Rural women face a decline in access to necessary reproductive health care

Women's rural health clinic in Bishop, California.

Credit: California Health Report

Maternal Health

The United States has the highest rates of maternal death among high-income countries, three-times higher than comparably wealthy nations. Maternal health disparities impact certain populations more severely than others. For example, the maternal death rate for black women is 49.5 deaths per 100,000 live births, compared to the US average of 22.3 deaths per 100,000. 

Rural populations face maternal death disparities too. "Noncore" areas (areas outside metropolitan and micropolitan statistical areas defined by the Census) have a maternal mortality rate of 26.8 deaths per 100,000 live births compared to 19.5 deaths per 100,000 for large central metro areas. Further, the situation for rural women is likely to get worse.

Maternal health access has been declining in recent years. In 2024, the National Rural Health Association shared that 36% of U.S. counties, a majority of which are rural, are maternity care deserts. A maternity care desert is any county without a hospital or birth center offering obstetric services. In 2022, more than half of rural counties (58.8%) had no hospital-based obstetrics unit, up from 51% in 2010.

Katy Backes Kozhimannil, a professor at the University of Minnesota School of Public Health, told The Daily Yonder that closures of obstetric units are due to "not having enough revenue to keep the units open, as well as not having enough births and specialized skills to care for obstetric patients and not having enough trained clinicians to keep the unit operating." 

Closure of rural hospitals exacerbates the maternal health crisis in these rural communities. Since 2005, 110 rural hospitals have closed, and almost 800 are currently at risk of closure due to financial distress. A previous blog post discussed the rural "slush fund" included in Trump's "Big Beautiful Bill," which included a $50 billion program to support rural health. The fund, named the Rural Health Transformation Program, is overshadowed by the fact that the bill cuts Medicaid funding by almost $1 trillion, estimated to be $137 billion in rural areas.

Credit: Allie Kelly, Business Insider

A study by Georgetown University Center for Families and Children showed that 47% of children and 18% of adults in rural and small towns rely on Medicaid (numbers that the study predicts underestimate the true values). Also, nearly half of all births in rural hospitals are covered by Medicaid. While the rural "slush fund" may provide some funding for rural health care infrastructure, its only one-third of what rural communities expect to lose from the cuts. 

The fund will be distributed over five years, $10 billion each year starting in 2026. The amount each state will receive this year averages $20 million. Half of the fund is distributed equally across states, with only a quarter of the fund being distributed based on need, meaning that states with significantly larger rural populations may receive similar amounts of funding to states with lower rural populations. Additionally, the fund is broadly available to aupport health care systems, with initiatives not directly tied to rural health, such as Make America Healthy Again (MAHA), posted by Centers for Medicare & Medicaid Services (CMS) as an example of what may receive funding.

Abortion Access

On another reproductive healthcare front, access to abortion clinics from rural areas is limited. In California, about 40% of counties do not have an abortion clinic, and most of these counties are rural. In Inyo County, CA, most residents live over 200 miles from the nearest abortion provider. The lack of abortion care is shocking in light of California's support for abortion access. But residing in a state that recognizes the right to abortion does not mean its residents automatically enjoy easy access to abortion providers. Avery Van De Berg previously wrote on this blog about the severely limited abortion access in Missouri, despite their amendment to protect abortion rights.

Rural residents in states that have enacted post-Roe bans on abortion face even greater barriers to care. Many residents now have to travel significantly farther to find abortion providers. Sarah Melotte of The Daily Yonder analyzed abortion care data and found that after Roe was overturned, rural travel to abortion providers increased from 103 miles on average to 159 miles on average. This distance can be significantly farther in some rural areas. Travel to an abortion provider is as far as 800 miles of travel from parts of rural Texas and 492 miles of travel for the average rural Louisiana resident.

What's the Solution?

Policy-makers have proposed solutions to the reproductive health care crisis facing rural residents experience. Similar to solutions posed to prevent legal deserts, a solution for maternity care deserts includes recruiting, training, and retaining physicians who provide maternal care. To improve access to care, Telehealth policies have been proposed to bridge the gap between physicians in rural area and maternal care needs. 

Undoubtedly, many of these solutions come down to investment in rural health care. We've yet to see whether laws like the "Big Beautiful Bill" will fulfill promises of affordable and available healthcare in rural communities.

For more academic analysis of these issues read more here and here.

Catching up on rural healthcare stories

I wrote several posts about rural healthcare this summer, mostly prompted by the consideration and passage of Trump's One Big Beautiful Bill, which was widely discussed as undermining rural health care and rural hospitals.  Since then, I've neglected the issues except to address some of them in this forthcoming law review article, which focuses on the challenge of maternal mortality for rural women.  

In this post, my plan is just to provide links to the stories I've seen about rural health care since the summer, making this something of a repository of resources to study how rural health care is faring in the Trump administration's first year and likely further degradation of services as a consequence of recent Republican policies.

First off, the Trump administration is withholding support to tsunami proof this hospital.  Katia Riddle reports from Astoria, Oregon.   One interesting aspect of this story is how local Republicans who supported Trump are flummoxed--or worse--about his administration's failure to support a rural hospital that has saved many local lives.  Here's some context:   

The Trump administration has canceled billions of dollars in federal grants across multiple agencies, and one of those grants is for a program that was designed to help local governments fortify places that are vulnerable to natural disasters.

* * *  

[The hospital in Astoria], called Columbia Memorial, was built decades ago. Now that we know more about earthquakes, it's hard to imagine a worse spot to build a hospital. Not only is the whole town in a major subduction zone, the building is just a few blocks from the water, on top of dangerously unstable ground.

And here's a key quote from a former mayor of Astoria, Willis Van Dusen, a Republican who voted for Trump but now is frustrated by the recent turn of events regarding the needed hospital work: 

Van Dusen: What is more important than a hospital in a rural community like Astoria? Now, it saved my life.

Riddle: Van Dusen points to a framed photocopy of a piece of paper - the EKG reading when he had a heart attack some years ago. At one point, he flatlined.

Van Dusen: All these are (imitating electric current), and they're hitting the paddles. And I had actually died.

Riddle: It was doctors at Columbia Memorial that brought him back. Van Dusen says he and many other people in Astoria wouldn't be here without this hospital. Making sure that it can keep providing care during an earthquake and a tsunami, he says, is the opposite of waste, fraud and abuse.

Van Dusen: And just to jerk that money away from us, I can't just say it makes - it's frustrating. It makes me livid. It makes me angry.

Riddle: Van Dusen says he's not the only one in this town who's mad.

Van Dusen: I know every single Republican that I have talked to is livid over what's happening.

