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Tag: decline

  • Early prenatal care, considered best for moms and babies, is on the decline in the US, data shows

    Early prenatal care improves the chances of having a healthy pregnancy and baby. But a new federal report shows it’s been on the decline.The share of U.S. births to women who began prenatal care in the first trimester dropped from 78.3% in 2021 to 75.5% in 2024, according to data released by the Centers for Disease Control and Prevention on Thursday.Meanwhile, starting care later in pregnancy or getting no care at all has been on the rise. Prenatal care beginning in the second trimester rose from 15.4% to 17.3%, and starting care in the third trimester or getting no care went from 6.3% to 7.3%.“We know that early engagement in prenatal care is linked to better overall health outcomes,” said Dr. Clayton Alfonso, an OB-GYN at Duke University in North Carolina. When patients delay medical care during pregnancy, “we’ve missed that window to optimize both fetal and maternal care.”While the trend identified in the report held for nearly all racial and ethnic groups, the decrease in early prenatal care was higher for moms in minority groups. For example, first-trimester care dropped from 69.7% in 2021 to 65.1% in 2024 for Black mothers. Getting late or no prenatal care raises the risk of maternal mortality, which is much higher among Black mothers.Michelle Osterman, lead author of the report, said the overall findings represent a shift. Between 2016 and 2021, the timing of when U.S. women started prenatal care had been improving.The earlier prenatal visits begin, doctors said, the earlier problems can be caught. Visits give doctors a chance to share health guidance, and can include blood pressure checks, screenings, blood tests, physical exams and ultrasound scans.The report doesn’t provide reasons why prenatal care is starting later. But the proliferation of maternity care deserts across the nation is a growing concern, said Dr. Grace Ferguson, an OB-GYN in Pittsburgh.Many hospitals have shut down labor and delivery units “and the prenatal care providers that work at those hospitals also have probably moved,” said Ferguson, who was not involved with the report.A 2024 March of Dimes report found that more than 35% of U.S. counties are maternity care deserts, meaning there’s no birthing facility or obstetric provider. Women living in these areas receive less prenatal care, the report showed.Ferguson, who provides abortions as part of her OB-GYN care, said post-Roe v. Wade abortion restrictions may play a part because some obstetricians are choosing not to practice in states with more restrictive laws.Alfonso, who was not involved in the CDC report, said he also suspects that access issues for patients are pushing prenatal care later, particularly in rural areas. Patients may have to travel farther to get to appointments and may struggle to find a practice that accepts their insurance, particularly if they have Medicaid.Doctors fear that things could get worse.“If this trend continues,” Alfonso said, “I worry about kind of what that would mean for morbidity and mortality for our moms.”

    Early prenatal care improves the chances of having a healthy pregnancy and baby. But a new federal report shows it’s been on the decline.

    The share of U.S. births to women who began prenatal care in the first trimester dropped from 78.3% in 2021 to 75.5% in 2024, according to data released by the Centers for Disease Control and Prevention on Thursday.

    Meanwhile, starting care later in pregnancy or getting no care at all has been on the rise. Prenatal care beginning in the second trimester rose from 15.4% to 17.3%, and starting care in the third trimester or getting no care went from 6.3% to 7.3%.

    “We know that early engagement in prenatal care is linked to better overall health outcomes,” said Dr. Clayton Alfonso, an OB-GYN at Duke University in North Carolina. When patients delay medical care during pregnancy, “we’ve missed that window to optimize both fetal and maternal care.”

    While the trend identified in the report held for nearly all racial and ethnic groups, the decrease in early prenatal care was higher for moms in minority groups. For example, first-trimester care dropped from 69.7% in 2021 to 65.1% in 2024 for Black mothers. Getting late or no prenatal care raises the risk of maternal mortality, which is much higher among Black mothers.

    Michelle Osterman, lead author of the report, said the overall findings represent a shift. Between 2016 and 2021, the timing of when U.S. women started prenatal care had been improving.

    The earlier prenatal visits begin, doctors said, the earlier problems can be caught. Visits give doctors a chance to share health guidance, and can include blood pressure checks, screenings, blood tests, physical exams and ultrasound scans.

    The report doesn’t provide reasons why prenatal care is starting later. But the proliferation of maternity care deserts across the nation is a growing concern, said Dr. Grace Ferguson, an OB-GYN in Pittsburgh.

    Many hospitals have shut down labor and delivery units “and the prenatal care providers that work at those hospitals also have probably moved,” said Ferguson, who was not involved with the report.

