional benefits of the Special Supplemental Nutrition Program for Women, Infants, and Children. The program's growth was spurred by decreasing participant requirements and in-person interviews. While those changes helped WIC become more popular with mothers, the program faces funding and waiver crunches that may limit access again. "WIC is not an entitlement program — it can only support additional participants if Congress allocates funding for them," reports Caitlin Dewey of Stateline. Temporary federal waivers "made it easier to participate during the pandemic, and Congress would need to change the law to extend them."

Despite the program's history of positive health outcomes and bipartisan support, "House Republicans have signaled a desire to hold WIC funding steady, with no increase to cover new participants. A series of continuing resolutions passed to buy Congress time as it works out a comprehensive budget deal also have maintained prior funding levels," Dewey explains. Without additional funding, some states may face waitlists, which, depending on the wait time, may not be helpful for pregnant women.

Dr. Aditi Vasan is a pediatrician at the Children's Hospital of Philadelphia, where she has researched participation in WIC. Vasan told Dewey, "It's a really important source of nutrition support for low-income pregnant women, children and families, because it provides both nutrition education and the funds to purchase nutritious food." Dewey reports, "[Before the pandemic] participants frequently reported problems scheduling appointments, taking time off work and accessing transportation to WIC offices." To contain Covid-19, WIC offices were allowed to conduct interviews and screenings remotely, which removed a major obstacle for program applicants. Many of WIC's pandemic adaptations were authorized under temporary federal waivers," Dewey writes. "By September 2026, when waivers end, Congress will need to change the statute underlying WIC to make those changes permanent, said Ali Hard of the National WIC Association."

Female election officials are often targets of physical and verbal threats, but there are tools to protect them

A polling station worker in Falls Church, Va.
(Reuters photo via Brookings)

As the U.S. heads into the final months of election preparation, officials are dealing with challenges that go beyond counting votes --  physical and verbal threats, especially against women. "The threat of violence against election officials is pervasive. Women make up 80% of election workers in the United States, and they face unique, gendered harassment," report Zoe Wynn, Hannah Fried, and Norman Eisen of Brookings.

With more partisan politics, election site hostility has become more common. "Legal tools are available to make things better. The Violence Against Women Act of 1994 lays out confidentiality provisions aiming to protect the personal information of survivors of domestic violence," Brookings reports. "If codified into state law, similar provisions based on those in VAWA could help protect female election officials in advance of the expected surge of election denialism in the 2024 election."

The harassment of female election officials has been well-documented, alongside the loss of seasoned election officials who have quit or retired. "An investigation by Reuters in 2021 found that threats to election officials were typically generated by men and directed at a predominantly female workforce. Reuters found that dozens of these threatening messages used sexual or misogynistic language," Wynn, Fried and Eisen write. "The Brennan Center for Justice found that one in five election officials are 'very' or 'somewhat unlikely' to continue serving through 2024. The election officials surveyed specifically cite attacks on the system and stress as their primary reasons for leaving."

The VAWA gives states a framework to begin protections, but a "one-size-fits-all" structure is not the answer. "The VAWA provides a useful legislative starting point for a tailored, female-specific anti-harassment law. The bill's aims include reducing violence against women, securing offender accountability, and ensuring victim safety," Brookings reports. "Eleven states have passed comprehensive laws to protect election officials. . . . Threats to female election require a tailored approach that accounts for the gendered nature of the issue."

"A critical portion of the law is its confidentiality provisions. Confidentiality provisions are measures to protect the personal information of survivors of domestic violence and can provide opportunities for disciplinary action if personal information is disseminated," Wynn, Fried, and Eisen explain. "Lawmakers identified these measures as an effective means of preventing abusers from tracking their victims and causing them further harm."

Brookings reports, "Women who serve in election posts should be awarded similar protections commensurate with the nature of the threat to their safety. The functioning of our elections, and therefore our democracy, depends upon it."

Rural voters in Ohio shift from Republican party policies; many who favored Trump supported abortion rights

Graph compares the vote by county type for Trump in 2020 to the 'no' vote on the
constitutional amendment. (The Daily Yonder graph, created with Datawrapper)

Republicans' strict anti-abortion position had wide-reaching ramifications in Tuesday's Ohio referendum vote, with rural voters pivoting away from the party's hard-line reproductive policies. "Rural voters in Ohio were part of a general shift away from Republican Party priorities, resulting in a victory for a state constitutional amendment protecting abortion rights," reports Tim Marema of The Daily Yonder. "Statewide, the measure protecting access to abortion and other reproductive rights passed 56% to 44%."

