By Skylar Baker-Jordan for The Daily Yonder.
Broadcast version by Chance Dorland for the Tennessee News Service/Public News Service Collaboration

The end of Roe v. Wade - the 1973 Supreme Court ruling that prevents excessive government restriction of abortion services - could create multi-state regions where abortion is illegal, greatly complicating access for rural women who already must travel farther to terminate a pregnancy.

"The effect of this will... fall disproportionately on those who are unable to travel," said Sarah Traxler, M.D., the chief medical officer of Planned Parenthood North Central States, which covers Iowa, Nebraska, Minnesota, North Dakota, and South Dakota.

"It is important to underscore that an abortion ban is not an abortion ban for all people. It is only an abortion ban for those who lack the means to travel to a state where abortion is safe and accessible, and that is one of the true moral outrages of this situation."

A 2017 study from the medical journal the Lancet found that 20% of women must travel more than 43 miles to get access to an abortion. This problem will be exacerbated as states bordering one another enact bans, which could ostensibly create regions where abortion is prohibited. The 50 states will transform into a patchwork quilt of reproductive rights.

Some states, like California and New York, would not be affected as state legislatures and courts have recognized a right to abortion at the state level. The situation elsewhere is much more restrictive. According to the Center for Reproductive Rights, abortion would become illegal in 13 states thanks to so-called "trigger bans" designed to go into effect should they ever become legally permissible. Other states, such as Arizona and Pennsylvania, are expected to try to enact bans should Roe be overturned.

Exacerbating an Existing Problem

Many pro-life activists, however, are quick to caution abortion rights supporters against panicking. While acknowledging that "a post-Roe nation will look different," Patrick T. Brown, a fellow at the Ethics and Public Policy Center - a conservative think tank - said in an interview that "in rural parts of the country and in redder states, it's not going to be a huge paradigm shift..." Those places, he said in an interview, already lack nearby abortion clinics, which means women are already forced to travel to access abortion care.

This pragmatism is shared even by some pro-choice activists. "In seeking abortion care, we already know rural clients are already traveling," said Katie* with the Mountain Access Brigade, an abortion doula collective and abortion fund in East Tennessee, in an interview. "They will continue traveling, their travels will just be further."

Traxler with Planned Parenthood echoed this sentiment in a recording of a video press conference. "There are patients in South Dakota who are already traveling to other places to access abortion," she pointed out. The same is true for other states where legislatures have already burdened abortion providers and restricted access to legal abortions. In that regard, repealing Roe will exacerbate a problem many rural women are already facing.

Abortion providers and reproductive rights activists have been preparing for that eventuality, though. "Our assumption has been that in some way Roe would be decimated and there would be a lack of access to abortion," Traxler said. "So, we've been thinking about our surrounding states and how that might impact patients who live there." To buttress their existing resources and prepare for a surge in interstate patients, Planned Parenthood has "been planning on a regional scale and a national scale about how to navigate places where abortion is accessible."

This is a sentiment shared by Katie with Mountain Access Brigade. "We have been preparing for quite a while," she said. "We are very realistic, down-to-earth people and we kind of had an idea that this was coming." Like Planned Parenthood North Central, the Mountain Access Brigade has been working to strengthen its relationship with providers in nearby states where abortion is likely to remain legal.

Both organizations are also looking at addressing the needs of rural women in a post-Roe world, including logistical challenges women face when seeking abortion. "It's really just going to up the cost," Katie said, listing the cost of travel, lodging, childcare, and lost wages. "That's why abortion funds are so important and so crucial in bridging the gap between clients getting the care that they can't afford. Because the price of an abortion is not going to change, but the price of getting there will."

Conservative Response to Cost of Parenthood?

The cost of parenthood is something that Brown at the Ethics and Public Policy Center has thought about. Though pro-life, Brown supports an economic agenda that he says would empower women and families - including those women who find themselves with an unexpected pregnancy. "I've been encouraging Republicans to be thinking about this and taking it seriously for a while now," he says.

The Republican base has been shifting "more away from the sort of chamber of commerce towards the blue collar or middle-income families," and Brown has been pushing the GOP and pro-life activists to consider how to help women who will no longer have the right to an abortion. Red states such as Tennessee and South Carolina - where he lives - are expanding Medicaid for new mothers, he points out.

This makes him hopeful that conservatives will begin thinking more about how to help expectant mothers. He points to conversations around the child tax credit, which he hopes will help empower women and families and help meet their needs in a post-Roe world. "If you're a mom facing an unplanned pregnancy," he says, "the knowledge that you'll be getting $300 a month after your child is born [is helpful]."

Brown hopes that overturning Roe could serve as a "tipping point towards an economic agenda that's more concerned with strengthening families and supporting parents than lowering tax rates and assuming everything will work out in the end." In an ideal world, he says, this would include expanding access to and options for early-years childcare. "If you have a kid who is under 5 and you want to have a parent stay home, let's make that achievable," he says. "If you're looking for childcare, let's try to make that affordable."

Others on the right have also been considering how to best help women once their constitutional right to abortion has been abolished. "The populist pro-life movement is far more than just making abortion illegal," the blogger Populist Pundit* told me in an email interview. He told me that he and others like him support "enacting an industrial family policy" which would mix "pro-family economics" such as marriage and child subsidies with "industrial policy" around things like trade and antitrust legislation.

"We need to focus on ensuring there are good men and a good economy ready to support our mothers," Populist Pundit says. This includes enacting universal healthcare and childcare in the long term while increasing the Children's Health Insurance Program (CHIP) and Medicaid access in the short-term, as well as "requiring prenatal child support from deadbeat dads."