    A 2024 March of Dimes report found that more than 35% of U.S. counties are maternity care deserts, meaning there’s no birthing facility or obstetric provider. Women living in these areas receive less prenatal care, the report showed.

    Ferguson, who provides abortions as part of her OB-GYN care, said post-Roe v. Wade abortion restrictions may play a part because some obstetricians are choosing not to practice in states with more restrictive laws.

    Alfonso, who was not involved in the CDC report, said he also suspects that access issues for patients are pushing prenatal care later, particularly in rural areas. Patients may have to travel farther to get to appointments and may struggle to find a practice that accepts their insurance, particularly if they have Medicaid.

    Doctors fear that things could get worse.

    “If this trend continues,” Alfonso said, “I worry about kind of what that would mean for morbidity and mortality for our moms.”

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  • ‘Water bankruptcy’ — U.N. scientists say much of the world is irreversibly depleting water

    Dozens of the world’s major rivers are so heavily tapped, they often run dry before reaching the sea. More than half of all large lakes are shrinking, and most of the world’s major underground sources are declining irreversibly as agricultural pumping drains water that took centuries or even thousands of years to accumulate.

    In a report this week, U.N. scientists warn that the world has entered a new era of “global water bankruptcy” — a term that starkly underlines the urgency of efforts needed to protect what remains.

    “For too long, we have been living beyond our hydrological means,” said lead author Kaveh Madani, director of the U.N. University’s Institute for Water, Environment and Health.

    Drawing on extensive research, the report says more and more regions of the world are effectively overspending from all their water accounts, and their reserves are dropping. The term “water crisis” is often used locally and globally, but the scientists said that denotes a temporary emergency from which a region can recover, whereas many parts of the world are depleting water beyond safe limits and are now bankrupt or approaching bankruptcy.

    Many rivers, lakes, aquifers and wetlands have been pushed past “tipping points” and cannot bounce back, the report says.

    “Millions of farmers are trying to grow more food from shrinking, polluted or disappearing water sources,” Madani said.

    An estimated 70% of water globally is used for agriculture. Where water resources are exhausted, it can mean collapsing economies, displacement and conflict. The report says about 3 billion people, and more than half of global food production, are concentrated in areas where water resources are in decline.

    The scientists said more than half of the world’s large lakes have shrunk since the 1990s. About 35% of the planet’s natural wetlands, nearly the size of the European Union in total, have been wiped out since the 1970s.

    Excessive pumping of groundwater has led to long-term declines in about 70% of the world’s major aquifers, and in many areas these declines are causing the land to sink. Land subsidence linked to groundwater overpumping, the report says, is occurring across more than 2.3 million square miles, nearly 5% of the global land area. This permanently reduces what the aquifers can hold and also worsens the risk of flooding.

    About 4 billion people endure severe water scarcity at least one month each year.

    Water bankruptcy is not only a problem in the world’s dry regions, Madani said. “Like financial bankruptcy, it’s not about how rich or poor you are. What matters is how you manage your budget.”

    And in many regions, the water people are using perpetually outstrips the supply year after year, effectively breaking the budget.

    The report points to the Colorado River and its depleted reservoirs, on which California and other western states depend, as symbols of over-promised water. Other hotspots of chronic overuse include parts of South Asia, the Middle East and North Africa.

    “We must prioritize prevention of further damage to our remaining savings,” Madani said. “By acknowledging the reality of water bankruptcy, we can finally make the hard choices that will protect people, economies and ecosystems. The longer we delay, the deeper the deficit grows.”

    Water bankruptcy also is caused by deforestation, loss of wetlands and pollution, the researchers said. These problems are compounded by climate change, which is upending the water cycle and bringing more severe droughts and floods.

    The report was released ahead of a U.N. water conference in the United Arab Emirates in December.

    Madani also authored a peer-reviewed article this week that presents a definition of water bankruptcy, saying the term is a diagnosis to “communicate the severity of the problem and the urgency of a transformative fresh start.”

    The banking analogy used throughout the report, he said, points to solutions that are similar to managing a financial bankruptcy — preserving remaining capital while cutting spending.

    Solutions for dealing with exhausted water resources will vary by region, Madani said, and will need to account for the reality that “simply taking water away from farmers can mean unemployment, immediate tension, chaotic situations,” and that farmers and others need assistance to use less water and adapt.

    In a related study published last year, scientists analyzed more than two decades of satellite data and found that vast areas of the world are losing fresh water and getting drier.

    In a recent World Bank report, researchers said global water use “increased by 25 percent from 2000 to 2019, with about a third of this increase occurring in regions already drying out.”

