General Discussion

McCamy Taylor

(19,240 posts) Sat May 10, 2014, 06:47 PM May 2014

GOP "Family Values": When Rural Hospitals Close for Lack of Medicaid, Women and Children Die

You should not need a study to prove it, but one was done anyway. In 1991, the Indiana University Department of Family Medicine discovered a statistically significant association between living in a rural county that lacked adequate obstetric coverage and infant mortality. Now, association does not prove causality, but if this is your first baby, and he is coming out breech and gets stuck and there is no one to do a stat c-section, your baby may not survive long. Or, if you go into early labor, and there is no one who knows how to administer the appropriate drugs to stop that labor, you may deliver a baby that is extremely small---with no Neonatal ICU staff around to save its poor little life.

http://europepmc.org/abstract/MED/1744606/reload=0;jsessionid=6DDvrJ8h0qU8tBmmnZ45.0

If you read my last journal, you know that Georgia Republican legislators are gleefully forcing “crack addicted” rural hospitals out of business on the grounds that it’s healthier for our country’s economy if we have fewer crack addicted hospitals among us. Unfortunately, it is not healthier for our country’s health. Rural women, in particular, suffer when they are denied access to health care that urban women take for granted.

General health conditions and behavior that U.S. rural women experience at higher rates than their urban counterparts include, self-reported fair or poor health status, unintentional injury and motor vehicle-related deaths, cerebrovascular disease deaths, suicide, cigarette smoking, obesity, difficulty with basic actions or limitation of complex activities (4, 5), and incidence of cervical cancer (6). Other comparisons show that death rates from ischemic heart disease in rural women exceed that for all U.S. women. In some regions of the country, women in nonmetropolitan areas have higher rates of heavy alcohol consumption (4). Proportionately fewer rural women receive recommended preventive screening services for breast and cervical cancer. Rural African American, Hispanic, Asian, and white women are less likely to have cervical cancer screening. African American, Hispanic, and white women are less likely than their urban counterparts to have mammograms (7). Comparisons of female patients in whom invasive breast cancer was diagnosed in Georgia from 2000 to 2009 indicate that women living in small rural and isolated areas were 30% more likely to have surgery and 17% less likely to receive radiotherapy as first-course treatment than their urban counterparts. Also, within these rural areas, African American patients were 57% less likely to have surgery than white patients.

http://www.acog.org/Resources_And_Publications/Committee_Opinions/Committee_on_Health_Care_for_Underserved_Women/Health_Disparities_in_Rural_Women

Rural women do not have the “Choices” that urban women have (from the link above):

Local availability of abortion services also is a concern. Eighty-seven percent of U.S. counties, in which 35% of reproductive-aged women lived, had no abortion provider in 2008. Obstetrician–gynecologists with rural mailing addresses were significantly less likely to perform abortions (6.5%) than their urban counterparts (17.0 %) (32). Rural women seeking abortions in 2008 traveled substantially greater distances than nonrural women. Thirty-one percent traveled more than 100 miles and an additional 42.9% traveled between 50 miles and 100 miles, compared with 3.8% and 7%, respectively, for nonrural women (33).

Among the 14 states ranked the highest on percentage of women aged 13–44 years in need of publicly funded contraceptive services and supplies, nine have rural populations exceeding 33% of the state population (20, 34). Only 46% of the agencies providing publicly funded family planning services reported that their clinic sites are located in mostly rural locations, the majority of which are health departments and Federally Qualified Health Centers (35). In Colorado, where almost three-quarters of the counties are considered rural, substantial numbers of reproductive-aged women live in counties where there is no identified pharmacy or health clinic that either prescribes or fills prescriptions for contraceptives (36). Despite concern about access to emergency contraception, data on current over-the-counter availability of emergency contraception in U.S. rural pharmacies are lacking.

And here, I have to wonder, is this all part of some huge Tea Party conspiracy? Deprive rural women of doctors, hospitals, so that they have no access to birth control or abortion? Force them to deliver their babies at home, without anesthesia, so that they can suffer the “wages of sin”? And what about the children who are born early, who die or who suffer the lifelong effects of prematurity? Is this the Religious Right’s way of ensuring that the “sins” of the mother will be passed on to the offspring? Remember, these are the sickos who objected to the HPV vaccine on the ground that cervical cancer is God’s way of punishing women for having sex, and if the state prevents God from punishing women for having sex, then the state is attacking religion.

Just how bad are things for women in rural America? While life expectancy for most people in the industrialized world keeps rising, women living in rural counties in the south and west of the United States have seen an increase in preventable death.

A new study offers more compelling evidence that life expectancy for some U.S. women is actually falling, a disturbing trend that experts can't explain.
The latest research found that women age 75 and younger are dying at higher rates than previous years in nearly half of the nation's counties — many of them rural and in the South and West. Curiously, for men, life expectancy has held steady or improved in nearly all counties.
The study is the latest to spot this pattern, especially among disadvantaged white women. Some leading theories blame higher smoking rates, obesity and less education, but several experts said they simply don't know why.

http://www.usatoday.com/story/news/nation/2013/03/04/study-life-span-women/1963093/

In Texas last fall, one rural community discovered exactly what can happen when the only hospital in town closes:

On this much, everyone agrees: 18-month-old Edith Gonzalez, who charmed folks in this East Texas town by shaking her pink tambourine in the church choir and pretending to mother her baby sister, shouldn’t have died.
A grape was stuck in her throat. Her family rushed her to nearby Shelby Regional Medical Center. But the hospital was locked and empty.
“I feel in the depth of my soul had a simple ER unit been in the Center area, the child would have survived,” said Charles Bush, a bystander who held her head and prayed as the family waited in vain for help.
The toddler’s Aug. 12 death has starkly exposed the vulnerabilities of a rural community suddenly left without its longtime safety net.

http://www.dallasnews.com/investigations/patient-safety/headlines/20130928-loss-of-east-texas-towns-hospital-hits-home-after-toddler-chokes-dies.ece

The hospital in question was kept afloat through fraud and mismanagement. It’s pretty difficult to make a profit from a rural hospital, when you are required by law to provide free care to folks that the law does not care to provide health insurance. When the owner was finally turned in, the hospital shut down, leaving the town---and Edith’s parents---with no place to turn in an emergency.

This is what the “best health care in the world” has accomplished---a system in which rural women and their children are treated as disposable. And the self-styled family values Republicans seemed determined to keep the rural women and children of their own states living---and dying---for lack of health care. This truly is America held hostage.