This is a rare instance when I've seen a Trump voter whose mind has been changed by Trump's spending priorities--and how those priorities have played out in the voter's own community.  It shows that Trump voters can be swayed when Trump's spending priorities impact them, something rarely illustrated.  

Regarding the $50 billion "rural health fund," sometimes referred to as the rural slush fund, Sarah Jane Tribble of Kaiser Health News reported about ten days ago on how states are competing for these funds.  It hardly seems like a fair fight.   Tribble provides details on how and why substantial chunks of the funds might not even wind up in rural places:  

Nationwide, states are racing to win their share of a new $50 billion rural health fund. But helping rural hospitals, as originally envisioned, is quickly becoming a quaint idea.

Rather, states should submit applications that "rebuild and reshape" how health care is delivered in rural communities, Centers for Medicare & Medicaid Services official Abe Sutton said late last month during a daylong meeting at D.C.'s Watergate Hotel. Simply changing the way government pays hospitals has been tried and has failed, Sutton told the audience of more than 40 governors' office staffers and state health agency leaders — some from as far away as Hawaii.

"This isn't a backfill of operating budgets," said Sutton, CMS' innovation director. "We've been really clear on that."

Rural hospitals and clinics nationwide face a looming financial catastrophe, with President Trump's massive tax-and-spending law expected to slash federal Medicaid spending on health care in rural areas by $137 billion over 10 years. Congressional Republicans added the one-time, five-year Rural Health Transformation Program as a last-minute sweetener to win the support of conservative holdouts who worried about the bill's financial fallout for rural hospitals.

Yet, the words used by CMS Administrator Mehmet Oz and his agency's leaders to describe the new pot of cash are generating tension between legacy hospital and clinic providers and new technology-focused companies stepping in to offer new ways to deliver health care.

It's "what I would call incumbents versus insurgents in the rural space," said Kody Kinsley, a senior policy adviser at the Institute for Policy Solutions at the Johns Hopkins School of Nursing.

I further detail possible non-rural uses of the fund in my forthcoming law review article, which relies on Tribble's reporting. 

Finally, Abigail Ruhman reported for the Texas Tribune a few weeks ago on how Texas' rural hospitals are competing for a piece of that "rural slush fund."  

As Texas develops its application for a new rural health funding program, rural hospital leaders say the priority should be financial stabilization for their facilities.

The recent sweeping tax and spending plan includes a $50 billion appropriation for the Rural Health Transformation program. States will receive funding based on applications they submit in early November.

During an hours-long public hearing Monday to discuss the program, several hospital leaders raised concerns that without direct funding, the state may experience more rural hospital closures.

Erin Clevenger, CEO of Memorial Medical Center in Port Lavaca, southeast of Victoria, said her hospital is high on the list of Texas hospitals at risk of closure.

“Every day is a battle to make sure we don’t become one of those statistics,” Clevenger said.

In the last decade, Texas has lost 14 rural hospitals. Of the 156 rural hospitals currently in the state, about 70% have lost services, and more than half are at risk of closing, according to a report from the Center for Healthcare Quality and Payment Reform.

Memorial Medical Center is in the southern part of the state, but it provides critical services that benefit people across Texas – even patients in Dallas.

“When even large urban hospitals could not take on more patients, we opened a COVID care unit and accepted their transfers, even flying patients in from Houston and Dallas,” Clevenger said.

Keep an eye out for more news about whether rural hospitals are getting the benefit of the "Big Beautiful Bill" and its rural slush fund--and whether any funds they receive are sufficient to keep them open.  It'll also be interesting to see if the anticipated closure of rural hospitals will turn rural Trump supporters against him--if those closures happen during his presidency.  

Meanwhile, the reduction and reinterpretation of other federal funding streams, along with other strains,  have been threatening--and in one instance, closing--hospitals in rural California.  Read more here (Inyo County in the eastern Sierra) and here (Imperial/Riverside County).  

When will women in rural Missouri have true abortion access?

On November 5, 2024, as much of the country watched Donald Trump regain the presidency, abortion advocates in Missouri celebrated. Amendment 3, a ballot proposition to repeal Missouri's total abortion ban, had passed. Missouri was one of seven states that enacted amendments to protect abortion rights on November 5. And in a state that Donald Trump won by over 18 points, voters had somehow simultaneously restored the right to abortion by a narrow margin of 52 to 48 percent. For abortion advocates, passing Amendment 3 was a hard-fought but undeniable victory. 

Then, the question became: "What's next?"

For rural Missourians, the answer is complicated. Over the past few decades, Missouri has severely limited abortion access. Hit hardest were women in rural communities. For years, there were only three abortion clinics in Missouri, which has a population of over 6 million. By 2017, a Planned Parenthood in St. Louis was the only place in the entire state you could get a medical abortion. And in 2022, Missouri passed the "Right to Life of the Unborn Child Act," a trigger ban that months later became the first in the nation to go into effect when Dobbs v. Jackson overturned the constitutional right to an abortion. 

This was the landscape framing desperate efforts to restore medical access to abortion in Missouri. But celebrations fell quiet in weeks after the election as anti-abortion advocates began to respond. Elected officials in Missouri pledged to "vigorously defend" abortion bans in the state. On January 16, 2025, U.S. Senator Josh Hawley (R-MO) introduced federal legislation to defund Planned Parenthood. I felt my own stomach churn when my little sister, a veterinary student at the University of Missouri, texted me: "I'm getting anxious. About living [here]." 

One-third of Missourians live in rural areas. But even those in urban counties have felt the effects of the decades-long effort to restrict access to abortion. Columbia, Missouri, where my sister lives, has a population of 130,000. But it's over a two hour drive to St. Louis, where the sole abortion provider in Missouri is located. Rural Ozark County ⁠— which has a 29.6 percent poverty rate, the highest in the state — is a four hour drive from St. Louis. Not to mention travel costs, medical expenses, and scraping together time off work — all challenges exacerbated by rurality.

While Amendment 3 granted abortion access until the point of fetal viability, the St. Louis Planned Parenthood cannot legally resume providing abortions. This is, in part, due to a December ruling by Jackson County Judge Jerri Zhang which upheld licensure requirements for abortion clinics — meaning that though Missourians have a renewed right to abortion, there is no place for them to obtain one. This leaves rural women in Missouri vulnerable, particularly those in the southern half, where the nearest abortion clinic might be several states away. 

