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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Florida's new law banning fluoride in public water systems has drawn sharp criticism from dental professionals, who cite decades of evidence supporting its safety and effectiveness in preventing tooth decay.

Dr. Jeff Ottley, president of the Florida Dental Association, warned that the change will lead to a rise in cavities, particularly among children and underserved populations.

"Over the next two to three years, we will see an increase in the number of cavities, particularly in children and older adults who take multiple medications, which cause dry mouth," he said. "Those older adults will start getting cavities along the roof surfaces of their teeth and under existing restorations, like crowns and fillings."

Backers of the ban, including libertarian groups and some GOP legislators, have argued that "fluoride is a choice" and have recommended topical treatments, such as toothpaste, over what they claimed to be "mass medication."

Ottley stressed that fluoride occurs naturally in water, and the ban eliminates adjustments that allow cities to reach optimal levels for dental health.

He also predicted severe consequences, especially for Florida's Medicaid system and rural communities.

"The Medicaid system in Florida already has the lowest reimbursement rate across the country," he said, "and so you're going to have an influx in the number of kids looking, and parents looking to treat their kids who are on Medicaid, and the providers just aren't going to be there."

Ottley warned that higher Medicaid payments will be needed to attract dental-care providers, which he said could lead to ballooning costs.

His interim advice for parents: Seek prescription fluoride vitamins, and everyone should maintain rigorous brushing and flossing routines, cut their sugar intake and avoid post-brushing snacks before bed.


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California lawmakers are considering a bill to ease regulations on birth centers at a time when maternity wards are closing in many counties. Assembly Bill 55 would streamline the licensure process, which allows a birth center to accept Medi-Cal, making midwifery care available to low-income families.

Sandra Poole, health policy advocate with the Western Center on Law and Poverty, said the bill would also no longer require a birthing center to be within 30 minutes of a hospital but instead rely on a transfer plan to address potential emergencies.

"Of course, if you're in an area where the labor and delivery has closed, that's going to be impossible," she explained. "There are 12 counties in the State of California that have absolutely no labor and delivery wards at all in the county."

Birth centers are non-hospital, homelike facilities for low-risk pregnancies. At least 40% of California's birth centers have closed since 2020, and just four of the 37 remaining centers are licensed, because the current licensing process is unnecessarily burdensome, according to a study published today by the Western Center on Law and Poverty, in partnership with the California Black Women's Health Project and the Black Women for Wellness Action Project.

The study also surveyed patients on the merits of birth centers. Holly Drayton is a mother and former doula from the Santa Barbara area.

"For people to have that option would really give them the opportunity to choose the birth that they want in an environment where they do feel comfortable to labor in the way that they're supported, to make it the best possible outcome," Drayton said.

Sarah Archer, a mother who supports birth centers, said they are an important part of the state's health care system, and are proved to reduce pre-term births.

"People deserve choices in the way they want to give birth, not just in a sterile hospital," she explained. "It's a very safe, very quiet, beautiful, serene environment versus a medical setting."

The bill has passed the State Assembly and is now before the Senate Health Committee.

The Illinois Department of Public Health said the first positive test for West Nile virus in 2025 has been detected in Winnebago County near Rockford.

Health officials warned people in the infected area and elsewhere to take precautions to avoid the mosquito-borne disease, which is expected to spread across the state. Last year, Illinois reported 69 cases of West Nile, with 13 reported human deaths.

Sameer Vohra, director of the Illinois Department of Public Health, said evidence of the disease usually emerges this time of year.

"In Illinois, we typically see the first environmental positive test for West Nile in mid- to late May," Vohra explained. "Mosquitoes typically emerge in the spring and are active until the first hard frost of the year."

Vohra noted West Nile virus is an endemic disease in Illinois, meaning it is commonly found in the state. Public health officials are highlighting the importance of taking action to "Fight the Bite" during National Mosquito Control Awareness Week, which runs from June 18-24.

Vohra pointed out most people who are bitten by infected mosquitoes do not contract the disease but one in five will show symptoms ranging from mild discomfort to a serious and possibly fatal illness.

"Right now, there's no treatment for West Nile virus," Vohra emphasized. "But supportive care is really important, especially if you're developing symptoms or you're that one of 150 people that can develop severe illness."

Public health officials have advised Illinoisians to wear long sleeves and pants outdoors, use Environmental Protection Agency-approved insect repellent and stay indoors during peak mosquito hours at dawn and dusk. They also recommend trying to keep mosquitoes from breeding.

"One way to do that is to dump any standing water," Vohra advised. "Examples of that include flowerpots, children's toys, pet bowls, bird baths, buckets, used tires, abandoned swimming pools, any place where you can get standing water."


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