In the last decade in Wyoming, three hospitals have closed their maternity ward. That includes Rawlins, where pregnant moms now have to risk travel on Interstate 80—notorious for weather-related closures—to deliver their babies in Laramie, 100 miles away.

But Wyoming isn’t the only state to face inadequate maternal care: Less than half of the rural hospitals in America even offer labor and delivery services.

Gwenith Wachter has experienced this erosion firsthand. She first gave birth in her hometown of Riverton, Wyoming, back when the local hospital was a bustling place with a well-seasoned staff. By 2016, the for-profit hospital’s owner had closed its labor and delivery unit. Five years later, when her last child was arriving, she had to travel 26 miles to Lander, the closest birthing facility.

Today, her county of Fremont, a New-Hampshire-sized area home to 40,000 people, has gone from two birthing hospitals and many obstetricians, to one delivery facility and a single pregnancy doctor for the general population. The trend prompts women in increasing numbers to travel out of the county to give birth—an expensive and logistically challenging option. “I just think it’s insane,” Wachter said. “It puts women at risk.”

The statistics bear out her observation. Women who live farther from delivery hospitals are more likely to experience adverse medical outcomes, such as requiring neonatal intensive care. 

But with traveling doctors and nurses filling the on-call schedule gaps, Fremont County has it better than some other rural counties, because at least it has a birthing facility. Keeping one going is complicated by factors like the unprofitable nature of deliveries for hospitals and burnout of medical staffers.

In an unfortunate “Catch-22,” robust health care is a key ingredient in creating the local jobs and tax revenue that in turn, drive patient volume and support the economics of rural communities. Worse, said University of Wyoming professor and midwife Esther Gilman-Kehrer, without enough staff, “I would envision that at some point we’ll see deaths.” 

Women who received no prenatal care at all are showing up already in labor at Fremont County general hospitals, according to nursing staff. Add that to the prevalence of risk factors like diabetes, substance abuse and high rate of travel, and the chance of a bad outcome grows.

Wyoming’s maternity-care gap, however, is not the state’s issue of highest concern—not by a long shot. It competes with other challenges such as high suicide rates and declining coal mining revenues. Many lawmakers also appear more interested in hot-button social issues like school library policies. People outside of the childbirth realm express shock when I tell them that health care for women has sharply deteriorated.

The state has begun to take notice. An obstetrics subcommittee of Gov. Mark Gordon’s Health Task Force is working to gather data on doctor shortages. An effort to create a maternal health strategic plan could spring from a University of Wyoming program. What’s known is that many factors, including more livable schedules and the chance for better pay offered at city hospitals, make it difficult to attract promising medical professionals.

Another issue is a pair of abortion bans held up in litigation. The Wyoming Legislature argues that while the state constitution guarantees residents the freedom to make health care choices, those choices don’t include abortion because “abortion is not health care.”

Will good solutions come fast enough? From 2018 through 2020, 13 Wyoming women died during pregnancy or within one year after the end of their pregnancy, according to the state health department. All six pregnancy-related deaths were deemed preventable. Meanwhile, maternal mortality more than doubled in the United States from 1999 to 2019, putting us far behind other first-world countries.

It’s a fundamental experience for women to have a baby, yet even in the smoothest case, there are lasting implications for women’s bodies. It’s time to stop shrugging the matter off and start treating maternity care with the gravity it deserves. The health of moms is absolutely central to healthy families and thriving communities.

Katie Klingsporn is a contributor to Writers on the Range, writersontherange.org, an independent nonprofit dedicated to spurring lively conversation about the West. She lives in central Wyoming and recently wrote a series about Wyoming’s maternal care shortage for WyoFile.

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The editorial was fierce: “It doesn’t seem to matter how horrible the care … how many of these residents live in filth and squalor … the responsible authorities apparently make little to no effort to whip the homes into shape or, failing that, shut them down.”

In 1976, my disabled brother, Mike Trimble, died in just such a care home, in Denver. I’ve spent a decade researching his life and death for my book, “The Mike File,” and I know well the details and politics of his death.

Mike left home after turning 14 when his diagnosis — “paranoid schizophrenia, capable of violence” — shattered our family. A court committed him to the Colorado State Hospital in 1957. He never lived at home again.