However, progress was made: In the same opinion, Judge Zhang struck down other restrictive laws, including a 72-hour waiting period and a requirement that physicians who perform abortions have admitting privileges in all hospitals that provide obstetric or gynaecological care within "30 minutes or a 15-minute drive." Judge Zhang considered rural Missourians in the decision, writing that: 

[A] person who travels three hours to get a medication abortion and then returns home, would not benefit from [these restrictions]. If complications arise after taking the medication, the individual would need to seek emergency care at the nearest hospital emergency room, as with any other medical emergency.

Aside from the judiciary, what else can be done? In a state like Missouri, where only 28.9 percent of statewide legislators are women, many will turn to grassroots organizing. "What's Next?," an organization dedicated to improving abortion access in Missouri, has advocated for Know-Your-Rights Trainings and other local initiatives. In a 2024 study by the Kaiser Family Foundation, over 35 percent of rural women reported they wouldn't know where to go or where to find abortion information. This post by Rooney Debutts details other statewide legislative efforts to improve abortion access. 

One thing is clear: The fight for abortion access in rural Missouri is far from over. 

Rural voters in Wisconsin protect abortion rights: Democrats should take note

Last week, on April 4, progressive Milwaukee County Circuit Court Judge Janet Protasiewicz was elected to the Wisconsin Supreme Court, thereby creating the high court's first liberal majority in 15 years. Protasiewicz won out over her conservative opponent Daniel Kelly, a former state Supreme Court justice, in the contest to replace retiring conservative Justice Patience Roggensack. Notably, the race became the highest profile and most expensive judicial election on record in the United States, with campaign spending totaling over $45 million.

While the campaign was hotly contested, in the end, Protasiewicz defeated Kelly by more than 10 points in what represented a significant shift towards the Democratic party by Wisconsin voters. Perhaps the most interesting voting pattern that emerged during this election was that the statewide voting trends were bolstered by a pivot on the part of rural voters towards the democratic candidate. While Protasiewicz did ultimately lose the rural vote, the 45% of the rural vote that she was able to accumulate constitutes a significant 5-point gain for Democrats with this demographic when compared to the 2020 presidential and 2022 Senate elections. 

The headway Protasiewicz was able to make with rural voters might come as a surprise to some, given that the existence of a widening urban-rural divide with regards to Americans' political ideologies and partisan affiliations has come into sharp focus in recent years. Specifically, over the past few decades, urban voters have increasingly leaned democratic and rural voters have overwhelmingly supported republican candidates (previous posts on America's urban-rural divide here, here, and here). Moreover, Wisconsin is no outlier from these trends; like elsewhere throughout the nation, Democrats in Wisconsin have struggled to pick up votes in the countryside and in small towns (another posts on the rural vote in Wisconsin here). This is particularly evident in the rural western and northern portions of the state, where Democrats continued to watch their voting bloc erode through the 2022 election cycle. In fact, less than a year ago a post on this blog discussed multiple news reports forecasting bad news for Democrats in rural Wisconsin, highlighting how they have gone largely unsupported by the Democratic national party.

So, what changed? One predominant theory is the United States Supreme Court's 2022 decision in Dobbs v. Jackson Women's Health Organization (recently discussed on this blog here and here). Dobbs is the Supreme Court case that reversed Roe v. Wade and Planned Parenthood v. Casey, stating that the constitution does not confer a right to abortion.  

Since Dobbs, there has been an emerging national trend by which support for abortion rights has appeared to translate into electoral gains for Democrats. In August 2022, Kansas voters shocked much of the nation by rejecting an amendment to their state constitution attempting to decoding abortion rights. Strikingly, the high-turnout, pro-abortion outcome represented a 30-point deviation away from the support former president Donald Trump garnered in 2020, with the most significant and surprising departures from Republican partisan loyalty coming from small cities and rural areas (more on the Kansas abortion referendum here). Considering these results, one possible takeaway is that rural voters, at least in Kansas and where abortion is concerned, are not completely behind every aspect of the leading Republican agenda. 

It is likely that similar forces were at play in the Wisconsin Supreme Court election last week. Abortion rose to the fore of debate surrounding the election as, post-Dobbs, it was almost guaranteed that access to abortion in the state would hinge on whether it was progressives or conservatives that would secure a narrow majority on the state's supreme court. Wisconsin's current governing law on the matter is a 1849 statute criminalizing abortion in virtually all cases, with a singular exception carved out for situation in which it would be necessary to save the pregnant person's life. 

Adopting a slightly controversial strategy, Protasiewicz openly campaigned on the issue of abortion, not only publicly announcing her personal pro-choice beliefs and collecting endorsements from pro-choice groups, such as EMILY's List, but also running ads painting Kelly as a staunch pro-lifer who would surely uphold the state's 1849 abortion ban. Kelly, on the other hand, feigned impartiality, but accrued endorsements from the state's top three anti-abortion groups, including Wisconsin Right to Life, and was perceived as very likely to act in accordance with his well-documented pro-life stances.

While it is difficult to assert an exact or singular cause, the theory that Protasiewicz's pro-choice position contributed to her victory is supported by a recent Marquette University Law School Poll indicating that a majority of Wisconsin citizens support abortion in most or all cases. That said, the election was also undoubtedly influenced by the other hot-button issues spotlighted during the campaign, including gerrymandering (Wisconsin's district maps are considered among the most undemocratic in the country) and election administration (Wisconsin is a perennial swing state in which the most recent presidential election results in favor of Joe Biden were upheld by the state supreme court by a margin of only one vote).    

Regardless of the exact mechanics of the outcome of Wisconsin's Supreme Court election, Democrats should take note and stop writing off rural voters as a lost cause. In conjunction with the referendum in Kansas and other rural Democratic success stories, such as the rise of John Fetterman in Pennsylvania, Protasiewicz's gains in rural Wisconsin suggest that rural counties might be much more politically contestable than many believe. It is even possible that inroads with rural America could be the key to Democratic success in 2024... but only if the party begins investing sufficient time and money into rural communities, constituents, and candidates. 

Lauren Boebert praises higher teen birth rates in rural America

Judy Kurtz for The Hill reported last week that Lauren Boebert, the 36-year-old Republican Congresswoman from western Colorado, was praising high rates of teen birth in rural areas.   Here's a direct quote:  

There’s something special about rural conservative communities — they value life. If you look at teen pregnancy rates throughout the nation, well, they’re the same in rural and urban areas. However, abortion rates are higher in urban areas, and teen mom rates are higher in rural, conservative areas because we understand the preciousness of the life that is about to be born.

The Hill provides this data for context: 

In 2015, 18.9 out of every 1,000 urban female teenagers gave birth, according to the National Center for Health Statistics, compared to 30.9 out of every 1,000 for those in counties of fewer than 50,000, PBS reported. Since 2007, the nationwide teen birth rate has dropped by approximately half, but it has only fallen by about one-third in rural areas. 