The outcome suggests that voters are paying attention to the abortion rights debate and weighing in. Tuesday's outcome in Ohio "represents a dramatic departure from Republican performance in the 2020 presidential election," Marema notes. "That year, former President Donald Trump won the Ohio vote by a margin of 8 points. This week, the constitutional amendment protecting abortion rights, which the Republican Party opposed, won by nearly 13 points.

"Rural voters were part of that shift. In 2020, Ohio voters in rural counties supported Trump 72% to 28%, a margin of over 40 points," Marema adds. "In Tuesday's referendum, rural voters opposed the abortion-rights amendment. But they did so by a margin of 18 points, less than half the margin that Trump racked up in the 2020 presidential election."

The graph shows that "in every county type, opposition to the amendment (the Republican position) trailed support for Trump in 2020," Marema explains, "Rural voters were the group with the second-biggest shift from 2020. The biggest shift occurred in the suburbs of major metropolitan areas such as Cincinnati, Cleveland, and Columbus. Those counties shifted 15 points from supporting Trump in 2020 to supporting the abortion-rights amendment in 2023."

New study reviews eight centers that are working to improve rural postpartum care through innovation and collaboration

A new case study highlights eight community-focused postpartum care centers working to address the unique challenges of postpartum health for rural women. The review from the University of Minnesota looked at programs serving rural communities in Colorado, Maine, Minnesota, Montana, Oregon, South Carolina and Washington.

The goal of each center is to reduce maternal mortality rates, which are disproportionally high in rural areas. Each organization reviewed provides support to rural women and their families through access to obstetric care, mental health services, logistical support and social services during pregnancy and after childbirth.

Researchers cite one of their key findings: "Despite challenges related to transportation, stigma, isolation, and affordability, the organizations profiled here innovate, including in their program offerings and finance models, and collaborate with local and national partners to provide a variety of critical resources to postpartum families in their rural communities. . . . Each organization expressed the importance of stable, secure funding for their work."

In the study, each center is reviewed for rural community context. The Postpartum Resource Group in Whitefish, Montana, is an example. The area "is a mountainous community located near Glacier National Park in northwest Montana. The town is one of only three in the [Flathead] county, which occupies 5,098 square miles and is home to about 108,000 people. . . . ."

Each center in the study is reviewed by discussing its services. In Whitefish, researchers spoke with Brooke Jaszczak, the Network Director of Postpartum Resource Group who gave a program overview: "The Postpartum Resource Group is a non-hospital-affiliated, community-based postpartum mental health support group that was founded in 2016 by a midwife who created a support group with her patients. She recognized the need for such support based on both professional and personal experience, as she was also experiencing postpartum mental health challenges at the time."

The researchers write, "Their mission is two-fold: to provide support, education, and resources for mothers and their families who are experiencing postpartum mood disorders, and to educate and inform the community and providers about postpartum mood disorders."

A discussion of each center's challenges is also shared. "In the Flathead Valley, many local residents struggle to afford basics like housing, food, childcare, and health care due to rising costs. Located near Glacier National Park, the region experienced a population increase during the Covid-19 pandemic, as people moved there to work remotely. The service industry workers were priced out of housing and health care, and a rationing of care and preventive services resulted due to their limited resources. Furthermore, the population is very spread out. Between winter weather and poor driving conditions through the mountain passes, it can be difficult to access areas of the community, its resources, and clinicians."

Researchers hope their analysis will inform and encourage other communities looking to bridge the gaps in rural postpartum health. 

Health investigation finds startling gap in funding to prevent maternal deaths, new grant award aims for change

USA Facts map, from CDC data

National maternal mortality rates have been on a steady incline, with far more minority women dying while pregnant or within 42 days of the end of pregnancy than white women, reports Sarah Jane Tribble of KFF Health News. Despite the rate difference, a federal program designed to "combat the alarming rates of rural women dying from pregnancy complications. . . . hadn't sent a grant to serve mothers in majority-Black rural communities."