When mental hospitals emptied their wards a decade later, Mike was mainstreamed back to Denver. Rejoining our family did not go well. Angry and resentful, Mike’s visits triggered emotional chaos. He soon cut off all contact.

In 1976, Mike died during a seizure, alone in his boarding home and undiscovered for three days. The Denver media used his solitary death to expose the “ratholes” that warehoused people with mental illness. Our mother found out about the loss of her 33-year-old son from the front page of the Denver Post.

The owner of Mike’s ironically named “Carefree Guest Home” described his death as a “slip up.” The staff member who should have checked on Mike was “snowed under.” Two other residents had died unnoticed in previous months.

In the days following Mike’s death, the director of the Colorado Commission on the Disabled demanded action. “I’m …thinking …of the other 85 residents there,” he said. “How many of them were not seen over the weekend but did not die?”

Officials issued “a severe reprimand.” Dr. Paul Kuhn, director of Denver’s Personal Health Service, said that Carefree had made “significant improvements,” but he mentioned only one: “Anyone not in the breakfast line is sought out and checked.”

Kuhn gave Carefree a break because of poor funding that left the guest home perpetually understaffed. “This is more than a Denver problem,” he said. “It’s a statewide problem. It’s a great societal problem.”

Reprimand issued, case closed, but hardly progress.

In 2002, The New York Times ran a Pulitzer Prize-winning series that included the story of Randolph Maddix, living in a private home for the mentally ill in Brooklyn. Maddix died during a seizure and wasn’t found for many hours. “His back, curled and stiff with rigor mortis, had to be broken to fit him into a body bag.”

In 2006, the Milwaukee Journal-Sentinel ran a series on the horrors of board-and-care homes, including the tale of a resident who died and wasn’t found for three days. These stories of outrageous neglect keep recurring, always about people overwhelmed by their mental disorders and neglected by their caregivers.

Why does Dr. Kuhn’s “great societal problem” persist?

As we steadily eliminated more than 500,000 beds in state psychiatric hospitals starting in the mid-1950s, according to a study by the American Psychiatric Association, the number of people with severe mental illness was growing with the U.S. population. Stigma and shame often silenced their families. Effective treatment disappeared into the fog of competing agencies, with no coordinated plan for people with chronic mental illness. Then add today’s epidemic of homelessness and prisons crammed with people who need psychiatric treatment more than incarceration.

While researching my book, I spoke with a Colorado psychologist who summed up our failure to care for our mothers and fathers, our brothers and sisters, our children and friends: “The mentally ill don’t have a strong lobby.”

The recent Tribune editorial proposes incentives for decently run care homes and appropriate punishments for neglect. But what we really need is a transformative system of care for the vulnerable and voiceless, and housing for those without homes. We know what to do. So far, we have chosen not to act.

This problem remains with us, just as it did in 1976 when I lost my brother. Please don’t let us read these same plaintive stories and unanswered calls for action when another 50 years have passed.

Utah writer Stephen Trimble is a contributor to Writers on the Range, writersontherange.org, an independent nonprofit dedicated to spurring lively conversation about the West. His latest book is “The Mike File: A Story of Grief and Hope.”

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But now, sadly, Wyoming has agreed to subjugate women. In March, Wyoming’s governor signed a “trigger bill” that would ban abortions in the state five days after the Supreme Court overturned Roe v Wade, which it did June 24.

Around the West, other states including Idaho, Utah, North Dakota, South Dakota and Oklahoma also passed bills restricting women’s reproductive health soon after the Supreme Court acted. Texas had a tough law that banned virtually all abortions since 2021, although their new law, set to take effect in the next month, introduces even harsher measures — a near-total ban, even after incest and rape.

Fortunately, some Western states recognize the needs of women, and are already being sought out by women seeking abortions who are blocked at home. Colorado passed an act in March giving anyone pregnant the “fundamental right to continue the pregnancy… or to have an abortion.”

Three coastal states, California, Washington and Oregon, said they would be havens for women seeking abortions. In addition, Oregon allotted $15 million to help cover abortion costs even for non-residents.

Corporations are also becoming allies. Apple, Citi, and Yelp adjusted their corporate policies in Texas to include travel for abortions as part of health insurance packages. Lyft and Uber have promised to pay legal fees if their drivers are charged with the crime of “assisting” abortion patients.