I wonder if Boebert has considered that one reason for the lower abortion rate in rural America is that regulation on the procedure have made abortions much harder for rural women to access.  Read more here.  

Boebert made her comments in relation to an announcement that she will soon be a 36-year-old grandmother because the girlfriend of her 17-year-old son, Tyler, sill give birth to their child next month.  Boebert said she and her husband are "so excited to welcome this new life into our family." 

Boebert made the comments as she was presented with the Moms for America "Mothers Influence Award" last Tuesday for "taking “an incredible stance in empowering moms, promoting liberty, and raising patriots!”  The Hill further quotes Boebert:

“Now my son, when I approached him and told him, ‘Tyler, I’m going to be a 36-year-old grandmother,’ he said, ‘Well didn’t you make Granny a 36-year-old granny?’”

“I said, ‘Yes, I did.’ He said, ‘Well, then it’s hereditary.’”

“Nice try, buddy,” Boebert, a far-right conservative with hard-line views on abortion, said to laughs from the crowd.

Ranked-choice vote counting done, Mary Peltola (D) and Lisa Murkowski (R) win in Alaska

Photos from Mary Peltola's twitter feed on
November 24, 2022, day after she was declared winner of 2022 midterm
one side of her mug says "made of salmon" and the other is
"Mary Peltola for Congress"

Here's the story about Peltola, about whom I've previously written here.  Peltola is from rural Bethel, and she talks rural--as well as fish--a lot.  Here's her tweet from the morning after her victory was declared, from which I took the photos above.  Here's another fun Peltola tweet reflecting her pro-fish campaign; it features dancing crabs. 

And here's the NYTimes story about Lisa Murkowski, who defeated fellow Republican Kelly Tshibaka, who was backed by Trump.  Democrat Pat Chesbro garnered nearly 10% of the vote in the first round of the state's rank-choice voting, which takes into account voters' second choices if no candidate gets more than 50% of the vote in the first round. 

Murkowski now begins her fourth full term in the Senate.  Peltola has now earned her first full term in Congress.  As she did in this election, Peltola also defeated Sarah Palin and Nick Begich back in August to fill the seat Don Young (R) had held for nearly five decades.  Young died in March.  

Here is the Washington Post's coverage of these Alaska wins.  Of Peltola, Nathaniel Herz writes: 

Peltola ran a locally focused campaign with both traditional and unconventional Democratic platform planks — she touted her support for abortion rights and “pro-fish” views, along with her endorsement of a new Alaska oil project and the large gun collection that she and her family maintains.

This Washington Post story also has a good explanation of rank-choice voting, and its short history in Alaska.   

Postscript:  Here's an AP piece on the bipartisan coalition that will govern the Alaska legislature after the recent elections.  The lede follows: 

The Alaska state Senate will have a coalition of Democrats and Republicans serving as a majority caucus next January, officials announced. Friday.

The coalition will include nine Democrats and eight Republicans, leaving three members of the 20-seat chamber in the minority.

Gary Stevens, a Republican from Kodiak, will serve as Senate president. Among other leadership positions include Bill Wielechowski, an Anchorage Democrat, as Senate rules chair, and Cathy Giessel, a Republican who previously served as the body’s president and regained her Senate seat in this year’s election, as majority leader.

On the midterm race in Washington's (rural-ish) Third Congressional District

This is the feature, "The Midterm Race that Has it All," on the front page of yesterday's Sunday Review in the New York Times, written by Michelle Goldberg.  Here's an except focusing on the rural and working-class elements of the story: 

The question of how you win an election in Washington’s Third Congressional District — a stretch along the southwestern border with Oregon that’s been reliably Republican, voting for Trump by four points in 2020 but still considered fairly moderate — is not just a political debate for right-wing YouTube. The race, pitting [Joe] Kent, a burgeoning MAGA-world star, against Marie Gluesenkamp Perez, a 34-year-old rural working-class Democrat who is emphasizing abortion rights, has national implications.

Her father, a Mexican immigrant, was an evangelical preacher; she told me she learned public speaking in his Texas church. She and her husband live, with their 13-month-old son, off an unpaved road in a house they built themselves “nail by nail,” as she likes to say on the stump. Like Kent, she is good-looking, resembling a taller, lankier Winona Ryder, which shouldn’t matter but probably does.

* * *

The shop Gluesenkamp Perez runs with her husband, Dean’s Car Care, employs eight people, and Gluesenkamp Perez speaks passionately about the struggles of both small-business owners and working parents. She often talks about putting infant noise-protecting headphones on her baby registry; because she couldn’t find a day care spot, her son spent a lot of time with her at the auto shop.

“If you think you can spend 15K a year on day care, per kid, and save for retirement, and save up for a mortgage, you’re living in a really different economy than me and most of the people that I know,” she said at one rally.

In high school, Gluesenkamp Perez told me, she was so obsessed with civics that she was active in both the Young Republicans and the Young Democrats. It was only when she was a freshman in college and her brother came out as gay that she decided the Republican Party wasn’t for her.

Kent beat Jaime Herrera Beutler in the Republican primary a few months ago. She was one of ten Republicans to vote in favor of Trump's impeachment. 

New York Times finally covering Beto O'Rourke's tour of rural Texas

Beto O'Rourke, Democratic candidate for Governor of Texas, began a "Drive for Texas" a few weeks ago, in which he is visiting 65 counties in 49 days.  I've written about it here, and mentioned it here and here.  Now, J. David Goodman is reporting on his rural outreach for the New York Times, in a story headlined, "In Deep Red Texas, Beto O’Rourke Takes on Guns and Abortion."  (To be honest, the story is not that much about guns and abortion, but never mind).  Here's an excerpt highlighting the rural nature of many of the places O'Rourke is visiting.  

Locked in a race against Gov. Greg Abbott that has grown unexpectedly close, Mr. O’Rourke has been venturing into deeply conservative corners of rural Texas, sparking confrontations and conversations between Democrats and Republicans who may rarely speak with each other about politics, even if they cross paths every day in the local grocery store or at church.

“This is refreshing to see people like me — there’s probably five Democrats in the county,” said John Wade, 73, a retired Methodist elder who came to see Mr. O’Rourke in Bowie, Texas, where nearly 90 percent of voters chose Donald J. Trump in 2020.

At five recent town hall-style gatherings across the deep red rural northeast of Texas, Mr. O’Rourke invited protesters inside for a break from the oppressive heat, answered questions from supporters of Mr. Abbott and took pains to direct his attacks against the governor, not Republicans in general.