    Jay Famiglietti, a hydrologist and professor at Arizona State University, said embracing the term water bankruptcy “is a brilliant way to convey that the water resources have been mismanaged, excessively utilized, and are no longer available for current and future generations.”

    He said water experts struggle to find the right “hook” to convey the severity and urgency of the problem, and calling it water bankruptcy promises to catch on.

    Ian James

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  • Where a Saudi company pumps desert groundwater, Arizona considers imposing limits

    VICKSBURG, Ariz. — Lush green fields of alfalfa spread across thousands of acres in a desert valley in western Arizona, where a dairy company from Saudi Arabia grows the thirsty crop by pulling up groundwater from dozens of wells.

    The company, Fondomonte, is the largest water user in the Ranegras Plain groundwater basin, shipping hay overseas to feed its cows in the Middle East. Like other landowners in the area, it has been allowed to pump unlimited amounts from the aquifer, even as water levels have declined.

    That soon could change, as Arizona officials are considering a plan to start regulating groundwater pumping in the rural area 100 miles west of Phoenix.

    Misha Melehes, who lives near the rural town of Bouse, Ariz., speaks during a hearing held by the Arizona Department of Water Resources at an RV park in the community of Brenda.

    At a meeting in mid-December, more than 150 residents of La Paz County sat listening in folding chairs as state officials underlined the severity of the declines in groundwater levels by showing graphs with lines sloping steeply downward.

    “This is where the heaviest pumping is. This is where we’re seeing the most decline,” said Ryan Mitchell, chief hydrologist for the Arizona Department of Water Resources, as he showed charts of the plummeting aquifer levels.

    The data from wells told the story: In one, water levels dropped a staggering 242 feet since the early 1980s. Another declined 136 feet.

    Structures storing alfalfa at Fondomonte's farm in Vicksburg, Ariz.

    Structures storing alfalfa at Fondomonte’s farm in Vicksburg, Ariz.

    Mitchell said current pumping in the Ranegras basin isn’t sustainable, and that in places it’s causing the land surface to sink as much as 2 inches per year.

    “That is a trend that is alarming,” he said. “The water budget for the basin is out of balance, significantly out of balance.”

    As he read the numbers, murmurs arose in the crowded hall.

    In recent years some residents’ household wells have gone dry, forcing them to scramble for solutions.

    The problem of declining groundwater is widespread in many rural areas of Arizona. Gov. Katie Hobbs has said Arizona needs to address unrestricted overpumping by “out-of-state corporations. ” She also said the declines in the Ranegras basin are especially severe, with water being depleted nearly 10 times faster than it is naturally replenished in the desert.

    The Arizona Department of Water Resources proposed a new “active management area” to preserve groundwater in this part of La Paz County, which would prohibit the irrigation of additional farmland in the area and require landowners with high-capacity wells to start measuring and reporting how much water they use. It also would bring other measures, including forming a local advisory council and developing a plan to reduce water use.

    Some residents say this kind of regulation is overdue.

    “What it is now is a free-for-all,” said Denise Beasley, a resident of the town of Bouse. “It’s just the Wild West of water.”

    Denise Beasley outside of her home in Bouse, Arizona.

    Denise Beasley stands outside her home in Bouse, Ariz.

    She believes the change will bring much-needed controls and help ensure that her well, and those of others in her community of about 1,100, will be protected.

    Fondomonte, part of the Saudi dairy giant Almarai, started its Arizona farming operation in 2014. It is part of a trend: Saudi companies have been buying farmland overseas because groundwater is being exhausted in Saudi Arabia, and as a result the country banned domestic growing of alfalfa and other forage crops.

    A lawyer for the company said it owns 3,600 acres in Vicksburg. The company also rents 3,088 acres of state farmland and 3,163 acres of state grazing land in the Ranegras basin under leases that expire in 2031.

    Grant Greatorex, who lives just outside Bouse, fills jugs at a water filling station at Bouse RV Park.

    Grant Greatorex fills jugs with purified drinking water at a water filling station at Bouse RV Park in Bouse, Ariz. He says this water tastes better than the water from his well at home.

    The State Land Department is charging the company about $83,000 annually under those leases, said Lynn Cordova, a spokesperson for the agency.

    Some residents who spoke at the hearing think it’s wrong that Fondomonte gets to use the water to grow hay and export it across the world. Others don’t see any problem with having a foreign company as their neighbor but believe the area must switch to less water-intensive crops.

    “This is a desert, and our water is drying up,” said Misha Melehes, who lives near Bouse. “We’re bleeding out. We need a tourniquet while we wait in the emergency room.”