Ironically, when Covid-19 was rampant, I often heard Westerners express a common sentiment about getting vaccinated, or not: “It’s my body and my choice.” I almost laughed, as that’s the cry of women who want the choice of becoming a mother, or not.

Before the Supreme Court decision was announced, I began talking to people about their views on access to abortion, and as you would expect, reactions were mixed, though no one I spoke to for this opinion agreed to be quoted by name due to privacy concerns. At a block party, a 22-year-old Jackson man, who self-identified as Hispanic, said he thought of abortion as “one of the worst sins.” Then he surprised me by adding, “But a woman should be able to make that decision.”

At a pizza joint, a fourth-generation Jackson resident I’ve gotten to know, said, “I don’t think the government should have a say about your individual body… The government should be building roads. We don’t believe in big government.”

An Indigenous man in his late 20s said, “Humans should be able to make choices for their own human bodies. Otherwise, we’re going back to slavery.”

Still, I get the sense that many well-intentioned men, trying to be supportive of the women around them, are opting to step back and let women fight this battle. This reticence has started to feel like men are saying, “Not my body, not my problem.” Perhaps our state legislators recognize this reluctance to get involved, thus freeing them to vote against women’s rights.

Sometimes an abortion is unwanted but necessary for a woman’s health. Sometimes an abortion is wanted but will now be illegal. I think whatever a woman decides must be her decision, not a ruling from the out-of-touch Supreme Court or from a male-dominated state legislature.

Five years ago, a friend was forced to travel to a Wyoming clinic to get an abortion after a doctor in Idaho told her that abortion was “wrong.” She was angry, and later when she told her father, he said he was proud of her for “sticking up for herself.”

“It was the best money I’ve ever spent,” my friend told me later. “I wouldn’t be half the person I hope to be without making that decision.”

Men retain control over their bodies, but in too many parts of this country, women no longer can. Deciding whether to bear a child is perhaps the biggest decision in any woman’s life. Controlling and criminalizing a woman’s choice is a tragic mistake.

Rebecca (Bex) Johnson is a contributor to Writers on the Range, writersontherange.org, an independent nonprofit dedicated to spurring lively conversation about the West. She works and writes in Jackson, Wyoming.

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 And there’s the rub. What this year took from us, along with far too many loved ones, is order itself, our sense of control over how life should go, our “normal.”  2020 put the lie to the notion that we are in charge.

Plans went out the window without a glimmer of warning. Not just specific plans, like someone’s birthday party or paying the rent, but the very ability to plan — to predict, to calculate, to organize.

The future went blank as the biggest jolts came seemingly out of the blue:  the coronavirus itself, the rise of one movement for social justice and another against established authority. Even immutable objects like the U.S. elections were battered by controversy and defied predictions, all as the stock market plummeted, then roared to historic highs. The mail did go through, but for a time even that was thrown in doubt.

With vaccinations barely under way, it’s still too early for much planning, but there are powerful choices we can make right now, especially in how we view what’s happened and what we intend to do about it. Like it or not, we learned a few things:

·      We discovered that kids actually want to go to school — just not necessarily for the teaching and learning part.

·      We must never forget the compassion, courage and sacrifice of our doctors, nurses and unsung helpers.

·      For those who thought leadership doesn’t matter that much in a land of the free and home of the brave, guess what: Leadership matters. Everywhere.

·      Some kinds of work can be done better without all the commuting and water cooler time.

·      As donations poured into food banks and other charities, many of us learned that where government wouldn’t or couldn’t help, we could still make a difference.

·      Some of us found we could get by with considerably less toilet paper than we thought.

 ·      We don’t actually need showy conventions and predictable speeches to nominate a candidate for public office.

·      We can name racism, face it, and do something about it. Justice is a work in progress.

·      Screen life, especially social media, can’t substitute for real life. But what we read and say online can have real consequences.

·      Flu seasons of the future might get a lot less deadly if we hang onto these masks and remember what we’ve learned about viral transmission.

·      Elections matter. They can be free and fair and without a lot of hype, thanks to legions of principled poll workers. Having different ways to vote will make an election harder, not easier, to steal.

·      Not everyone made it through lockdown on quarantines, streaming and sourdough bread. A lot of people made it by a hair’s breadth, in debt or despair, putting their lives on the line for everyone else. Others didn’t make it at all.

