By Sarah Varney for KFF Health News.
Broadcast version by Brett Peveto for Maryland News Connection reporting for the KFF Health News-Public News Service Collaboration

In the two counties around nurse practitioner Samantha Marsee's clinic in rural northeastern Maryland, there's not a single clinic that provides abortions. And until recently, Marsee herself wasn't trained to treat patients who wanted to end a pregnancy.

"I didn't really have a lot of knowledge about abortion care," she said.

After Roe v. Wade was overturned, she watched state after state ban abortion, and Marsee decided to take part in the first class of a new training program offered by the University of Maryland School of Medicine and the University of Maryland-Baltimore.

Marsee learned how to administer medication abortion pills, procedural abortions, and highly effective birth control methods, including hormonal implants and intrauterine devices.

She cares for patients with all sorts of everyday ailments and health conditions, including pregnancy. "I do have patients who come in for confirmation of pregnancies and then disclose they don't want to continue with the pregnancy for whatever reason," Marsee said.

Now, with her new training, she can help.

Expanding the pool of health care providers with reproductive health care skills outside of the state's urban centers is vital, said Mary Jo Bondy, associate dean of the School of Graduate Studies at the University of Maryland-Baltimore. She helped create the new training program.

In 2022, Maryland lawmakers passed the Abortion Care Access Act, expanding the type of medical care nurse practitioners, physician assistants, and certified nurse-midwives could offer, including abortion, and the training program "prioritized that group," Bondy said.

Those types of professionals have long provided abortions to rural patients in other states, Bondy said, and "we have proof that receiving this care from an advanced practice clinician is safe."

As many as 120 health care providers will be trained over the next two years. Some participants have said they are returning to communities that are hostile to abortion rights.

On Nov. 5, voters approved a ballot measure to protect reproductive rights in the Maryland Constitution, by an overwhelming margin, preliminary results show. The state is widely considered a safe haven for patients who live in states with abortion bans. The number of abortions in Maryland increased 29% from 2019 to 2023, driven largely by out-of-state residents. But one training participant, a family physician from the Eastern Shore, said providing abortions makes her concerned for her physical safety and asked not to be identified.

"The rural catchment and politics really drive it either out or at least into the quiet," she said of abortion availability where she lives. She worries that her employer will question the prescriptions she writes for medication abortion pills and said pharmacists often refuse to give the medication to her patients.

Even in Maryland, pharmacists are allowed to refuse to dispense medication abortion pills.

As more health care providers are trained in abortion care, they need help from the state's medical schools and health officials to overcome these barriers, the family physician said. She wants help with "access to medication and pushing in some ways the hand of our employers, or normalizing, 'This is just health care.'"

For Marsee, the next step is to figure out how to let her patients know she can provide abortions. She plans to tell her current patients and hopes they'll tell others.

"I'm working on a way to let people know that I'm here and can provide it," Marsee said. "This is a conservative area, so it's walking that line. I want people to know I'm here, but I don't want to cause too much outrage and attention."


Sarah Varney wrote this story for KFF Health News.


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As the new year unfolds, rural health providers in North Dakota and other states will continue to have extra latitude in using telehealth technology. But a temporary extension of key rules still leaves uncertainty.

When Congress avoided a government shutdown in late December, it approved a funding resolution that runs through mid-March. For the next few months, that plan keeps in place relaxed telehealth regulations for people on Medicare that started during the pandemic.

Even though telehealth use has declined since the COVID emergency ended, said Brad Gibbens, deputy director of the Center for Rural Health at the University of North Dakota School of Medicine and Health Sciences, this option is still useful in remote areas.

"People can not only stay in their own community and interact with a physician or another type of provider and not having to travel," he said, "they can actually, in many cases, do this right out of their home."

He added that because these interactions are timelier, telehealth cuts down on health-care costs by reducing hospital admissions. A number of health organizations want the relaxed rules made permanent, so providers can better plan for them and patients don't lose continuity.

Telehealth access has bipartisan support, but skeptics have voiced concerns about privacy breaches and lower quality of care.

Gibbens stressed that telehealth should not be seen as a replacement for in-person visits. When the situation allows, he said, doctors still prefer having a patient come see them.

"They feel they get more of a review of the patient by seeing their body language and how they react," he said, "and it's kind of the nature of medicine."

However, Gibbens disagreed with assertions that there's a dropoff in the level of care when the visit happens online. He said that for patents in areas with very limited provider access or transportation gaps, telehealth is better than no care at all. He added that broadband investments have helped smaller clinics overcome technology barriers in enhancing online appointments.


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Holidays are traditionally a slow time for blood donations, but recent events have made the need for people to give blood and plasma in the Magnolia State even more urgent.

Following the deaths and injuries from a terrorist attack in New Orleans in the early hours of New Year's Day, Mississippi officials have pitched in to supply blood for victims of the violence. As a member of the Blood Emergency Readiness Corps, Mississippi Blood Services is supporting the efforts of the Blood Center of New Orleans.

Kasey Dickson, Mississippi Blood Services' director of public relations and marketing, said they have immediate needs.

"We are desperately looking for individuals that are eligible to donate platelets," she said, "as well as individuals with the blood types of O, negative or positive, and B, negative or positive."

Dickson said the agency is contacting its list of regular donors as well as putting out a call for new ones. Donations can be made at the blood centers in Flowood, in Cleveland and Oxford, and at mobile vans around the state. To find one, look online at MSBlood.com or call 888-90-BLOOD (888-902-5663).
Dixon said donors need to be at least 17 years old, be in general good health and complete a health history questionnaire. Approved individuals can donate about every two months, platelets every seven days, and plasma once a month.

"Fortunately, the donors of Mississippi helped get our supply ready, and we were able to ship enough products to assist the Blood Center of New Orleans ahead of time," she said. "And now, we're wanting to replenish our supply, so we can continue those efforts to help them."

Dickson said it was an honor to help another state with blood in its time of need, but added that it's equally important to care for Mississippians. She said people need to remember that blood isn't created, it's given.

"Blood itself can only be donated," she said. "It cannot be manufactured in a tube or re-created in a tube, so it has to be given from person to person."


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With the 2025 legislative session around the corner, the nonprofit advocacy group Alabama Arise said it plans to take aim at poverty and systemic challenges that hit families the hardest.

Big issues like health care access, public transportation and unfair court fines often weigh on lower-income families.

Robyn Hyden, executive director of Alabama Arise, said it is time for state leaders to step up and tackle the concerns.

"Our state, because we underfund state government and we underfund our court systems, we heavily rely on fines and fees that really disproportionately hurt low-income families and working families," Hyden contended.

Hyden believes cutting court fines and fees could be life-changing for some, freeing up money for essentials like food and health care. She highlighted the need for Medicaid expansion, removing the grocery tax and protecting voting rights as top priorities for 2025. State legislators have so far refused to expand Medicaid.

One of the most pressing issues Alabama Arise wants to see addressed is health care during and after pregnancy since the state has among the highest rates of maternal and infant mortality. A new report from Pregnancy Justice shows Alabama led the nation with 104 prosecutions of pregnant people in the year following the Dobbs decision.

Hyden stressed she wants to see an end to the state criminalizing pregnancy-related issues and instead, improving access to prenatal care.

"We don't think that women should be prosecuted because they have a miscarriage," Hyden emphasized. "We believe that health care providers should be able to provide lifesaving care to women in those situations. And we believe that when women are given drugs during labor, which does happen, they should not then be incarcerated or have their children removed."

The legislative session begins in February. Hyden added Alabama Arise is planning an advocacy day in March to unite voices in support of low-income and working families.