Recent coverage of rural maternity care deserts

I've seen a great deal of coverage of this topic in recent weeks.  With no time to compose a post, I'm just going to list and link to the stories here. 

CalMatters published "As hospitals close labor words, large stretches of California are without maternity care" by Kristen Hwang, Ana Ibarra, and Erica Yee on November 15, 2023.   

Sarah Jane Tribble reported "Can family doctors deliver rural America from its maternal health crisis?" for NPR on December 18, 2023.

Wyofile published a series of stories under the heading Delivery desert.  It includes this piece on tribal clinics by Katie Klingsporn.

This piece by Liz Carey for the Daily Yonder goes beyond maternal and OB/GYN care.  It is titled "Rural Hospitals, Medicaid Expansion Priorities for Kansas Governor." 

This Idaho Capital Sun published this related piece back in the summer, "As US maternal mortality rates surge, Idaho abandons panel investigating pregnancy-related deaths." 

This piece in the Washington Post, out of Madera, California, is not maternity-care specific.  "A hospital’s abrupt closure means, for many, help is distant," by Scott Wilson, published on Nov. 16, 2023, is about  the closure of the county's only adult-care hospital.  I wrote about those events in this June post.  

Democrat declares pro-rural stance (whatever that means)

Colorado Public Radio was just one media outlet covering last night's news that Colorado congresswoman Lauren Boebert would be abandoning the state's 3d congressional district and running instead in the 4th.  Boebert was barely re-elected to her seat in the 3d district, which covers essentially the western half of the state and all of the so-called Western slope.  It also includes the city of Pueblo in south central Colorado.  It's an area featuring a lot of rural gentrification.  The 4th district, now represented by Ken Buck who has announced his retirement, covers the state's eastern plains and a little slice of the front range, including Castle Rock and Parker, in Douglas County, not far south of (and arguably part of) greater Denver.   The 4th district is more dominated by agriculture, while the third is more dominated by tourism, though it certainly features significant agricultural enterprises, as in the San Luis Valley.  

Boebert was being challenged in the third district by Adam Frisch, formerly a member of the Aspen City Council and a businessman.  Frisch narrowly lost to Boebert in the 2022 race.  Colorado Public Radio reported this from Frisch, responding to Boebert's announcement and the likelihood he'll face a somewhat more moderate candidate in the general election.  That occurrence is likely going to make it more difficult for Frisch to prevail in the race:

[I]n a statement, Frisch remained positive about his chances. “From Day 1 of this race, I have been squarely focused on defending rural Colorado’s way of life, offering common sense solutions to the problems facing the families of Colorado’s 3rd Congressional District. My focus remains the same.”

Given that Frisch had made a living off rural gentrification in Apsen, it would be interesting to know what he means by "rural Colorado's way of life."  

Here's the New York Times coverage of Boebert's decision; it also quotes Frisch's statement.

Here's some commentary from the summer of 2023 about Governor Jared Polis' alienation of rural Colorado:  "because he can."  

Are elite colleges finally looking for rural students? NPR and Hechinger say "yes"

NPR's Elissa Nadworny and the Hechinger Reports' John Marcus filed this story from Crossville, Tennessee, population 12,000.  The story features high-school student Isabella Cross: 

As a 17-year-old in a rural community, and the daughter of a single parent, "I always kind of felt, like, I wouldn't say necessarily trapped, but a lot of kids feel trapped," says Cross. "And a lot of them never get out. They never get to explore and never get to see other things."

Now, Cross thinks applying to a top-flight college might be possible after all.

Recruiters from some of the nation's most selective universities — MIT, the University of Chicago, Yale — have, for the first time, come to her "little no-name town." It's part of an effort by top schools to pay more attention to rural America, where students are less likely than their urban and suburban counterparts to go to college and, if they do, are more likely to drop out.

"It kind of just felt like they heard us, and they see us, and that they know that there's a need as well for small-town kids like me to have really big dreams," says Cross.

The college fair in Crossville this fall was part of a string of events throughout the state, where admissions officers from about a half-dozen of the nation's most selective universities visited with students and parents. It was among the first by a new consortium called STARS, or Small Town and Rural Students College Network, prompted by a $20 million grant from a University of Chicago trustee.