Not featured in these excerpts, but also in the story are vignettes that illustrate the lack of anonymity that marks rural communities.  (See the opening paragraphs, for example).   

Oh, and by the way, the story's dateline is Whitesboro, population 3,793, in metropolitan Grayson County (seat Sherman). Also mentioned in Goodman's story is Bowie, population 5,218, in neighboring Montague County, population 19,965.

One more piece (for now) on the Kansas abortion vote, this one on how it defies rural and red-state stereotypes

Author Sarah Smarsh published in the New York Times a few days ago an essay titled, "Why the Defense of Abortion in Kansas is so Powerful."  She's a Kansan and the author of Heartland:  On Working Hard and Being Broke in the Richest Country on Earth.   Here are the excerpts most salient to rural folks and the stereotypes about them:  

Despite red-and-blue maps suggesting that the political fault line of our era runs between urban and rural areas, much of the countryside joined cities like Wichita and Kansas City in voting down the amendment. Fourteen Kansas counties that went for Mr. Trump in the 2020 presidential election, as well as all five that went for Joe Biden, saw majority votes against the amendment. Even in counties where most voted yes, sizable numbers voted no.

* * *

One dismal aspect of our political climate is the ease with which many liberals and progressives dismiss and disdain whole states and regions — as though every Kentucky flood victim voted for Mitch McConnell, as though ideology should be a litmus test for assistance amid acute suffering, as though such places are undeserving charity cases rather than rural landscapes from which resources are extracted to make possible the lives of urban dwellers who sit in judgment.  (emphasis mine) 

Prior posts on the Kansas abortion vote are here and here.   

More on the rural vote in relation to the failed Kansas abortion amendment

New York Times map

Here's how the New York Times explained the abortion rights referendum in Kansas: 

The ballot referendum was rooted in a 2019 ruling by the Kansas Supreme Court that found that the right to an abortion was guaranteed by the State Constitution. Abortion in Kansas is legal up to 22 weeks but requires a waiting period and parental consent for minors.

* * * 

Abortion rights supporters used conservative-sounding language about government mandates and personal freedom in their pitch to voters, and made a point of reaching out to independents, Libertarians and moderate Republicans.

* * *

The abortion rights victory included overwhelming margins on Kansas’ few patches of left-leaning political turf: 81 percent to 19 in the county that includes the college town of Lawrence; 74 percent to 26 in the county that includes Kansas City; and 68 percent to 32 in populous Johnson County, a suburban area that was once reliably Republican but that has trended rapidly toward Democrats since Mr. Trump’s entrance into national politics.

But the abortion rights side also won convincingly in the county that includes Wichita, a more conservative place with a long, sometimes violent, history at the center of America’s abortion debate. Abortion rights supporters won in Topeka, the politically mixed state capital, and in Republican-leaning areas around military bases. Perhaps most surprising, they carried several rural and exurban counties where Republican candidates routinely trounce Democrats.  (emphasis added)

Here's a paragraph from a different New York Times story (the one featuring the map above) also from yesterday:

And in some rural areas that overwhelmingly supported Mr. Trump, Kansans’ margins in favor of amending the Constitution to remove abortion protections were much less decisive than their presidential votes. In Hamilton County, which voted 81 percent for Mr. Trump in 2020, less than 56 percent chose the anti-abortion position on Tuesday. In Greeley County, which voted more than 85 percent for Mr. Trump, only about 60 percent chose the anti-abortion position. (Around 90 percent of the votes have been counted in each county.). (emphasis added)

This tack of comparing a county's vote on an issue to how that county responded to Trump's candidacy is something we increasingly see in political analysis, making Trump's support in 2020 a baseline for how conservative (or extreme) a county is.  We also saw this analytical frame here.

Big headline from today's primaries: Rural Kansas doesn't quite come through for "pro-lifers"

A referendum on the (state-based) constitutional right to an abortion in Kansas came down on the pro-choice side tonight (59-41%), and folks everywhere seem surprised.  After all, Thomas Frank's book, What's the Matter with Kansas?, suggested that, well, something is the matter with Kansas--at least from the perspective of progressives.    

Tonight, however, many progressives are re-thinking that assumption.  Here is an excerpt from the Washington Post's coverage: 

In a major victory for abortion rights, Kansas voters on Tuesday rejected an effort to strip away their state’s abortion protections, sending a decisive message about the issue’s popularity in the first political test since the Supreme Court overturned Roe v. Wade in June.

The overwhelming support for abortion rights in a traditionally conservative state bolsters Democrats’ hopes that the historic Supreme Court ruling will animate their voters in an otherwise difficult election year for their party. The Kansas vote signals that abortion is an energizing issue that could affect turnout in the November midterms.

The question presented to voters here was whether abortion protections should be stripped from the state constitution. A “yes” vote would allow Kansas’s Republican-led legislature to pass future limits on abortion — or ban it altogether — in its coming session in January. A “no” vote would leave those protections in place.

While Kansas is thought of as a rural state, you can see quite a rural-urban contrast in the vote here--or, if you like, a western (rural) Kansas-eastern (urban) Kansas divide.  

A few select Tweets about this outcome, which mostly play on Kansas stereotypes, follow: 

Nate Cohn for the New York Times wrote, "In rural Kansas counties, there's bad news for 'yes' to ending abortion rights in Kansas.  In heavily Republican areas, 'yes' is running well behind the level of support the anti-abortion measures have received in conservative parts of other states." 

 

Bryan Lowry is a journalist with the Kansas City Star-Tribune

Yet another story on Democrats' woes in rural America, this one with a focus on religion

Searcy County, Arkansas
(c) Lisa R. Pruitt 2012

Alan Greenblatt reported this week for Governing, which "provides news, analysis and insights for the professionals leading America’s states and localities."  The headline is "How Rural America Learned to Love the Republican Party."  

It’s not only economic issues that have pushed voters in Muhlenberg County, along with much of rural America, away from Democrats and into the arms of Republicans. “I’ve seen so many people that were strong Democrats but changed because they felt that Democrats were not Christian,” says Greenville Mayor Jan Yonts. (She’s a Democrat but her office is nonpartisan.) “They feel that Democrats are baby killers.”

Along a commercial corridor in Central City, which is the most populous city in Muhlenberg County, a Baptist church is fronted by a 50-foot tall lighthouse with the name “Jesus” spelled out in enormous black letters along two sides. Churchgoers in Central City have plenty of other choices for places to worship. “Religion makes a big impact here,” says Jack Reno, who chairs the Muhlenberg County Democratic Party. “Rural Kentucky is very much religion first, guns second.”