A KFF Health News investigation discovered the possible funding-bias and criticized the program for neglecting some of the most marginalized women. The program has addressed that problem by "supporting an organization that serves predominantly Black counties in the Deep South," Tribble writes.

The Institute for the Advancement of Minority Health in Madison, Mississippi, was "one of two winners in the latest round of an initiative administered by Health Resource and Services Administration," Tribble writes. Mississippi has the highest rate of maternal mortality in the U.S. and the highest proportion of Black births in the U.S. "In June, KFF Health News found that HRSA's Rural Maternity and Obstetrics Management Strategies Program had failed to fund any sites in the Southeast . . . . despite a White House declaration to make Black maternal health a priority, and despite statistics showing America's maternal mortality rate rising sharply in recent years."

Peiyin Hung, deputy director of the University of South Carolina's Rural and Minority Health Research Center, is a member of the health equity advisory group for the maternal grant program. Hung said "the Mississippi nonprofit is an unusual awardee because it is not part of a larger health system." Tribble reports: "The grant application process skewed toward large health systems because they 'have much higher capacity to form a statewide network', Hung said. That's, in part, because grant winners were required to create a network of specific health care clinics, hospitals, and the state Medicaid office. In recent years, the agency has 'become much more flexible,' Hung said."

Tribble adds: "The success of the Mississippi application is a 'promising signal' for states that don't have large rural health systems focusing on maternal care, said Hung, who hopes a South Carolina applicant receives a grant in the future."

Farm safety quick hits: Create a rescue plan; manure pit accidents; women in ag; ATV safety; mental health first aid

Farming comes with a distinct set of dangers and demands. Sound planning, accident prevention and know-how can improve measures to keep farm workers safe, reports Lisa Foust Prater of Successful Farming. Prater also looks at the medical needs of women in agriculture and mental health for everyone who works the land.

Have a rescue plan before entering a silo, grain bin, manure pit or other confined space. The Department of Agriculture recommends identifying confined spaces on your farm and taking steps to prevent accidental entry. "Workers who do enter must receive specific training and have a permit to enter."

Dirty and deadly, take extra care around manure pits.
(Photo via Successful Farming)

Manure pits are dangerous. "Working in a manure pit is one of the dirtiest jobs on the farm, and it's also one of the deadliest. The majority of people who are overcome by the gases in a storage pit or lagoon do not live to tell the tale. . . . The most common task leading up to these injuries or fatalities in 2022 was performing maintenance tasks in or around manure storage structures, including pump repairs. This is true with all cases documented since 1975."

Whether you're delivering cookies to the back forty or hauling feed, ATVs are speedy, farm-friendly vehicles. Curt Porterfield, health and safety training coordinator at Virginia Tech, offers these tips to keep ATV riding safe: Recognize that ATVs can be deadly, the common hazards associated with their use, and your skill levels. Evaluate your equipment, terrain, environment, and load. Control and maintain your ATV properly. . . .and control your ride by driving safely.

Almost a third of all American farmers are women.
(Photo via Successful Farming)

The number of women in agriculture has increased, but information studies have yet to keep pace with the change. "Despite the fact that 31% of all American farmers are women, health and safety education for the agricultural population is most often aimed at men. . . . Women on the farm fill more roles than ever before – or are at least being publicly recognized for filling these roles – including primary operator, mother, wife, ag implement salesperson, and large animal veterinarian, to name a few. Specific areas of risk include heart disease, diabetes, breast cancer, broken bones and chronic pain."

Farming offers many benefits, but mental health often takes a back seat to getting the work done, which can ultimately cause a breakdown. "Becoming trained in mental health first aid allows you to stand in the gap of a crisis until professional help arrives. . . . If the emergency is someone having an anxiety attack, dealing with an opioid addiction, or contemplating suicide, having someone available who knows what to do can mean the difference between life and death."

With fewer rural hospitals providing obstetric care, freestanding midwife-led birth centers offer one solution

Without rural maternity care, giving birth is more dangerous.
(Photo by Carlo Navarro, Unsplash)

The number of rural hospitals with labor and delivery care has shrunk as financially strapped hospitals shed services, leaving women to find alternative care closer to home. "One solution gaining ground across the U.S. is freestanding midwife-led birth centers, but those also often rely on nearby hospitals when serious complications arise," reports Claire Rush and Laura Ungar of The Associated Press. "The closures have worsened so-called 'maternity care deserts'—counties with no hospitals or birth centers that offer obstetric care and no OB providers. More than two million women of childbearing age live in such areas, the majority of which are rural."