    Others fear that state-imposed rules could lead to downsizing farms and even shipping water away to Arizona’s fast-growing cities.

    Farm vehicles work an alfalfa field owned by the company Fondomonte, in Vicksburg, Ariz.

    An alfalfa field owned by the company Fondomonte, in Vicksburg, Ariz.

    (Kayla Bartkowski/Los Angeles Times)

    Kelly James, a resident who lives nearby, called the proposal a “water grab.” He urged the state to delay the decision and let locals develop their own plan.

    He and others pointed out that Arizona has a history of cities finding ways to buy water that farms previously depended on, and that under state law three groundwater basins adjacent to Ranegras already are set aside as reserves to support urban growth.

    The state proposal says nothing about transporting water out of the Ranegras basin. In fact doing so would be illegal under the existing law. But that doesn’t quell the misgivings of some people in the area.

    “I have a lot of suspicion,” said Robert Favela, who uses his well to water a stand of bamboo on his 5-acre property in Vicksburg. “Trust me, they’re going to take our water.”

    Larry Housley pumping water into buckets for horses at his farm near Bouse, Ariz.

    Larry Housley pumping water into buckets for horses at his farm near Bouse, Ariz.

    (Kayla Bartkowski/Los Angeles Times)

    Jennie Housley, who owns a 40-acre horse ranch near Bouse with her husband, Larry, fears the area could lose its agriculture industry and eventually lose its water to growing subdivisions and swimming pools.

    “I believe that to sustain our country, we have to have agriculture in places like La Paz County,” she said.

    Larry Hancock, a farmer who grows crops in neighboring McMullen Valley, wrote a letter to the state making a similar argument. He said growers already are “conserving water because it’s in our best interest,” and imposing regulation would bring economic harm.

    Arizona Department of Water Resources Director Tom Buschatzke is scheduled to announce his decision on whether to start regulating groundwater in the area by Jan. 17.

    No representative of Fondomonte spoke at the meeting. The company did not respond to requests for comment.

    Efforts to curb the depletion of groundwater present complex challenges for communities and state agencies throughout much of Arizona, California and other Western states.

    Large farming operations expanded in Arizona in recent years, while global warming has put growing strains on the region’s scarce water. Scientists using satellite data estimated that since 2003 the amount of groundwater depleted in the Colorado River Basin is comparable to the total capacity of Lake Mead, the nation’s largest reservoir.

    Arizona has limited pumping in Phoenix, Tucson and other urban areas since the state adopted a groundwater law in 1980.

    But the law left groundwater entirely unregulated in about 80% of the state, allowing large farming companies and investors to drill wells and pump as much water as they want.

    Since Hobbs took office in 2023, she has supported efforts to curb overpumping where aquifers are in severe decline. In January her administration established a new regulated area in the Willcox groundwater basin in southeastern Arizona, and Hobbs this month appointed five local leaders to serve on an advisory council that will help develop a plan for reducing water use.

    “We feel like it has given us hope for a sustainable future,” said Ed Curry, a farmer who is a member of the Willcox council. “It gave us power.”

    Worker Luis Machado dismantles a pipe after testing a water well in Butler Valley, Arizona.

    Luis Machado dismantles a pipe after testing a water well in Butler Valley, Ariz. Workers recently removed pumps from wells in the area after Arizona ended leases of state-owned farmland to the Saudi company Fondomonte.

    Several months ago Hobbs toured La Paz County and spoke with residents about ways to protect the area’s water. The Democratic governor has taken other steps to rein in water use, terminating Fondomonte’s leases of 3,520 acres of state-owned farmland in Butler Valley in western Arizona. The decision followed an Arizona Republic investigation that revealed the state was charging discounted, below-market rates.

    Now those former hay fields sit dry, with weeds poking through the parched soil. Workers have been removing pumps from the leased land, and power lines that once supplied the wells stand unused in the desert.

    Dried remnants of hay spread across the Butler Valley alfalfa farm, where the company Fondomonte previously leased land.

    An alfalfa farm in Butler Valley sits parched after Arizona ended leases of state-owned farmland that had been granted to the company Fondomonte.

    While Fondomonte continues farming nearby, the company also faces a lawsuit by Arizona Atty. Gen. Kris Mayes alleging that its excessive pumping violates the law by causing declines in groundwater, land subsidence and worsening water quality.

    The lawsuit says the company uses at least 36 wells and accounts for more than 80% of all pumping in the Ranegras basin.