It follows a long history of neglect of rural areas by many colleges and universities. Not even public research universities recruit in rural places, a 2019 study by scholars at UCLA and the University of Arizona found, disproportionately favoring higher-income public and private high schools in major metropolitan areas.

The story is chock full of quantitative data about rural students, and then there's this telling vignette: 

Outside the high school's auditorium, Nae Evans Sims stopped and thought for a moment about the smallest community she'd ever visited as an admissions recruiter for Case Western Reserve University. "Oh, my gosh," she says. "Probably this one."

A prior post about rural students and college placement is here.  

Rural teacher shortages afflict New York (too)

Amy Feiereisel for North Country Public Radio reported yesterday on teacher shortages in northern New York.  Here's an excerpt:  

Just ten years ago, when Stan Maziejka was a superintendent in Saratoga County, he says they almost under-advertised open jobs.

"We didn't want to have to sift through 1000 applications," he said. "So it was easier just to put an ad in the paper or on the website and deal with 100 or 200 applications."

These days, he says they’d be grateful for 10 applications.

This is a nationwide problem. According to a recent study by the National Center for Education Statistics, 86% of public schools report that they are still struggling to hire educators.

And they've been struggling with staffing since the fall of 2020, because of COVID-era retirements, and fewer new teachers entering the field.

That means everyone is fighting for a smaller pool, and inevitably luring teachers away from other districts.

"Unfortunately, it turns into a bidding war," said Maziejka. "You know, if I have a math opening, and two other districts have a math opening, that person's probably going to go where they can make the most money."

That’s driving starting teacher salaries up across the North Country.

But often, districts are competing with a suburban or urban district outside Northern New York. In that case, Maziejka says the richer district almost always wins. "Not all districts are alike. Some districts have greater capacity to pay higher wages than other districts."

That tracks with what the Education Statistics survey found, which is that overall, poorer, rural districts are having a harder time with hiring.

Most North Country Districts fall into that camp.

A Los Angeles Times story about teacher shortages in rural California is here.  

Are rural places getting more than their fair share from metros? A report from Minnesota

That's the gist of this Minnesota Reformer piece headlined, "Twin cities metro sends money to rural counties."  Madison McVan reports: 

A common refrain from Minnesota Republicans goes something like this: Rural communities are overtaxed, underfunded and ignored by legislators. Greater Minnesota sends their tax dollars to the Twin Cities, where metro residents benefit from government programs.

At a Nov. 15 event in New Ulm, Republican State Sen. Gary Dahms repeated the sentiments that have fueled the kinds of outstate Republican campaigns that helped them win the Minnesota House a decade ago:

“If you look at the money that’s collected in rural Minnesota, for gas tax and things like that, we do not get our fair share for transportation. If you look at health care, we do not get our fair share for health care,” Dahms said, according to the New Ulm Journal. “It really shows up in education, when you see what we get per student, versus what the seven-county metro area … there is a major, major difference there.”

It’s a sweeping argument that plays into the state’s often bitterly divided partisan and geographic politics, which have become deeply intertwined during the past decade, with Republicans dominating greater Minnesota while the Democratic-Farmer-Labor Party has locked down the metro. It also simplifies a complicated web of tax and revenue distributions — and it’s factually untrue.

Department of Revenue data show that the Twin Cities metro is the state’s biggest driver of tax revenue, and rural counties benefit more than the metro area from government aid.

Twin Cities metro residents paid an average of $4,362 in taxes and received $3,252 in aid and credits per capita in 2019, according to analysis by the Minnesota House Research Department. In the non-metro area counties the same year, residents paid an average of $2,871 per person in taxes and received $3,423 in state aid and credits per capita.

That the 7-county metro would contribute more to Minnesota’s overall tax base isn’t surprising, nor complicated: The metro has more people, its jobs pay more, and the property values are higher. Because both income and property taxes are progressive — the more you make and the more your house is worth, the more you pay — the metro’s contribution is larger.

Kelly Asche of the Center for Rural Policy and Development speaks to the higher costs facing rural programs, which tend to be "less efficient when people are spread out."  She said, 

In a rural area, we are fighting against the economies of scale. It is the rural enemy to be efficiently run.

Read more analysis of what rural Minnesota needs here, with accompanying map here.

This is, of course, an old debate.  In California, for example, we hear it in relation to the would-be State of Jefferson when people ridicule the notion that Jefferson would be better off separate from California, given that these rural counties get more from the state coffers than they pay in.