Traxler cautioned that if Roe is overturned, agencies in states where abortion would still be legal may have trouble meeting demand, - a problem compounded by the overall healthcare worker shortage. "In the short term, as states see a surge, we may actually be at a point where we are not able to meet all the demand in the short term," she said. "But that will eventually work itself out as everything sort of falls into places and we figure out where people will be traveling to."

For his part, Brown hopes that Republicans will pivot away from cultural battles and onto the hard economics of family and childrearing. Pointing to "culture war fights down in Florida and in other places," he hopes that conservatives will adopt an economic platform that helps mothers, families, and the working- and middle-classes. "Actually being for parents involves not just taking their cultural interests seriously," he says, "but also their material interests as well."

As for Katie and the Mountain Access Brigade, they remain ready to help any women they can. "We do this work to meet people's needs, and as those needs change, the work changes," she says. "We've been working really hard to get ready for this, and we do have people's backs - especially here in rural Appalachia."

*Names have been changed or omitted at the interviewees' requests because of fear of reprisals.

Skylar Baker-Jordan wrote this article for The Daily Yonder.


get more stories like this via email

Health advocates are promoting a package of bills this legislative session to make health care easier to get - and more affordable.

The Care 4 All California coalition, which includes more than 70 organizations, unveiled a set of 10 bills Wednesday in Sacramento.

Andrea Rivera, senior legislative advocate for the California Pan Ethnic Health Network, said grassroots support can make big things happen.

"Historically, communities of color, we're not invested in," Rivera pointed out. "Together, we are stronger, louder, and more powerful. Together, we cannot be ignored."

The coalition sees the bills as a series of steps on the way to achieving universal coverage by bringing down costs and removing barriers to care.

Right now, the Affordable Care Act bars undocumented people from purchasing health coverage through the Covered California marketplace.

Asm. Joaquin Arambula, D-Fresno, introduced a bill to ask the feds for a waiver.

"That's why I introduced a before this year, a bill that will end the unjust exclusion of our undocumented community from Covered California," Arambula explained. "We have to create a health care system that is more universal, affordable and equitable for all Californians."

Asm. Pilar Schiavo, D-Chatsworth, authored Assembly Bill 1208 to eliminate deductibles and lower copays for people on Covered California Silver plans. She wrote a second bill to allow Medi-Cal to offer additional services to new mothers.

"AB 608 would expand a mother's access to perinatal health workers who screen for postpartum depression, help with child nutrition, and provide a warm handoff to a host of other social services," Schiavo outlined.

Other bills in the package aim to eliminate surprise ambulance bills, require private health plans to cover things like wheelchairs when prescribed by a doctor, improve access to mental health care for youths, increase oversight of health care mergers, and improve financial transparency from medical groups.


get more stories like this via email

Colorectal cancer is second only to lung cancer in the number of lives it will take in Iowa this year. Now, doctors at the University of Iowa are studying ways to not only save lives, but reduce the number of colon cancer surgeries for patients.

Currently, colon cancer patients typically have to undergo surgery to have part of their colon removed or resected. Now, University of Iowa researchers are using immunotherapy to reduce surgeries and improve survival rates. If a patient's tumor biopsy has a certain genetic marker or mutation, they can receive targeted therapy instead of undergoing surgery.

Dr. Saima Sharif, Oncologist at the University of Iowa Holden Cancer Center, is directing a new treatment trial and said the number of people with the genetic mutation could be as high as 20%.

"So one in five patients who are getting their colonoscopy is a significant amount of patients," Sharif pointed out. "If we look in Iowa, we are expecting to have about 1,600 new cases diagnosed in 2023."

If doctors can detect the tumors early and treat them, they can reduce the number of people who need surgeries and, potentially, the number of deaths. Researchers began accepting patient applications for the clinical trial this week.

Cancer tricks the body's natural immune system into thinking abnormal cancer cells are normal, so the body will not attack them, allowing the cancer to grow. Immunotherapy turns the tables on cancer and uses the body's own cells and other drugs to attack it. Sharif noted immunotherapy makes the cancer fighting cells unrecognizable, which is what makes it successful.

"So what immunotherapy drugs do is it helps release the brakes off of the patient's immune system that the cancer has placed," Sharif outlined. "Preventing it to recognize cancer as abnormal, and this unleashes the patient's own immune system against the cancer to fight the cancer cells and kill them."

The trial will start with 25 patients. Sharif added they will grow the study depending on how many patients' tumors respond well to the treatment.

This March marks the 50th anniversary of National Nutrition Month.

Making sure children eat healthy can be tricky.

Chuck Larimer, an elementary school physical education teacher in Stayton, southeast of Salem, said his school has been part of the American Heart Association's Kids Heart Challenge for 23 years.

He observed students look forward to the program, but it's not just about getting active.

"There's more to it than just exercise, which is also important," Larimer explained. "It's that whole body wellness that's more of a focus"

The Kids Heart Challenge has been going on for nearly 45 years in elementary, middle and high schools across the country.

The American Heart Association said a few tips for parents can help introduce healthy foods to kids, even if they're picky eaters. Parents should include at least one item in meals everyone at the table likes. The group urged parents to shop and cook with their kids, and not get discouraged.

"I know at least with my boys' experience that taste buds do change and things that taste weird, or they might not like early on," Larimer noted. "That can change. And just try to continue to introduce different items."

Research has shown it can take at least 11 tries for a child to decide they like a new food, according to the American Heart Association. It also advised parents to offer fruits and vegetables when it is snack time to get them used to it.