    Fondomonte’s lawyers argued in court documents that the attorney general doesn’t have the authority to regulate groundwater pumping and that the suit is an attempt to have the court “wade into a political question.”

    The Department of Water Resources’ proposal is a way to finally protect water for the area’s residents, said Holly Irwin, a La Paz County supervisor who for years has pushed to address the problem.

    “You’re starting to see more and more wells get depleted. If we don’t try to slow this thing down, where are we going to be in 20 years?” Irwin said.

    Nancy Blevins, who lives near the Fondomonte farm, agrees.

    In 2019 she and her family watched their well run dry. She spent months driving back and forth to a friend’s house, filling up plastic bottles and bringing the water home.

    Nancy Blevins stands next to cracked dirt outside her home in Vicksburg, Arizona.

    Nancy Blevins outside her home in Arizona’s La Paz County.

    Eventually, they bought a new pump and installed it at a lower level in their well, restoring their tap water. She still stores bottled water in a shed next to her mobile home in case the well dries up again.

    “They should start regulating,” Blevins said. “People’s water levels are dropping around here.”

    If something doesn’t change, the water eventually will run out, she said, and “future generations are going to be in trouble.”

    Ian James

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  • ‘They just don’t come’: What’s making L.A.’s tourism tumble

    Months of negative news have triggered a tough summer for tourism in Los Angeles, deepening the economic woes for a city buffeted by natural disasters and immigration raids.

    Tourist arrivals fell by close to 10% this season, according to the latest numbers from Visit California.

    The region’s economy and image suffered significant setbacks this year. Shocking images of the destructive Eaton and Palisades fires in January, followed by the immigration crackdown in June, made global news and repelled visitors. Meanwhile, President Trump’s fickle tariff policies and other geopolitical posturing have convinced many international tourists to avoid America.

    On Hollywood Boulevard, there are fewer tourists, and the ones who show up spend less, says Salim Osman. He works for Ride Like A Star, an exotic car company that rents to visitors looking to take a luxury vehicle for a spin and snap the quintessential L.A. selfie.

    Last year, crowds lined up to rent its Ferraris and Porches for around $200 an hour, Salim says. However, this summer, foot traffic dropped by nearly 50%.

    “It used to be shoulder to shoulder out here,” he said, looking along the boulevard. “It’s a lot harder for people to come here, or they’re afraid of what’s going on here, so they just don’t come.”

    Business has been slow around the TCL Chinese Theater, where visitors place their hands into the concrete handprints of celebrities like Kristen Stewart and Denzel Washington.

    There were fewer people to hop onto sightseeing buses, stop inside Madame Tussauds wax museum and snap impromptu photos with patrolling characters such as Spiderman and Mickey Mouse. Souvenir shops nearby say they have also had to increase the prices of many of their knick-knacks because of tariffs and a decline in sales.

    Of all the state’s international travelers, the most significant absence was from Canadian tourists. Arrivals from visitors from up north fell around 30% in June and July.

    Summer in Palm Springs was okay this year, said its mayor, Ron deHarte, but only because domestic tourists offset the sharp decline in Canadians.

    “We’ve hurt our Canadian Friends with actions that the administration has taken. It’s understandable,” he said. “We don’t know how long they won’t want to travel to the States, but we’re hopeful that it is short-term.”

    A view of travelers at Long Beach Airport in Long Beach. Long Beach Airport saw a 10.5% decrease in passenger traffic when compared to 2024.

    (Allen J. Schaben/Los Angeles Times)

    Visitors from China, India and Germany also avoided the state. Surprisingly, Mexican tourists didn’t stay away. There were 5.4% more arrivals from our southern neighbor despite the ICE raids, which often targeted Latino people.

    There was a dip in traffic to most Los Angeles airports. With the World Cup on the books for next year and the Summer Olympics gearing up in 2028, the growing decline in tourism is worrisome for many across all industries.

    Cynthia Guidry, the director of the Long Beach Airport, says reduced airline schedules, economic pressures and rising costs also impacted airport traffic. She’s currently seeking out ways to best prepare for the Olympics, which don’t involve flight revenue, such as dining at the airport and souvenir shopping.

    “We’re focused on attracting new service, growing non-aeronautical revenue and managing expenses to stay resilient,” she said.

    Many of the state’s most prominent attractions are also experiencing dry spells. Yosemite reported a decrease of as much as 50% in bookings ahead of Memorial Day weekend.

    Dennis Speigel, president of International Theme Park Services, a consulting firm in the industry, says that this past year has been a “soft year” for most theme parks nationwide.