Reno credits Republicans with doing “a fantastic job” of tying all Democrats to national party figures such as Joe Biden and Nancy Pelosi who don’t play well in rural Kentucky. Just under 31,000 people live in Muhlenberg County, making it possible for local candidates to make themselves known and liked by enough voters to win office. But it’s become increasingly difficult for them to carve out identities that separate them enough from national Democrats to win.

“I’ve had a lot of discussions with my neighbor and he was actually surprised I was a Democrat,” says Brittney Hernandez-Stevenson, the party’s candidate for state House seat in the county. “Some of the support that I think I would get, I may not, unless they pay attention to me as a person and the things I’ve done, versus my party.”

A rural populist Democrat's campaign for U.S. Senate seat from Missouri

Stephanie Akin reported for Roll Call last week about the candidacy of Democrat Lucas Kunce for the U.S. Senate seat from Missouri.  Here's an excerpt focusing on the rural vote: 

Rural voters receptive

Aftyn Behn, the campaign director for RuralOrganizing.org, one of several Democratic groups focused on winning rural voters that has sprung up in the aftermath of Trump’s first election, said their research shows that rural voters are receptive to populist messages.

“Rural voters aren’t looking for a more corporate candidate,” she said. “They’re looking for a candidate who will fight for small businesses, fight corruption. They really want authentic messagers.”

The group has been advising Democrats to adopt “hyperlocal strategies,” hire local campaign teams and not skirt identity issues, like support for abortion rights, that their polling says are popular in rural areas, contrary to a lot of assumptions. Those are all things Kunce is doing.

He brags that 14 of the 18 people on his staff are from Missouri. And he says outlawing abortion on a federal level will create a “two-tiered system” under which “country club Republicans” will still fly their wives and daughters and mistresses to get legal abortions.

“That’s un-American,” he said, adding that he wants to get rid of the filibuster to codify Roe v. Wade.

Daniel Ponder, a Drury University political scientist, said Missouri voters have shown their receptiveness to progressive issues even in areas that have become deeply Republican. In 2018, the same year Hawley won the Senate race, Missouri voters overwhelmingly passed measures to legalize medical marijuana and raise the minimum wage, for example.

“I do think that Democrats are going to claw their way back into it, and I think Kunce is on to the right strategy,” he said. “Whether that takes root in 2022 or not is the question. I kind of doubt it. We’re still in a polarized era. Maybe over the next few election cycles.”

Candidate takes on "Dirt Road Democrat" label--and a bold progressive stance--in Missouri legislative race

Screenshot from Twitter feed on July 3, 2022

Jess Piper is a Democrat trying to flip the script for her party in rural northwest Missouri as she seeks a seat in the state legislature.  I've been following her for a while, and she'd been getting bolder in her progressive stances.  Piper's main calling card--beyond generally pointing out the existence of rural progressives and trying to rally the troops--is saving rural schools.  She recognizes that money flowing to charter schools will be particularly harmful for already under-funded rural schools.  (Senator Jon Tester of Montana made this point about rural schools in his book, Grounded). Piper, herself a former teacher, often deploys the slogan Dirt Road Democrat as she talks about the loss of other rural infrastructure, such as rural hospitals. 

Here are some additional screenshots from her campaign's Twitter feed:  

Piper has also been outspoken about the reversal of Roe v. Wade in the U.S. Supreme Court's Dobbs decision handed down about 10 days ago. 

This is from the Fourth of July, at a pro-choice rally in Kansas City, not in the district Piper seeks to represent.  

Screenshot of Melissa Robinson Twitter Feed July 4, 2022

And here's a TikTok video she posted on July 1, after a day of knocking on doors in Burlington Junction, population 537, in Nodaway County.  

Whatever happens in the election this fall, I admire Piper's courage, boldness, and energy. 

Postscript:  On July 5, 2022, Piper picked up this endorsement from the Missouri National Education  Association.  

This earlier post based on a Washington Times story also features Piper.  

On Democrats' political neglect of the rural South and, as a related matter, how they fail the rural poor

I'm old enough to remember when Democrats counted on Southerners, including rural residents, to win presidencies and control the U.S. Congress.  Lately, of course, that has not been the case.  Most attribute that to the racism of Southerners.  The conventional wisdom is that Southerners moved toward the Republican Party during and after the Civil Rights era, alienated by the Democrats' concern for and assistance to people of color.  Republicans efforts to leverage the Democrats' assistance to Black folks is referred to as The Southern Strategy (though Angie Maxwell and Todd Shields have written a more nuanced analysis in a book called The Long Southern Strategy).  

But what role does Democrats' neglect of Southern voters play in Republicans' recent dominance in that region?  That is, how hard has the Democratic Party worked over the past few decades at attracting these voters?  I was struck by this from a recent New York Times guest column by a woman who lives in Alabama: 

The South has flaws, but so does every place. Every time I write an essay about my home, I get hate mail. It’s less directed at me and more directed at the South — a place that I am sometimes told should no longer exist. It’s easy to write off an entire region from afar, less easy when you live here.

There’s so much beauty in rural Alabama, and it often abuts terrible poverty. A brilliantly hued hydrangea next to a trailer with blacked-out windows. A row of abandoned old houses next to a field of unmown wildflowers. I do believe that Democratic policies are friendlier to the poor, but how would you know that if you live in a trailer without running water or internet in the middle of a state that has long been out of play for Democratic candidates in national elections? (The victory by a Democrat, Doug Jones, in the U.S. Senate special election in 2017 was anomalous; three years later, he was beaten by a Republican former college football coach with no political experience.)

I understand why Democratic presidential candidates wouldn’t want to waste time and money campaigning here; Alabama feels as if it belongs to Republicans. This is a state with three abortion clinics. As of 2017, there were 113 of them in New York.

* * *

I can believe in the ideals of the Democratic Party while believing that the party has, in certain respects, lost its way; I can become enraged at its recent, hollow attempt to codify abortion rights into federal law. The party’s leadership seems to be looking at this moment as a way to improve its chances in the midterms.

* * *

I look at this moment quite differently. I think of all the poor women who live in this state, the women who will disproportionately be forced to carry pregnancies they do not want, who cannot afford to travel to the nearest clinic that legally provides abortion. Is it naïve to wonder why Democrats at the national level didn’t try harder to provide easier access to abortion in red states when they could have? Why don’t elected officials truly serve both the people who vote for them and the people who don’t? That these questions seem naïve, that I already know the answers, doesn’t make them any less pressing.  