Less maternity care means having children is more dangerous. "One study showed rural residents have a 9% greater probability of facing life-threatening complications or even death from pregnancy and birth compared to those in urban areas — and having less access to care plays a part," AP reports. "The American Hospital Association says at least 89 obstetric units closed in rural hospitals between 2015 and 2019. More have shuttered since." The main reasons for ending obstetric services include medical labor shortages, lower birth rates, low reimbursements and poor profit margins.

"A lack of money was the major reason why Henry County Medical Center in Paris, Tennessee, closed its OB unit," Rush and Ungar explain. "CEO John Tucker told AP that it was a necessary financial step to save the hospital, which has been struggling for a decade. The percentage of births there covered by Medicaid — 70% — far exceeded the national average of 42%. Tennessee’s Medicaid program paid the hospital about $1,700 per delivery for each mom, a fraction of what the hospital needed, Tucker said. . . . Private insurance pays hospitals more — the median topped $16,000 for cesarean sections in Oregon in 2021. State data shows that’s more than five times what Medicaid doles out."

In Summertown, Tennessee, pop. 900, a new freestanding birthing center is a solution: At The Farm Midwifery Center led by midwife Corina Fitch, where women receive group and individual prenatal care. AP reports, "Some states and communities are taking steps to create more freestanding birth centers. Connecticut Gov. Ned Lamont recently signed legislation that will license such centers and allow them to operate as an alternative for low-risk pregnancies. . . . Alecia McGregor, who studies health policy and politics at the Harvard T.H. Chan School of Public Health, called midwife-led birth centers 'a major sort of contender among the possible solutions' to the maternity care crisis."

Wisdom from the world's best homemaking hackers

Amanda Ahlenius, left, with her wise-tipster Grandma,
Marcia Clupper. (Amanda Ahlenius photo via WaPo)

Scratchy towels, stubborn stains, and tomato paste dilemmas all have handy hacks. But who are the best homemaking hackers? Grandmas! And other wise women who have been sharing their ingenious solutions long before hacking was a thing, writes Cathy Free of The Washington Post.

Mother and professional dietitian Amanda Ahlenius, "was feeling overwhelmed with her responsibilities when she began thinking about her grandmother, and how easily and seamlessly she seemed to tackle household chores. . . . Ahlenius has gotten dozens of life tips from her grandmother to make household tasks easier."

“I remember watching her do these things as a little girl, and she’s still doing them now," Ahlenius told Free. "I thought, ‘Wouldn’t it be great if we could all start sharing the advice we’d learned from the older women in our lives, like our moms, grandmas and aunts?’” Free reports,"In February, Ahlenius decided to post a quick video on TikTok, asking, 'How much could we learn from each other if we all shared the random things that the women in our lives have taught us?'"

Her video's theme had broad resonance. "That first video has been viewed more than 865,000 times, and another video with a tip about how to scrape tomato paste from a can has more than 9.3 million views. In another video, she said her grandmother has a solid set of tools and expertly knows how to use them all," Free adds. "She now regularly posts life hacks contributed by her 330,000 followers from their own grandmas."

"She said that as a child she would sit at her grandmother Marcia Clupper’s kitchen table in the farm town of South Whitley, Ind., population 1,800, and watch her flawlessly move from one household task to another," Free writes. Ahlenius told her: “She was born in the 1930s, so she knows how to save money. One thing she taught me is that when the price of milk is high, you can buy a gallon of milk, mix it half and half with powdered milk, and it will be cheaper and taste the same. . . What I’m really hoping for now is a solid tip on how to fold a fitted sheet. I’ve watched all the videos, and I still can’t do it.”

Deliveries in rural hospitals with lower numbers of birth have poorer outcomes; 'tailored' support needed, study says

In an obstetric suite (MedPage Today photo)

Rural hospitals that have lower numbers of births had "a higher risk for severe maternal morbidity compared with rural hospitals delivering more babies," Rachael Robertson reports for MedPage Today on a study published in the American Medical Association's Health Forum Network. The study "used data from more than 11 million urban births and more than half a million rural births in California, Michigan, Pennsylvania, and South Carolina.” Severe cases were defined by Centers for Disease Control and Prevention parameters “and generally included unexpected outcomes of labor and delivery that result in significant short-term or long-term health consequences, excluding blood transfusion."