    The "Forever Marilyn" statue towers over visitors who attend the weekly Palm Springs Villagefest along Museum Way.

    The “Forever Marilyn” statue towers over visitors who attend the weekly Palm Springs Villagefest along Museum Way.

    (Genaro Molina/Los Angeles Times)

    There have been fewer international visitors and more domestic traffic, as more people are embracing the idea of staycations, or spending their holidays closer to home.

    “People in the locales where the parks are stayed in their areas,” he said, adding that this summer people stayed home because of “the general economy, the media, the tariffs, the confusion and the uncertainty that came with that.”

    Los Angeles and California depend on tourism.

    Last year, the state’s tourism hit a new high, with visitors spending $157.3 billion, up 3% from 2023, and creating 24,000 jobs, according to a 2024 economic impact report from Visit California.

    “Los Angeles is California’s primary international gateway; the impacts are felt statewide,” Adam Burke, president of Los Angeles Tourism, said in a statement to The Times. “Looking ahead, long-term recovery will depend on global economic conditions and how the U.S. is perceived abroad.”

    Tourists walk across celebrity stars on Hollywood Boulevard in front of the Dolby Theater.

    Tourists walk across celebrity stars on Hollywood Boulevard in front of the Dolby Theater.

    (Gina Ferazzi/Los Angeles Times)

    Australian tourists Geoffrey and Tennille Mutton ignored the warnings of their friends and family to bring their two daughters to L.A.

    “A lot of people have had a changed view of America,” said Geoffrey as his family enjoyed Ben & Jerry’s ice cream outside of Hollywood’s Dolby Theater. “They don’t want to come here and support this place.”

    Cerys Davies

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  • Opinion: Why are so many California hospitals closing their labor and delivery units?

    Opinion: Why are so many California hospitals closing their labor and delivery units?

    Last week, Keck Medicine of USC announced the closure of USC Verdugo Hills Hospital obstetric services on Nov. 20. They cited a 40% decline in deliveries over the past decade within “our community” and the resulting financial effect on the hospital as reasons for the decision. While this justification appears reasonable at first glance, it conceals an unsettling trend with significant implications for maternal health.

    The closing of hospital labor and delivery units is a nationwide trend, resulting in “maternity care deserts.” The closures primarily affect patients with Medicaid insurance, which pays for more than 40% of deliveries in the United States, and through Medi-Cal, more than 50% of deliveries in California. Unequal access to obstetric care contributes to America’s shamefully high maternal mortality rate which, at 22 maternal deaths per 100,000 live births in 2022, was double or triple the rate of peer nations.

    Obstetric care is different from many other types of healthcare in its unpredictability. Babies do not arrive on anyone’s schedule, and the busyness of labor and delivery units can wax and wane accordingly. For doctors to care for laboring mothers and their babies safely, hospitals must be staffed for the possibility of a sudden abundance of patients requiring emergency care.

    The modern fee-for-service healthcare model, which pushes hospitals to maximize efficiency and reduce staffing, treats the resiliency necessary for delivering babies as a drag on their bottom line. In this model, hospitals must fund round-the-clock capacity but are only reimbursed when their facilities and staff are in action. So if not enough deliveries are happening, expenses outweigh reimbursement. This drives hospitals to get out of the baby delivery business altogether.

    California has experienced a higher rate of obstetric unit closures than other states, and it continues to accelerate. More than 46 labor and delivery departments closed in the state between 2012 and 2023, with 60% occurring within the last three years. These closures are not limited to sparsely populated rural areas: 17 were within Los Angeles County, resulting in a local rate of closures that far outpaces the declining birth rate. This year, five more California hospitals have stopped providing obstetric care, and USC Verdugo Hills Hospital will be the fifth in L.A. County to close labor and delivery within a two-year period.

    Healthcare and medical benefit administrators talk of scaling and consolidation, of concentrating obstetric care at fewer hospitals so that there will be enough deliveries to cover the expense of remaining open. This will only work if we assume that market forces will sort out the balance between supply and demand so enough labor and delivery departments remain open to meet demand. But such forces only work if prices are dynamic and responsive to changes in supply. Insurance providers, especially Medicaid and Medi-Cal, have not shown this type of flexibility.

    Medi-Cal, the Medicaid program in California, has reimbursement rates for obstetric care that are fifth lowest in the nation. In our state, even busy labor and delivery departments that care primarily for Medicaid patients do not break even. South L.A.’s Martin Luther King Jr. Community Hospital is struggling to stay open despite increasing its volume of obstetric patients as other Los Angeles labor and delivery units have closed. This shows that the amount paid by Medi-Cal is below the market cost of providing obstetric care. This deficit is at the core of the California closures.

