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Polycystic Ovarian Syndrome (PCOS) is an endocrine disorder that affects 1 in 10 women and is the leading cause of female infertility. It’s a condition where tiny follicles can be built around the ovaries, usually caused by hormone imbalance. In honor of September being PCOS Awareness Month, our Hy-Vee dietitians wanted to share our top tips as registered dietitians on how to balance hormones and manage PCOS naturally. Most women with PCOS are told to lose weight (which can be very difficult with PCOS) or to just go on a birth control pill to help treat their symptoms. The key to treating your symptoms is to find the root cause of your hormone imbalance. Typically, we see the most common causes of PCOS are insulin resistance, inflammation, adrenal stress, or any combination of these. Let’s dive into some strategies that can help naturally manage these! Manage Blood Sugar Levels Managing blood sugar is especially important if insulin resistance is the root cause of your PCOS. Balancing blood sugar starts with having a balanced meal. We recommend using the plate method where you have ½ your meal non-starchy vegetables, ¼ protein, and ¼ complex carbohydrates. For better blood sugar balance, you also want to try to have at least 25-30 g of protein at breakfast (see the Peachy Overnight Oats recipe below for a yummy option). For balanced snacks, be sure to pair fiber and protein together like whole grain crackers with cottage cheese and cherry tomatoes, steamed edamame with Good Foods dip or fruit with nut butter. Regular exercise can also help with blood sugar balance. Even just a five-to-10-minute walk after a meal can help. Reduce Inflammation Working on reducing inflammation is key if inflammatory PCOS is your root cause. Eating a balanced diet (see the plate method discussed above) does wonders for this and includes more omega-3 fatty acid foods. These foods include tuna, salmon, chia seeds, flaxseeds and walnuts. Improving gut health can also help reduce inflammation, so eating more fermented foods like yogurt, kefir, kombucha, and kimchi can be beneficial. However, underlying food sensitivities could be the source of your inflammation, so you’ll want to have a medical professional help you check for this as well. Good Foods dips are a great option if you do because they are free of the top 9 allergens, gluten-free and vegan. Manage Stress Reducing stress is the primary target if you have adrenal PCOS. For this, you’ll want to aim for seven to eight hours of adequate sleep every night, as this can significantly reduce stress and help your body better adapt to it. Of course, utilizing the plate method for balanced meals can also help reduce stress (specifically, not skipping meals). With adrenal PCOS, you also want to avoid overexercising, as this can worsen your hormone imbalance rather than improve it. Take 30 minutes of exercise two to three days a week and remember to embrace the rest days. To reduce stress, also be mindful of your caffeine intake, as overconsuming caffeine can worsen symptoms. What To Do Next Now, you might be thinking, “How do I know the root cause of my PCOS?” Getting specific lab tests such as fasting insulin, HgA1c, DHEA-S, total testosterone, and vitamin D can help pinpoint your root cause. This is where you will want to work with a Hy-Vee dietitian to help! We can review your medical history, lab work, and symptoms to help decipher your root cause and provide a clear path forward. You do not have to manage PCOS alone. Let our Hy-Vee dietitians provide guidance and encouragement along the way! It can take two to three months to start seeing results. Sign up for Hy-Vee’s Healthy You Subscription at Hy-Vee.com/Health to access monthly visits with a Hy-Vee dietitian, personalized nutrition advice and coaching, and access to virtual Hy-Vee classes and other online resources. Peachy Overnight Oats Serves 1 All you need: ½ cup Hy-Vee quick oats 1 tbsp chia seeds ½ cup Fairlife 2% milk ¼ cup Chobani Zero Sugar Vanilla ½ cup peaches, sliced 1 tsp Hy-Vee cinnamon All you do:
Adapted from: https://www.hy-vee.com/recipes-ideas/recipes/peachy-overnight-oats 