·      The power of human touch and the joy of being together should never be taken for granted. Never.

 As for that “normal” we’re in such an all-fired rush to get back to? Not so fast, pardner. There’s some normal we should have shed a long time ago, and this pandemic we can’t wait to leave behind is giving us a chance to see the world anew and make real changes in it.

As 2021 begins, it’s as if we’re pausing atop a great historic pivot, the likes of which we may never see again. We may not control the outcome, but we can step up and own our part in it.

No matter who won the 2020 elections, we all win when we choose hope over hate; when culture and community flourish with or without Twitter and TikTok; when George Floyd’s grandkids go about their lives without fear; when we help each other find jobs, food, shelter, promise and meaning in life. When we help each other, period.

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Those willing to take risks that seem reckless to others include Lauren Boebert, the always-armed owner of Shooter’s Grill in Rifle, Colorado, who served patrons despite Gov. Jared Polis’s order, and Doug and Christine Lohman, owners of Hardware Brewery in Kendrick, Idaho, who made a big deal of opening May 1, also against a governor’s order.

Kendrick, population 307, is where Doug and Christine Lohman poured their life’s savings into a pub fashioned out of a former hardware store. The bar depends almost entirely on customers from somewhere else, like the University of Idaho, 30 miles away, or Lewiston, about 60 miles away.  Their Hardware Brewery would be recognized in most towns as a pleasant local Cheers, except it’s not in anybody’s neighborhood.  

Under a plan published by Idaho Republican Gov. Brad Little, the pub could have reopened as a restaurant May 16 and as a bar June 13.  It likely would also have received $10,000 from a small business relief fund created by Little with federal dollars. Instead, the Lohman’s said they had to open early or go bankrupt. Feeling that they’re “as safe as McDonalds,” the couple invited some Very Important People to their opening.

Janice McGeachin, the Republican lieutenant governor, traveled 500 miles from Idaho Falls to attend.  She said she’d been incensed from the start that only establishments providing food, medical care, public protection or construction were deemed “essential.”  All businesses are essential, the lieutenant governor said, including pubs —such as the one she also operates — and should be open as a constitutional right of assembly.    

With her was Raul Labrador, the chairman of the Idaho Republican Party and a recent member of Congress who lost a close primary election to Little in 2018, plus two state legislators from Lewiston.  Labrador wanted the state open in April.

All opposed the governor from the first, as did the speaker of the Idaho House, many other legislators and numerous sheriffs and county commissioners — opponents similar in other Western states. 

You have to hand it to Little, who has negotiated the pandemic with patience and skill.  New cases are trending downward, crushing the curve at least for now, and testing is expanding rapidly.  A recent poll by the Idaho Association of Commerce and Industry found nearly 80 percent of Idahoans support the governor’s four-stage reopening plan, with even higher support among Republicans.   

Like other small states, Idaho received $1.2 billion in federal funds, among the highest amounts per-capita nationally, on top of payroll protection and enhanced unemployment insurance.  Little is using $300 million for grants of up to $10,000 each to small businesses like Hardware Brewing and most recently, to day care centers.

With the minimum wage an abysmal $7.25 an hour, Idaho wages are so low unemployment payments can be more attractive than working.  For few months at least, about half of the 100,000 unemployed Idahoans have caught a rare break in life.

Notably, protestors chose not to stage their rebellion in nearby Nez Perce County where 20 of its 95 infected county residents have died, or at a meat packing plant south of Boise where 23 workers have been sent home after testing positive.

The “open now” leaders have championed near-absolute freedom versus what they label as government oppression.    Little has cast his decisions in soft language, advising residents to shelter in place “as best you can” or saying of the Kendrick protesters, “they certainly aren’t making this any easier.” 

Recently, however, he suggested that those who open bars or hair salons prematurely “could lose their operating licenses.” But the governor took no action as six businesses opened early in Idaho Falls. In Colorado, Shooter’s Grill was handed a cease and desist order — no ambiguity there.

When this all began, we might have assumed it would only last a few months. Instead, it could turn out to be like World War I, an epic slog which ended with vastly more people dying from flu than combat. This pandemic likewise requires wartime-like unity, good will and clear thinking.

Meanwhile, caution makes more sense than showboating and anger. 

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