Women with low-risk pregnancies, "defined as having none of 27 comorbidities such as advanced maternal age or placenta accreta spectrum, were actually at particularly high risk in rural hospitals with relatively few deliveries," Robertson reports. Co-author Stephanie Leonard, an epidemiologist at Stanford University, told her: "If they gave birth at a low-volume rural hospital, they were at over twice the risk of having severe maternal morbidity as a similar person who delivered at a high-volume rural hospital."

Dr. Shon Rowan of West Virginia University told Robertson, "This study was done on larger states, which shows that this is a nationwide issue. . . . I think it lets us know that we need to maybe divert even more resources to these small hospitals. . . . It's not unheard of for a patient [from an obstetric care desert] to drive two to three hours to a delivering facility. And that's leading to more patients showing up in emergency rooms that don't have the resources."

The study recommended "'a need for tailored quality improvement strategies for lower-volume hospitals in rural communities,'" Robertson reports. Leonard said research should examine differences in prenatal and postpartum care," and the role of people's trace and ethnicity. She said, "It's already been well shown that in rural communities that have substantial populations of Black and Indigenous people, you see the highest rates of severe maternal morbidity. . . [that] certainly is a big area that needs attention."

Abortion clinic opens in Wyoming, where state constitution and 'hands-off conservatism' make it possible, for now

Abortion opponents protest in front of the new Wellspring clinic.
(Photo by Rachel Woolf, The Washington Post)

An abortion clinic in Casper, Wyoming, has opened despite the state's deep-red history and Roe vs. Wade reversal. Wyoming law and Western self-determination beliefs have made Wellspring Health Access' surgical clinic possible, reports Karin Brulliard of The Washington Post. "Most of Wyoming is an abortion desert, and most lawmakers in America's reddest state — having passed laws restricting nearly all abortions as well as the nation's first explicit prohibition on abortion pills. . . . Yet with the state's restrictions tied up in court, Wellspring. . . represents a dramatic abortion standoff and a stark expansion of abortion services in a region of wide-open range and sky." 

Originally scheduled to open in May 2022, the clinic was burned down by an arsonist who "was opposed to abortion," Brulliard writes. The new building opened in spring of 2023. It is a rarity "in what may be the unlikeliest abortion clinic in the country. . . . Wyoming's only other provider, 280 miles away in Jackson, offers just abortion pills. Wellspring's four physicians have already seen patients from South Dakota, Utah and Nebraska, neighboring states with limited or no abortion services. The clinic serves a dozen patients a week on average. Nearly half receive abortions, the rest reproductive health care."

"Wellspring's ability to operate is rooted in the hands-off brand of conservatism that characterized Wyoming politics before hard-liners began gaining influence," Brulliard explains. "In 2011, lawmakers worried about the Affordable Care Act potentially mandating enrollment in an 'Obamacare' plan approved a resolution that put a constitutional amendment to a public vote. It passed, giving adults the right to make their own health-care decisions."

If abortion is health care, the state cannot control an adult's health-care choices. "In court filings, the state has said its policy 'is and has always been to criminalize abortion' and argues that abortion is not health care. . . In March, a state judge in Jackson issued a temporary restraining order on the ban, which makes most abortions a felony punishable by as much as five years in prison. Later this month, she is scheduled to consider a similar order for the medication abortion ban just before it is slated to take effect."

Locations of Wyoming's abortion clinics (Wikpedia, adapted)

The town of 60,000 people on the edge of the Rocky Mountains has tried to keep a level approach, Bruillard reports: "The nonpartisan city council has mostly avoided debate over the clinic, though it has been a flash point." The town's mayor, Bruce Knell, "who describes himself as a 'literal Bibleist,' is not heeding calls for a city resolution condemning abortion." Knell told Bruillard: "They are a legal, law-abiding business, so they have a right to be here. We will allow this to play out in the courts. And I do think the pro-life folks will see a result that they're happy with."