We usually see this rural v. urban funding debate play out at the federal level--that is, which states get more than their fair share.  I wrote about that most recently here.   

Colorado gets US DOJ money aimed at alleviating legal deserts

 Colorado Public Radio reports: 

A statewide organization that helps rural Coloradans find legal solutions received a grant of over a half-million dollars this fall to figure out the legal needs of people living in legal deserts, and this month, hired a new staffer to manage it.

The Colorado Access to Justice Commission received a two-year Rural Legal Deserts Grant [from the Department of Justice, Bureau of Justice Assistance] in October to bring legal solutions, in the absence of lawyers, to parts of Colorado where there aren’t enough.

The $627,000 grant comes from a Congressionally Directed Spending Award supported by Colorado U.S. Sens. Michael Bennet and John Hickenlooper. After the first two years, the grant will expire; the commission can then reapply for additional funding, according to Elisa Overall, executive director of the commission.

She said that outside metropolitan areas like Denver, Colorado Springs and Fort Collins, most parts of Colorado have too few lawyers to serve their communities.

“Right now, 45 percent of the state's counties have 10 or less attorneys,” she said. “And that's certainly considered a legal desert.”

The American Bar Association defines a legal desert as a county with fewer than one lawyer per 1,000 people, according to Legal Evolution – an online publication that focuses on the legal industry.

The graphic in that article shows Colorado and seven other states (North and South Dakota, Utah, Montana, Tennessee, Mississippi and Georgia) are identified as “moderate/high legal deserts.” Only five states (Idaho, Arizona, New Mexico, Arkansas and Wisconsin) fall into the category of “high legal deserts.”

Overall said that each rural area has different needs for legal services, and the grant will help them figure out those needs based on where the county is located.

Then there's this quote from Overall about Alamosa, in the southwestern part of the state: 

In Alamosa, we tend to see a lot of drug addiction, substance abuse, and so custody tends to be something that the communities have a greater need for, or potentially expungements of drug-related offenses ... There are areas with high numbers of immigrants and that's where immigration needs are very great and interpretation and translation.

More on the rural(ish) housing crisis, this time for students in far northern California

Debbie Truong reported for the Los Angeles Times last week from Cal Poly Humboldt in Arcata, population 19,000 (but part of the Eureka-Arcata-Fortuna metropolitan area).  The headline is "Cal Poly Humboldt students live in vehicles to afford college.  They were ordered off campus."  Here's the lede, which is powerful indeed: 

Maddy Montiel and Brad Butterfield marveled at the community they found this semester at Cal Poly Humboldt.

Montiel, an environmental science major, and Butterfield, a journalism major, had lived in their vehicles for several years, the only way, they said, that they could afford to attend college. They usually found parking in campus lots or on nearby streets.

But the pair and about 15 others like them — students living in sedans, aging campers, a converted bus, who could afford a $315 annual parking permit but not rent — found one another on campus parking lot G11. They started parking together in a row of spaces and named their community “the line.” They shared resources: propane tanks to heat their living quarters, ovens to cook meals. They helped one another seal leaky roofs and formed an official campus club aiming to secure a mailing address.

They felt safe. 

“None of us have ever had something like that before,” said Montiel, 27. “People who live like this don’t really congregate, and try to stay out of view.”

Then the notices arrived late last month. The university was going to enforce a campus policy, written into parking regulations, that prohibits overnight camping. Remove vehicles by noon on Nov. 12, or they could be towed and students could face disciplinary action, the letter said.

Montiel and Butterfield moved their vehicles to another campus parking lot, hoping the university would back down if they became less visible. They found two spots under redwood trees at the edge of campus. Others from G11 scattered, driven back into hiding.

On the morning of Nov. 13, several students who stayed at G11 and other campus lots awoke to discover parking violations on their windshields, a $53 fine for living overnight in their vehicles, $40 for those whose vehicles were too large for one spot.

The actions by Humboldt — defended by university officials as necessary for health and safety — provide an up-close look at how low-income California State University students determined to earn a college degree struggle to meet their basic needs amid the state’s student affordable housing crisis.

Prior posts about Cal Poly Humboldt are here, here and here.  A Lost Coast Outpost story about Cal Poly Humbolt's housing crisis is here.  Prior posts about greater Eureka are here (housing crisis), here (drug crisis) and here (bad behavior by law enforcement).   Posts by a former student who grew up in Humboldt are here and here.     