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Have you ever craved something sweet, but unsure about natural sugars vs. sugar substitutes? With so much information online, it can be hard to decide what is ‘good’ or ‘bad’ for you and your health. Today, our Hy-Vee dietitians will explain the differences between some of the sugar substitutes, the science behind them, and ways to use these sugars (and substitutes) in recipes! Natural Sugars Natural sugars, like sucrose, glucose, and fructose, give us energy throughout the day and are found in foods like grains, fruit and sweet snacks. However, consuming excess amounts these sugars over time may raise our blood sugar and lead to pre-diabetes or diabetes. We recommend pairing these types of food with protein or fat to help balance your blood sugar. Fairlife milk is one of our favorites because it contains 50% more protein and 50% less sugar (compared to regular milk). It’s important to point out that we want our sugar intake at a manageable level, so we aren’t addicted to it. But we don’t necessarily need to cut it out completely! For a snack, our Dietitian Pick of the Month is Perfect Bars. They are a delicious blend of creamy and crunchy with a cookie-dough-like texture. These bars are high in protein and fiber, helping you feel fuller for longer. Pair them with your favorite fresh fruit for a delicious and nutritious snack. Stevia Stevia is a plant that makes things taste sweet without adding sugar or calories. In fact, it’s 200-300 times sweeter than sugar. This sweetener is one of the more well-known sugar substitutes. Science shows that stevia may be beneficial to our bodies as it may reduce blood pressure and may positively impact the gut microbiome.1 Our favorite way to use stevia is by adding it to tea or baked goods for sweetness without the calories. Monk Fruit Monk fruit is like a magic fruit that tastes sweet but does not impact our blood sugars. Just a little bit of this ‘sugar’ can make foods sweet as it’s over 100 times sweeter than sugar. Studies show that monk fruit has anti-hyperglycemic, anti-hyperlipidemic, and anti-diabetic properties.2 In layman’s terms, monk fruit can help our blood sugar and help reduce the fat stores in our bodies. One way to use monk fruit is in a homemade salad dressing for a touch of sweetness. Allulose Allulose is another non-nutritive sweetener that’s about 70% as sweet as sugar. It looks and tastes like sugar, but it comes from dates, raisins and prunes. Studies using allulose are similar to those using monk fruit and stevia; when using allulose instead of glucose, we tend to notice lower blood sugar levels tested after we eat.3 We enjoy using allulose sprinkled on fruit, like strawberries, for some extra sweetness. Give allulose (or one of the other sugar substitutes) a try in the recipe below if you prefer your smoothies on the sweeter side! Want more guidance on sugar substitutes or managing blood sugars? Consider our Balancing Your Blood Sugar Program. During this action-based group program, learn how to lower inflammation, reduce sugar intake and control cravings. Intended for those living with prediabetes, diabetes or gestational diabetes, these virtual sessions are designed to facilitate positive lifestyle changes. Program includes (4) 60-minute virtual group sessions with your Hy-Vee dietitian, and A1C screenings are completed at the beginning and end of the program at select Hy-Vee stores to track progress. Register online now Strawberry Walnut Date Smoothie Serves 2 All you need: 1 ½ cups hulled, quartered Basket & Bushel strawberries ½ cup California walnuts ½ cup Hy-Vee plain Greek yogurt ½ cup Fairlife milk 3 pitted dates, coarsely chopped Chopped California walnuts, for garnish All you do:
Adapted from: https://walnuts.org/recipe/strawberry-walnut-date-smoothie/ Shop all of these ingredients at Hy-Vee Aisles Online. The information is not intended as medical advice. Please consult a medical professional for individual advice. This content was made possible with the paid support of our sponsors: Perfect Snacks, Fairlife, and Foundation for Fresh Produce Cited Sources:
 Missourians average 1 year in jail waiting for court-ordered mental health treatmentby Clara Bates, Missouri Independent The number of people languishing in Missouri jails in need of court-ordered mental health treatment currently stands at 344 — and the wait time for a hospital bed averages one year. That’s up from 254 people this time last year, according to Missouri Department of Mental Health data provided to The Independent. A spokeswoman for the department said that because the agency’s inpatient beds are at capacity, the number of people waiting in jails for treatment will continue to rise. Debra Walker, the department’s spokeswoman, said February was the first month the number of individuals waiting ever exceeded 300. None of the people on the waitlist have been convicted of a crime. They were arrested, found incompetent to stand trial and ordered by the court into mental health treatment, designed to allow them to stand trial, a process called competency restoration that generally includes therapy and medication. “We do want to increase the number of individuals who are getting competency restoration,†said Jeanette Simmons, deputy division director of the Missouri Department of Mental Health’s Division of Behavioral Health, during a mental health commission meeting earlier this month. “We have a growing number of individuals who are waiting for those services.