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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Seven cases of H5N1 avian flu have been reported in Michigan since Dec. 16. The first case was discovered at a poultry facility in Ottawa County.

Avian flu circulates in wild birds and can infect poultry, causing illnesses classified as highly or low pathogenic. Michigan's first cases in 2022 introduced a highly pathogenic strain.

Dr. Kimberly Dodd, dean of the College of Veterinary Medicine at Michigan State University and an infectious disease expert, explained why the initial outbreak was unique.

"Generally, once it comes to wintertime the number of cases drop off and sometimes that's all we see at the outbreak, and it's resolved," Dodd noted. "In this case, the outbreak continued over the winter and spread across the entire country."

The recent outbreak has affected more than 340,000 birds. Early findings showed the virus also infecting wild mammals, especially young carnivores and scavengers, later spreading to marine mammals near infected waterfowl.

As of now, avian flu has been detected in 30 dairy cattle herds across Michigan. The initial case, reported in March 2024, marked the first instance of avian flu in dairy cattle in the U.S. Since then, the virus has spread to additional herds around the state. Dodd pointed out dozens of domestic and wild cats were also infected after the virus spread to dairy cattle.

"We think this is primarily due to the fact that these barn cats may have access to raw milk on the farm," Dodd emphasized. "We know that raw milk contains high levels of virus."

The Centers for Disease Control and Prevention has reported 67 confirmed human cases of avian flu in the United States, with one death reported in Louisiana. However, the CDC views the situation as a low health risk to the public.


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The Medicaid and CHIP programs are vital to rural Missouri, according to a report that says reliance on this safety-net health coverage is much higher in small towns than in cities - especially for children.

The Georgetown University report says proposed federal cuts threaten rural communities, where nearly 41% of children rely on Medicaid, compared to 38% in metro areas.

Dr. Shanon Luke, a pediatrician at a Federally Qualified Health Center in rural Missouri, said her clinic is essential to a community where the nearest hospital is 45 minutes away.

"The clinic being open is incredibly important to these kids receiving healthcare," said Luke. "Having Medicaid allows them to come in for their well-child checks, and for us to do some monitoring and treating of things before they get to scary points."

The report says to stay afloat, many rural hospitals have already been forced to close less profitable units. In 2022, 52% eliminated their maternity wards, compared to 36% of urban hospitals.

The report also reveals disparities, with about 40% of American Indian and Alaska Native people more likely to live in non-metro areas without access to adequate healthcare.

Joan Alker is the executive director and co-founder of the Center for Children and Families at Georgetown University. She said Medicaid helps recipients through much-needed preventive care.

"People wind up sicker and then, they're in the emergency room," said Alker, "and children can't get their asthma inhalers and they miss school."

Statistics show Medicaid helps prevent medical debt, covers most nursing home residents, and funds a significant portion of births and maternal care - issues Dr. Luke said her patients are familiar with, firsthand.

"For our families, both financially and medically, as well as mentally," said Luke, "it's really important to know that they have that coverage."

Just over 24% of Missouri's population lives in rural areas.

This month is National Blood Donor Month, and blood donor groups are making sure people know the importance of giving blood.

Blood can't be manufactured, so people need to donate blood at their local blood bank. Nearly 400 people a day donate blood to the American Red Cross in the DMV metro area.

Bethany Bray Patterson, communications director of the National Capital and Greater Chesapeake Region of the American Red Cross, said donor blood is used in a variety of medical situations.

"Donated blood," said Patterson, "goes to people who are heading into surgery, fighting cancer, newborn babies in the NICU and people who are living with sickle cell disease and other chronic illnesses."

Patterson added that someone in the U.S. needs a life-saving blood transfusion every two seconds.

However, only 3% of eligible donors donate each year. According to America's Blood Centers, if just 1% more of Americans donated, blood shortages would be alleviated.

Patterson said the blood supply in the country is stable, but organizations like the Red Cross are also on the look out for universal donors.

"There is an increased need right now for type O blood donation, and platelet donations," said Patterson. "Type O blood is always in demand. It's often going out to hospitals faster than it's coming in through blood donation, because it is the universal blood type. It's used the most by hospitals."

You can find blood donation locations and schedule an appointment at RedCrossblood.org.




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