A few days ago (and a week after Truong's story ran) the Los Angeles Times editorial board published this, "Homeless college students just need safe parking overnight.  How tough can that be?"

Here's another Los Angeles Times story about a student housing crisis, this one in Santa Cruz.  This story is related, also partly about the Santa Cruz situation.  Here's the Wall Street Journal's story about the Santa Cruz housing crisis and its impact on students.  Students at UC Santa Barbara have also faced housing crises in recent years.  

Postscript from Dec. 7, 2023:  Santa Cruz is the state's least affordable housing market.

With rural lawyers long in the news, Law 360 turns to rural courthouses and the challenge of distance

This story by Jack Karp for Law 360 is a real gem for several reasons.  But before I move to those, here's the lede: 

The U.S. House of Representatives unanimously passed a bill in November, following the Senate's lead, that would add two federal court locations in rural parts of Texas and Washington state.

Lawmakers hope the legislation will improve access to the federal courts for those who live in remote areas. Experts, however, say there's already a sufficient number of courthouses to serve rural residents. It's getting to them that's the problem.

On this point, I can't resist pointing to my detailed analysis of the struggles rural residents sometimes face in getting to services in metro areas; read more here and here.  Karp's story continues: 

Long distances, geography, weather and even wildlife can make traveling to the local courthouse difficult for residents of rural communities, hampering access to the legal system, according to attorneys.

* * * 

Some attorneys say remote proceedings have eased the problem, but others insist that the cost and lack of broadband and computers make online hearings inaccessible for rural litigants, who often prefer being able to go to a physical courthouse staffed by real people.

Then Karp quotes Michele Statz of the University of Minnesota Medical School, Duluth, who researches rural access to justice, with a focus on far northern Minnesota and Wisconsin, including tribal courts:  

There's this sort of 30,000-foot view that we'll put in the technology and people can just attend court differently. But it's so much more than that. It's so much more than just a hearing.

* * *

Overwhelmingly, our survey data with self-represented litigants show that litigants almost always want to attend in-person hearings, which very powerfully counters the sort of message on the streets where we have this technological silver bullet. In reality, humans are what people want.

Besides pithy quotes like these, one thing that makes this story so great is that Karp touches on several regions, though the Western U.S. features most prominently.  (Western states tend to be divided into counties that cover much greater land area than those of their eastern and midwestern counterparts.  Arizona, for example, is the 6th largest state but only 15 counties).  

Here's an excerpt from California, featuring my former student from Law and Rural Livelihoods, Kaly Rule, now family law facilitator and self-help center director in Lake County California, population 68,000: 

Gas is expensive, and if you're living on the edge — you have a low income, you can barely afford to pay your rent or you're not even paying your rent — the gas to get to and from the courthouse is going to be a huge barrier.

Also featured prominently:   Columbia Legal Services and the work they are doing in the rural reaches of Washington State.  Here's a quote from that part of the article: 

In Stevens County, Washington, which has a population of 40,484, it can take over an hour for people in the county's most populated area to drive to the district courthouse, according to Judge Lech J. Radzimski, presiding judge for the Tri-County Judicial District, which includes Ferry, Pend Oreille and Stevens counties.

Distances like that are a problem, especially for low-income litigants and defendants who may not be able to afford the time off work or child care expenses that traveling those stretches requires, according to area attorneys.

"If they have to take an hour or an hour and a half just to get to the courthouse, they can lose their jobs because they don't have sick time or vacation time or personal days," said Columbia Legal Services Executive Director Merf Ehman. "If they're agricultural workers, particularly in eastern Washington, that can be a huge problem."

Another terrific part of the story is that Karp speaks to lots of folks--not just academics.  He also got this quote from Nathan Hall of the National Center for State Courts:  

There are just beautiful examples of the steps leading to the courthouse, and then what you'll see is there'll be, like, a little side door that's the handicapped entrance.

Karp provides some specific examples of these problems, including one out of eastern Washington state and one out of Fresno, California.  He also quotes Hall regarding how expensive it is to build new courthouses. 

A fourth commendable part of the story is that it includes some cool photos, like the lead one of a horse in front of a court house.  Please click through to see it and the others.