†Missouri has faced a years-long struggle with this issue, due to increasing numbers of court referrals for competency restoration, staffing issues and limited psychiatric hospital capacity. It’s worsened over the last year. The legislature appropriated $300 million this year for Department of Mental Health to open a new hospital in Kansas City, but it could be around five years before construction is complete. State officials are also working to implement the “jail-based competency restoration†program approved by the legislature this year in response to the issue. This year’s budget set aside $2.5 million for the jail-based competency programs to be established in jails in St. Louis, St. Louis County, Jackson County, Clay County and Greene County. Services in jail-based competency restoration will include room and board, along with medical care for 10 slots at each jail, contracted staff from a local behavioral health organization, and psychiatric care from “mobile team practitioners.†The department is currently training two agencies in Kansas City that will be going into county jails to provide jail-based treatment. Clay County has a “tentative go live date†for September, Simmons said. “So we're really looking forward to that and getting that launched, because we do believe that it's going to take a multifaceted approach to target those numbers,†she said. Simmons said the agency has mobile teams of doctors going into county jails prescribing medications “to try and get folks started on those medications that they need to stabilize their mental illness.†The department is working with community behavioral health liaisons as well as jail mental health or medical staff, she said, to get people services. The Department of Mental Health is also working on trying to get information to the courts about outpatient restoration, for those who can be safely treated in the community and don't require hospital-level care. A law passed this year gives the agency the authority to treat certain arrested people on an outpatient basis. “Sometimes I think the courts don’t really consider that as an option,†Simmons said of outpatient treatment. “It’s something very new.†SUPPORT NEWS YOU TRUST.
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In other states, including some bordering Missouri, lawsuits have been filed over similar wait times, alleging they violate individuals’ rights to due process and the Americans with Disabilities Act. A federal lawsuit filed last year in Oklahoma alleged jails are holding patients for three months to one year. A proposed settlement set a benchmark of a 60 day maximum wait and ultimately a goal of 21 days, but it has faced opposition from the governor. A lawsuit filed in Kansas in 2022 alleged that individuals are detained for longer waiting for a psychiatric bed than they would be if they had been convicted. Many of the charges are for low-level crimes, national investigations have found. County sheriffs and jail administrators in Missouri have raised the alarm about challenges caring for individuals who are being detained pretrial. And state officials have acknowledged the long waits contribute to mental deterioration. The Missouri Sheriffs’ Association recently published an issue of their ‘Missouri Jails’ magazine focused on managing mental health challenges in county jails, which shared several examples of local issues, including that one county spent $30,000 to provide around-the-clock guarding over a suspect for two months, because the secure medical centers didn’t have any openings. Some county sheriffs are looking to build or expand jails to combat the issue, according to the magazine, including by increasing the number of solitary cells to keep those with mental health diagnoses out of the general population. Others have contracted with private health provider Turn Key Health Clinics to provide increased mental health care while people are awaiting transfer. “As mental health professionals and legislators struggle to find solutions to the crisis,†magazine contributor Michael Feeback wrote, “sheriffs and other agencies are looking for answers on their own.†SUPPORT NEWS YOU TRUST.
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Missouri Independent is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Missouri Independent maintains editorial independence. Contact Editor Jason Hancock for questions: [email protected]. Follow Missouri Independent on Facebook and X.