The vast gaps between deaths of black and white babies in Southern states look like a crisis with no clear solution

Photo by E+, Getty Images, via KFF Health News

Black babies in Southern states have a much higher risk of dying in their first year than white infants. The South is "where infant mortality is by far the highest in the country, with Mississippi's rate of 8.12 deaths per 1,000 live births ranking worst. . . . Nationally, the average is about 1% for Black infants and less than 0.5% for white infants," reports Lauren Sausser of KFF Health News. Even Southern states making progress still have big gaps: "In Florida and North Carolina, the Black infant mortality rate is more than twice as high."

The figures "reflect politics," Sausser writes. "They're a direct product of generational poverty and racism. . . . Often, babies die under circumstances that state, communities, and parents can help control, like making sure infants don't suffocate in beds or in unsafe cribs or extending health coverage so that young women can afford to see a doctor before they become pregnant. In many of these respects, the South is failing."

Addressing the problem means understanding the causes, and that has been difficult. "Multimillion-dollar programs to improve South Carolina's numbers over the past decade have failed," Sausser reports. "To make things more complicated, separate state agencies have reached different conclusions about the leading cause of infant death." To address prenatal care deficits, "South Carolina and several other states recently extended postpartum Medicaid coverage for women who give birth, which means their coverage remains in place for one year after delivery. Historically, Medicaid coverage was cut off 60 days after having a baby," Sausser writes. "Even when they become pregnant and are newly eligible for Medicaid, it isn't unusual for women in South Carolina to put off seeing a doctor until the third trimester, physicians told KFF Health News. These women can't afford to take time off work, can't find child care, or don't have a car, among other reasons."

In states where abortion is illegal, some physicians are afraid to say the word; women struggle to get needed care

Lauren Miller traveled Colorado for medical care that is
now illegal in Texas. (Photo by Nitashia Johnson, NPR)

Hormone changes, nutritional deficits, and mental worry make pregnancy stressful for women and their bodies. When things go wrong, such as in the case of fetal fatality or an abnormality that prevents viability, women face an entirely new set of stressors. In some states, needed medical care may be illegal -- so illegal that physicians don't even want to say the word "abortion," reports Selena Simmons-Duffin of NPR.

The case of a woman in Dallas is an example of a state with tough abortion laws and no exceptions. "This past fall, when Lauren Miller was 13 weeks pregnant with twins, she got horrible news. One of the twins had trisomy 18, a genetic abnormality that causes about 90% of fetuses to die before birth. The other twin was healthy," Simmons-Duffin explains. "She learned from a genetic counselor that continuing to carry both fetuses could put the healthy one at risk. She saw a doctor who specializes in high-risk pregnancies who told her: 'You can't do anything in Texas and I can't tell you anything further in Texas, but you need to get out of state.'. . .That's exactly what she did. Miller traveled to Colorado and, at 15 weeks pregnant, she had a 'selective reduction' procedure to help ensure her pregnancy with her healthy twin could continue." In Miller's case, she was able to afford to go to another state, but many women do not have the means.

Once Miller had the procedure, she encountered another barrier. "When she returned and continued her prenatal care, she found herself navigating silence around abortion. She wondered if the ultrasound technician knew she'd traveled out of state for an abortion, could she get reported? Miller told Simmons-Duffin, "You don't know where anybody stands, so it feels like we're all kind of talking in code."

"What Miller did does not violate current abortion laws in Texas, legal experts say," Simmons-Duffin writes. "But the fear among doctors and patients in the new legal landscape in Texas is extreme, to the point where some doctors won't say the word 'abortion' in the exam room. Elizabeth Sepper, professor of law at the University of Texas, told Simmon-Duffin, "Physicians have independent speech rights, to speak to their patients openly," she says. "Physicians should not be scared to say the 'a-word.'" Simmons-Duffin adds, "Many doctors in Texas who treat pregnant patients are extremely scared. Especially of language in one of the state's abortion bans that allow people to take civil action against anyone who 'aids or abets' abortion." 

While some many states have abortion exceptions, the exceptions are rarely granted, reports Amy Schoenfeld Walker of The New York Times. "But in the months since the court’s decision, very few exceptions to these new abortion bans have been granted." In Kentucky, the only exception is threat to the woman's life; Alex Acquisto of the Lexington Herald-Leader wrote about two women who had to go out of state because Kentucky laws banning abortion "do not legally permit the standard-of-care treatment for a nonviable pregnancy."