On Dobbs: More women must now travel (to states where abortion is legal), but rural women have been burdened by travel all along

In Dobbs v. Jackson Women's Health decided a few days ago, the U.S. Supreme Court overturned Roe v. Wade (1983). This means abortion will now only be available in some states, and the laws of other states prohibiting abortion will be respected--not trumped by a federal right.  This turn of events means the pro-choice community is once again talking about the burden of travel--travel from jurisdictions without abortion rights to those where abortion is legal.  

This focus on travel is a bit ironic to me because I have been writing about rural women in relation to abortion access for 15 years.  Yet that work--focusing on the distances rural women must travel to access abortion--has rarely gotten traction among mainline abortion scholars.  (My earlier work is here, here, here and here). 

Here's an excerpt from my first article on the topic, Toward a Feminist Theory of the Rural (2007), in which I sought to demonstrate that burden by reference to a woman living in Boulder, Utah, though which I'd travelled a few years earlier while visiting Grand Staircase Escalante National Monument.  Leavitt refers to Utah Women’s Clinic v. Leavitt, 844 F. Supp. 1482 (D. Utah 1994); Casey refers to Planned Parenthood of Pennsylvania v. Casey, the Supreme Court's 1996 decision holding that no state could pass a law that imposed an"undue burden" on the abortion right:

The geography of Utah may be referenced to illustrate th[e] point [that Casey's 'undue burden" standard, and the ways in which it has been interpreted, has particular consequences for rural women]. Consider first a working-class woman in Salt Lake City who enjoys little work schedule flexibility. She would likely have difficulty securing time off both to go through the informed consent meeting and to have the abortion. Depending on her schedule, she could arrange the two different appointments on different days of the same week or on consecutive weeks. If she were without a vehicle but lived in the Salt Lake City metro area, she would have some public transportation options to facilitate her journeys. Making two trips would likely be inconvenient, even burdensome to her. Multiple journeys might, for example, significantly increase the cost of the abortion if a lack of work flexibility or the existence of other duties forced her to schedule her second appointment during her second trimester. Still, the burden of the waiting period on her is unlikely to be as great as that on a woman living in rural southern Utah, as far as 300 miles from Salt Lake City.

Imagine a woman living in Boulder, Utah, for example, in the shadow of Grand Staircase-Escalante National Monument and fifteen miles from Utah Highway 12. She would be 327 miles (seven hours) from Las Vegas, (seven hours and fifty-five minutes) from Flagstaff, Arizona, hours and fifty-eight minutes) from Aspen, Colorado, 367 miles 381 miles (seven and 261 miles (five hours and twenty-nine minutes) from Salt Lake City, the locations of the four nearest abortion providers. These one-way travel times assume the woman has access to private transportation. If she does not and must rely on public transportation, her situation is even more dire. Boulder, Utah, has no public transportation services.

The nearest Greyhound bus stop is 143 miles (three hours and forty minutes) away in Parowan, Utah. Only two buses a day serve the Parowan-Salt Lake City route, and the journey each way is four hours. A woman without a car, living in Boulder would thus have to borrow a car or hitch-hike to Parowan, and then make a four-hour bus journey to Salt Lake City, the site of the nearest abortion clinic.

A working-class woman with little work schedule flexibility, but this time in rural Utah, will face considerable practical and financial obstacles to terminating her pregnancy. If, as Leavitt assumes, she is able to secure consecutive days off from work, her burden may nevertheless be greater than an overnight hotel stay. If she must travel several hours to reach the bus station and several more by bus to reach the abortion provider (and again to return home) the woman may need three or more consecutive days off work—and several nights’ hotel stay—to accomplish the termination. If, contrary to the Leavitt court’s assumption, she is unable to take several consecutive days off work, the obstacles are much greater. A woman in such a situation will not only have to make two return journeys to Salt Lake City by whatever means are available, each of those journeys may require several days. Contrary to Leavitt’s conclusion, then, the worst-case scenario may not be merely an overnight stay. It may be several days’ stay. It may, in fact, require two journeys, each lasting multiple days, with attendant impacts on the woman’s employment, family and financial circumstances.   

An even more dramatic example could be generated from the geography of Alaska, with its dearth of abortion services, which the Leavitt court used to illustrate its point that there is no constitutional right to convenience in procuring an abortion. But Casey made accessibility relevant by burden standard, and at some point—even the Leavitt court might concede if it acknowledged detailed facts—waiting periods constitute an undue burden for the most isolated, most disadvantaged women.

My aim here is not to identify the most extreme example of hardship created by waiting periods. Rather, it is to demonstrate that courts have not seriously considered the practical obstacles confronting rural women. As Judge Wood wrote in A Woman’s Choice, the undue burden question “is whether an Indiana woman living 60 miles away from a clinic in Indiana who cannot afford (either financially, socially, or psychologically) to make two visits” will be deterred from exercising her fundamental right. The undue burden standard is not only about the woman who is worst-situated for getting an abortion; it is about all those who will be deterred by the obstacle that the waiting period presents.

Certainly, some women in rural areas will be better situated to secure abortions than others, even in states with mandatory waiting periods. Women with job flexibility and security, and access to a car, child care, and—of course— money, will more easily overcome the obstacles. But the Casey Court said that, for the purposes of analyzing any regulation, “[t]he proper focus of constitutional inquiry is the group for whom the law is a restriction, not the group for whom the law is irrelevant.”  (emphasis mine)

One purpose of this article was to make as real or identifiable as possible, for judges and scholars, the burden of distance.  I was trying to put them in the shoes of rural women. This approach--specifying just how great the practical burden would be on some women, was not one I'd then seen in briefs or court opinions; the closest to it was the NAACP brief in Casey, which mentioned rural women. 

By the time the Supreme Court decided Hellerstedt v. Whole Woman's Health (2016), the Court was paying much more attention to the burden of distance and even used the word "rural."  That explicit mention of rural women felt like a victory to me.  Here's what I wrote elsewhere (with Ezera Miller-Walfish) detailing the Hellerstedt Court's handling of the burden associated with rurality and distance more generally: 

In Whole Woman’s Health v. Hellerstedt, Justice Breyer, writing for the majority...used the word “rural” only once, though he used the word “miles” 19 times.

Specifically, Breyer quoted the trial (federal district) court opinion, which acknowledged the added burden the clinic closures were causing “poor, rural, or disadvantaged women.” The disadvantaged group most focused on in that litigation were Latinas living in the Rio Grande Valley, who tended to be “poor, rural and disadvantaged.” Interestingly, the Court did not again use the word “poor” or “poverty” in the majority opinion, which is bit unusual–and disappointing–given that poor women disproportionately seek abortions compared to their more affluent counterparts. The Court did, however, use the term “Rio Grande Valley” twice, which suggests that population drew particular solicitude.