    There are at least two paths forward.

    The first is to increase Medi-Cal’s reimbursement of each delivered patient. The second would require directly regulating and subsidizing the maintenance of labor and delivery units the way the state does for emergency rooms. Either approach will be costly, because providing safe, modern, evidence-based obstetric care is expensive.

    Reproductive freedom is much in the news this campaign season. It should include reasonable, safe and dependable access to labor and delivery services.

    Anna Reinert is an assistant professor of clinical obstetrics and gynecology at USC’s Keck School of Medicine.

    Anna Reinert

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  • Pelosi sends signal to Biden: ‘Time is running short’

    Pelosi sends signal to Biden: ‘Time is running short’

    WASHINGTON — 

    Former House Speaker Nancy Pelosi, one of the most influential voices in President Biden’s sphere outside of his family, sent a rare public signal Wednesday morning that suggested she is trying to nudge him to consider dropping out of the election.

    “It’s up to the president to decide if he is going to run,” she said on MSNBC. “We’re all encouraging him to make that decision because time is running short.”

    Pelosi sandwiched her comments between praise for Biden and his record. But Pelosi is notably careful and calculating in her public comments and well aware that Biden has repeatedly and forcefully said he has already made that decision. She spoke on MSNBC’s “Morning Joe,” Biden’s favorite cable news show and the same venue where on Monday he gave one of his most defiant declarations that he would remain in the race.

    Pelosi, a San Francisco Democrat, is no longer in Democratic leadership but remains in the House after one of the most consequential tenures in history. At 84, she is three years older than Biden and served alongside him for most of his political career. She also had the experience of watching close friend Sen. Dianne Feinstein deteriorate before dying in office last year.

    Pelosi said Biden would have the “overwhelming support” of House Democrats. “He’s beloved, he is respected, and people want him to make that decision.”

    She also suggested that she would not make a more direct call for him to withdraw.

    “I’ve said to everyone, let’s just hold off, whatever you’re thinking, either tell somebody privately, but you don’t have to put that out on the table until we see how we go this week,” she said.

    The comments preceded a high-profile call to withdraw from a different sort of influencer: George Clooney. The actor, who is a major backer for Democrats, headlined a Hollywood mega-fundraiser for Biden last month.

    “The one battle he cannot win is the fight against time,” Clooney wrote in an op-ed published Wednesday in the New York Times. “None of us can. It’s devastating to say it, but the Joe Biden I was with three weeks ago at the fundraiser was not the Joe ‘big F— deal’ Biden of 2010. He wasn’t even the Joe Biden of 2020. He was the same man we all witnessed at the debate.”

    Noah Bierman

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  • California State University system sees unprecedented decline in enrollment

    California State University system sees unprecedented decline in enrollment

    (FOX40.COM) — The California State University system is experiencing an unprecedented decline in the number of students enrolled in its programs.

    According to the most recent enrollment report from California State University (CSU), enrollment has dropped by nearly 6% since 2019. That means there are about 28,000 fewer students enrolled in a CSU.

    The CSU system is the nation’s largest four-year public education university system and includes 23 universities and seven off-campus centers. Although CSU enrollment is trending on the decline, California is not alone.

    According to the Education Data Initiative, college enrollment statistics indicate that more Americans are forgoing higher education; “some may be putting off college attendance to build savings.”

    From 2010 (enrollment peak) until 2023, enrollment has declined 9.8% nationwide, according to educationdata.org. The rate of enrollment among new high school graduates has also declined by 7.3% year over year.

    Veronica Catlin

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  • American Religion Is Not Dead Yet

    American Religion Is Not Dead Yet

    Take a drive down Main Street of just about any major city in the country, and—with the housing market ground to a halt—you might pass more churches for sale than homes. This phenomenon isn’t likely to change anytime soon; according to the author of a 2021 report on the future of religion in America, 30 percent of congregations are not likely to survive the next 20 years. Add in declining attendance and dwindling affiliation rates, and you’d be forgiven for concluding that American religion is heading toward extinction.

    But the old metrics of success—attendance and affiliation, or, more colloquially, “butts, budgets, and buildings”—may no longer capture the state of American religion. Although participation in traditional religious settings (churches, synagogues, mosques, schools, etc.) is in decline, signs of life are popping up elsewhere: in conversations with chaplains, in communities started online that end up forming in-person bonds as well, in social-justice groups rooted in shared faith.