Some think Texas physicians are over-reading that state's law. Amy O'Donnell of the Texas Alliance for Life, an anti-abortion rights group, told Simmons-Duffin that its attorneys "believe there is a constitutional right to interstate travel," but courts have yet to rule on the law and without precedent, it seems physicians will remain fearful. Dr. Andrea Palmer, an obstetrician-gynecologist in Fort Worth, told NPR, "People are scared to talk . . . The law's vague – it's really poorly written. . . . Nobody wants to be defendant number one on this."

New abortion clinics change blue-state towns near borders

A sign installation for Choices, a new abortion clinic in Carbondale,
Ill. (Photo by Erin Schaff, The New York Times via Redux Pictures)

Since the overturning of Roe v. Wade, small blue-state border towns are experiencing an increase in abortion clinic openings and an influx of visitors as women seek abortion services. Carbondale, Illinois, is one blue-state town where a Tennessee-based provider opened a clinic named Choices, reports Shia Kapos of Politico. "Choices is seeing a steady stream of abortion patients from Arkansas, Tennessee, Mississippi and Texas since it set up space in a shuttered dermatology office last fall, its only location outside Memphis."

Choices CEO Jennifer Pepper told Kapos, “For towns like Carbondale in states that continue to have access to abortion and border states that don’t, how can you not be impacted by having two, three or four clinics pop up? There are thousands of people traveling through your town.”

Carbondale, Ill. (Google map)

Kapos writes: "For Carbondale, a college town of 22,000 people, geography had a lot to do with Choices’ new site: Illinois is bordered by five states that all have abortion laws more restrictive than its own, turning the Democratic-controlled state into a destination for those seeking the procedure since Roe v. Wade fell in June. . . . And with the influx of patients has come more customers at local restaurants, booked up hotels and other early measures of economic change, particularly in the Midwest and the West."

Alison Dreith of the Midwest Access Coalition, a fund that helps people access abortion care across the region, told Kapos, “The current hotel infrastructure can’t handle the needs of the university community, let alone the new and emerging abortion community. It’s something we know we have to face down the line.”

Conservatives have voiced worry over the phenomenon. Jeanne Ives, a former state representative who sits on the Illinois Right to Life board, told Kapos, "They come in for a quick in-and-out procedure, and a lot of abortions are not easy decisions. It basically makes it a drive-thru service decision and I think that’s shameful."

Meanwhile, border towns will continue to experience a higher demand for services. Mayor Rachel Medina of Cortez, Colo told Kapos, “What’s tough about border towns is that they’re rural and don’t have a lot of funding. Small towns take the brunt of it and can barely meet the needs of their own residents."

Some anti-abortion states consider extending Medicaid to likely increasing number of pregnant women

Viola's House in Dallas provides housing and services to young,
expectant mothers. (Photo by Allison V. Smith, The Washington Post)

After Roe v. Wade was reversed, many states further restricted abortion. Now some of them are thinking cause and effect, and considering extending Medicaid coverage to pregnant women, reports Molly Hennessy-Fiske of The Washington Post.

Usha Ranji, associate director for women’s health policy at the Kaiser Family Foundation, told Hennessy-Fiske, "There’s a discussion among Republicans and those who are anti-choice about, 'What should we be doing to support mothers?'"

Texas is one red state with coverage and care dilemmas: "The limits on Medicaid coverage after the emergency insurance lapses hinge on Texas’s long-standing rejection of the Affordable Care Act, which included provisions for expanded Medicaid," Hennessy-Fiske writes. "And it has set up an uncomfortable dynamic: While Texas and nearly a dozen other red states have resisted expanding Medicaid for those who are pregnant, many of them have also restricted access to abortion, leading to more new mothers needing coverage."

Steve Aden, general counsel and chief legal officer for Americans United for Life, told Hennessy-Fiske, “On our side, there is an awareness and a very strong move after Roe’s overturn toward caring for women. I think the whole movement is looking for ways to implement policy on the state level to support the increasing number of women who will have children.”

John Seago, president of Texas Right to Life, told Hennessy-Fiske, “We want Texas to be abortion-free, but we also want Texas to be pro-life. We want these mothers to be healthy and to have access to the care they need.” The group wants postpartum coverage: “Don’t call it Medicaid expansion, just ensuring insurance for moms up to a year after birth.”