The Hellerstedt Court’s use of “miles” also mostly tracked the district court’s findings, here about the specific impact of the law on women’s abortion access. Because the challenged law had the effect of closing abortion providers across Texas, the geographical distribution of abortion providers shifted, with these consequences:

[T]he number of women of reproductive age living more than 50 miles from a clinic has doubled, the number living more than 100 miles away has increased by 150%, the number living more than 150 miles away by more than 350%, and the number living more than 200 miles away by about 2,800%.

Also looming was the fact that if another pending restriction went into effect, Texas would have abortion providers “only in five metropolitan areas.” Finally, Breyer used “miles” when quoting the federal district court for the proposition that Texas is big–specifically, that it covers nearly 280,000 square miles and that 25 million people–5.4 million of them women of reproductive age–live on that vast land area.

Ultimately, Breyer’s opinion concluded:

We recognize that increased driving distances do not always constitute an “undue burden.” See Casey, 505 U. S., at 885–887 (joint opinion of O’Connor, KENNEDY, and Souter, JJ.). But here, those increases are but one additional burden, which, when taken together with others that the closings brought about, and when viewed in light of the virtual absence of any health benefit [from the Texas law], lead us to conclude that the record adequately supports the District Court’s “undue burden” conclusion.

That was a real victory for rural women, however defined, though the focus was much more on the distance–really increased distance–that any woman might have to travel to reach an abortion provider. Though this did not explicitly focus on rural women, the Hellerstedt majority went much further than any prior opinion in taking seriously material distance, expressed as miles traveled.

I thought, after Hellerstedt, that abortion rights were safe for a while.  And I was thrilled that the Court finally acknowledged the burden of distance.  But alas, we have seen now that the abortion right is entirely gone, leaving abortion access a patchwork among states. 

Somewhat ironically, this means many more women will be traveling for abortions--but they will be traveling between states--between those where abortion is illegal and those where it is legal.   Suddenly, it seems, the pro-choice community is thinking about the burden of travel again--just as they were before Roe v. Wade.  

My earlier musings here on Legal Ruralism about the struggle to get our urbannormative nation to see rural distance are here.  This story in the New York Times was especially urban-centric, focusing on the consequences when clinics in more remote parts of state (especially the Rio Grande Valley) closed, sending those rural women to the larger urban clinics that remained open and impeding urban women's access to services.  Of course, something similar will happen now, as women from "red" states will clog the abortion clinics in "blue" states, impeding the latter's access to services.    

Hannah Haksgaard of the University of South Dakota has also written about these issues here and here, the latter commenting on an international collection on the need to travel for abortion services, Abortion Across Borders: Transnational Travel and Access to Abortion Services by Christabell Sethna and Gayle Davis (2019).

Here is a related post from May, 2022, on the Daily Yonder.  Recent postings to that website also feature a useful map.  

Rural California prosecutor brings murder charges against women who experienced stillbirths

The San Francisco Chronicle reports from Hanford, population 35,000, the county seat of Kings County, California.  The headline for Lauren Hepler's story is, "Two women were charged with murder after having stillbirths. The cases are rocking this conservative corner of California."  Here's the lede:  

In early 2018, a 29-year-old Central Valley woman became the first person in decades to be jailed in California for the death of her stillborn infant.

In late 2019, it happened again. Another pregnant woman who struggled with addiction delivered a stillborn baby who tested positive for methamphetamine at Adventist Health hospital in the Kings County seat of Hanford. She was also flagged by doctors, investigated by local law enforcement and charged with murder by District Attorney Keith Fagundes.

The cases sparked national backlash from civil rights groups, which successfully fought to overturn the convictions. But now, as Gov. Gavin Newsom positions California as a reproductive rights sanctuary ahead of the Supreme Court’s anticipated reversal of Roe v. Wade, the cases are once again dividing residents in a bitter district attorney’s race in this corner of California’s heartland.

Increasing polarization between so-called red states and blue states

Shawn Hubler and.Jill Cowan reported yesterday for the New York Times under the headline, "Flurry of New Laws Move Blue and Red States Further Apart."  While I often remind folks that "red" is not synonymous with "rural state" and "blue" is not necessarily synonymous with "urban state," I'm doing to indulge the shorthand here, making it my justification for blogging about the story here on Legal Ruralism.  A brief excerpt from the Hubler-Cowan story follows:   

After the governor of Texas ordered state agencies to investigate parents for child abuse if they provide certain medical treatments to their transgender children, California lawmakers proposed a law making the state a refuge for transgender youths and their families.

When Idaho proposed a ban on abortions that empowers relatives to sue anyone who helps terminate a pregnancy after six weeks, nearby Oregon approved $15 million to help cover the abortion expenses of patients from out-of-state.

As Republican activists aggressively pursue conservative social policies in state legislatures across the country, liberal states are taking defensive actions. Spurred by a U.S. Supreme Court that is expected to soon upend an array of longstanding rights, including the constitutional right to abortion, left-leaning lawmakers from Washington to Vermont have begun to expand access to abortion, bolster voting rights and denounce laws in conservative states targeting L.G.B.T.Q. minors.

Other culture wars issues playing out in state legislatures:  abortion and voting rights.  The NYT piece continues:

Some legal analysts also say the anticipated rollback of abortion rights could throw a host of other privacy rights into state-level turmoil, from contraception to health care. Meanwhile, entrenched partisanship, which has already hobbled federal decision making, could block attempts to impose strong national standards in Congress.

“We’re potentially entering a new era of state-centered policymaking,” said Karthick Ramakrishnan, a professor of public policy and political science at the University of California, Riverside. “We may be heading into a future where you could have conservative states and progressive states deciding they are better off pushing their own visions of what government should be.”

The story notes that control of the state legislature is split between parties in only two states:  Minnesota and Virginia.  Contrast that with 15 states with divided legislatures just three decades ago.  Hubler and Cowan note a lot of legislative activity in the American West, in particular.  

As a related matter, my colleague recently noted on Twitter that California is now banning business travel to 20 states based on their regressive laws on LGBTQ issues.   

And that reminds me of this January 2017 column, by Roger Cohen for the New York Times, published soon after Trump's election:   

Getting America out of its mess begins with the acknowledgment that New York and California do not have a stranglehold on truth, any more than Kansas and Missouri do. Out there in God-fearing gun country there are plenty of smart, upstanding Americans who, as Mark Lilla of Columbia University put it, paraphrasing Bernie Sanders, are “sick and tired of hearing about liberals’ damn bathrooms.”

Oh, and after this Hubler-Cowan New York Times story on red-blue divide was published, Oklahoma passed a draconian abortion law, providing yet another piece of evidence of this red-blue divergence.