    For centuries, houses of worship have been the center of their communities, where people met their friends and partners, where they raised their kids, where they found solace, where they broke bread, where they organized around important issues.

    Shadi Hamid: America without God

    As Robert D. Putnam and David E. Campbell demonstrated in their 2010 book, American Grace: How Religion Divides and Unites Us, most Americans no longer orient their lives around houses of worship. And that loss is about more than just missing out on prayer services. It means that when people move to a new city, they have to work much harder to find new friends than previous generations did. When someone falls ill, they might not have a cadre of their fellow faithful to offer home-cooked meals and prayers for healing. This reorientation away from houses of worship is one of the factors that has led to the decline of a sense of community, the rise of social isolation, and the corresponding negative effects on public health, especially for older adults.

    Religion has historically done four main “jobs.” First, it provides a framework for meaning-making, whether helping our ancient ancestors explain why it rained when it rained, or helping us today make sense of why bad things happen to good people. Second, religion offers rituals that enable us to mark time, process loss, and celebrate joys—from births to coming of age to family formation to death. Third, it creates and supports communities, allowing each of us to find a place of belonging. And finally, fueled by each of the first three, religion inspires us to take prophetic action—to partake in building a world that is more just, more kind, and more loving. Through the pursuit of these four jobs, religious folks might also experience a sense of wonder, discover some new truth about themselves or the world, or even have an encounter with the divine.

    So rather than asking how many people went to church last Sunday morning, we should ask, “Where are Americans finding meaning in their lives? How are they marking the passing of sacred time? Where are they building pockets of vibrant communities? And what are they doing to answer the prophetic call, however it is that they hear it?”

    There have never been more ways to answer these questions, even if fewer and fewer people are stepping into a sanctuary. People are meaning-making in one-on-one sessions with spiritual directors and chaplains. One in four Americans—across racial and religious (and nonreligious) backgrounds—has met with a chaplain in their lifetime, according to a recent survey that Gallup conducted for the Chaplaincy Innovation Lab, of which one of us, Wendy, is a founder. Most find their time with chaplains valuable.

    People are preparing for the end of life with the Shomer Collective, a group that helps people as they prepare for and navigate the end of life, offering wisdom from the Jewish tradition. Death doulas now work with people from a variety of backgrounds, giving hand massages, preparing food, and doing much more for dying people and their loved ones.

    These spiritual offerings are not just for individuals. People are gathering in communities in new ways to celebrate Shabbat rituals with OneTable, and mourning the loss of their loved ones with the Dinner Party. They’re joining small groups through the New Wine Collective, a movement helping people build spiritual communities, and the Nearness, a platform for nurturing your spiritual life while discovering community online. And they’re pursuing faith-driven justice work with organizations such as the Faith Matters Network and Living Redemption.

    From the April 2017 issue: Breaking faith

    Many theological schools aren’t yet training their students to reimagine how to serve people outside traditional religious contexts. Most are still preparing clergy to serve in congregations, a job with diminishing prospects these days. However, a growing number of groups, many of them led by seminary graduates, support spiritual leaders who are fostering new kinds of spirituality in their flocks.

    The Glean Network, of which Elan is the founding director, has incubated more than 100 faith-rooted ventures over the past seven years through its partnership with Columbia Business School. Some of these programs focus on meaning-making, many on building communities, others on creative rituals, and still others on answering a prophetic call. The Chaplaincy Innovation Lab brings chaplains traditionally siloed in the settings where they work—health care, the military, higher education, prisons—into a broader learning community. More than 4,000 chaplains belong to the Lab’s private Facebook group—what we believe to be the largest virtual gathering of chaplains in the world—sharing advice, insights, and improvisational rituals from around the globe. These networks and a growing number of others equip spiritual leaders from a broad range of faith traditions to do their best work, and challenge theological schools to make their education more responsive, expansive, accessible, and practical.

    This swell of spiritual creativity comes at a time when Americans seem to need it most. We are more lonely, more divided, less hopeful, and less trusting than in previous decades. And while there is much to celebrate as these new offerings take shape, their growth comes alongside an unprecedented decline in religious affiliation, which does entail losing some things that are unlikely to be replaced by these creative efforts.

    We are witnessing a tectonic shift in the landscape of American religious life. Putnam was right when he declared a decade ago that religious disaffiliation has “the potential for completely transforming American society.” But he also predicted that it “has the potential for just eliminating religion,” and we beg to differ. Before we conclude that this transformation is solely about decline, let’s make sure we’re looking in all the right places.

    Wendy Cadge

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