As summer ends, it’s time to start planning for going back to school. This can bring a long list of to-dos as you try to set your kids up for a successful school year. It’s also the perfect time to start implementing new healthy habits. Consuming enough fruits and vegetables can be challenging, especially during a busy school year. The best way to make an action stick for the long term is to turn that action into a habit. First, let’s learn how to turn actions into habits, then review some healthy hacks that make consuming enough fruits and vegetables simple and easy! So, how do you turn an action into a habit? Consider these three steps in the process of habit formation.
Regarding a successful school year, eating habits can make all the difference. Try these healthy hacks you can easily repeat all school year long: Buy pre-cut fruits and vegetables, such as our Hy-Vee Short Cuts, in the refrigerated produce section to make consuming fresh produce easy. Plus, save time in the kitchen by having nutrient-dense fruits and veggies already prepped and ready to go in the fridge. Instead of buying whole, fresh produce, set aside some time at the beginning of the week or on the weekend to chop up the produce, and store them in containers in your fridge. You can also choose finger foods that don’t require any preparation, such as cherry tomatoes, grapes, clementines, sugar snap peas, or baby carrots. You can purchase canned or frozen fruits or vegetables if you can’t get to the fresh produce before it goes bad. You won’t compromise on nutrition and won’t have to worry about a short shelf life. (Tip: When buying canned fruit, look for the “no sugar added” or “canned in water” label on the front of the can.) Throw a bag of steamable broccoli in the microwave to add to dinner or put some frozen berries into a smoothie for a nutritious after-school snack. Set up a “smoothie station” for preschool fuel with various fruits, yogurt, and Fairlife milk. Include walnuts to boost brain health with omega-3 ALA. Allow kids to blend their concoction in a blender or smoothie maker. Making these options fun and rewarding for kids and adding them to your weekly routine are sure-fire ways to keep kids eating their produce into adulthood. For example, throw veggies into a delicious, simple, breakfast such as these Veggie Loaded Egg Muffins. (Recipe below) Want more dietitian-approved healthy hacks? Join our Hacks for Healthy Back-to-School Habits Challenge for a chance to win 1 of 5 $100 Hy-Vee gift cards! During this 1-week challenge, our team of dietitians will highlight the benefits of fresh produce and simple hacks for an easier and healthier back-to-school. Throughout the challenge, you will receive reminders to track and self-reflect on your progress meeting your produce goals. Visit Hy-Vee.com/Health to sign up today. Brought to you in partnership with the Foundation for Fresh Produce. Veggie Loaded Egg Muffins All you need: 2 jarred roasted bell peppers 1 green onion 2 cups baby spinach ½ cup Soiree reduced-fat feta crumbled cheese 12 Hy-Vee large eggs ¼ cup Hy-Vee low-fat milk 1 tsp Hy-Vee Italian seasoning ½ tsp kosher salt ¼ tsp ground black pepper All you do:
Recipe source: Veggie Loaded Egg Muffins - American Egg Board (incredibleegg.org) Shop all of these ingredients at Hy-Vee Aisles Online. The information is not intended as medical advice. Please consult a medical professional for individual advice. This content was made possible with our sponsor's support, the Foundation for Fresh Produce. As schools prepare to head back into session, metro health departments emphasize the importance of vaccinations to protect children in Kansas and Missouri classrooms this year. Free or low-cost vaccines are now available, and parents are encouraged to make appointments or visit a walk-in clinic now to avoid the long wait times that typically occur every August. “Vaccines are one of the most effective tools for preventing the spread of infectious diseases and keeping metro kids safe because we have decades of scientific evidence to prove it,” said Bridgette Shaffer, director of Jackson County Public Health. Measles, once nearly eradicated in the United States, has reemerged in recent years, with more cases so far in 2024 than all of last year. Decreased vaccination rates contribute to the increase in measles cases. Healthy People 2030 set a goal of 95% measles, mumps and rubella (MMR) vaccine coverage for kindergarteners, but the U.S. falls short of this at 93%, and both Kansas and Missouri are at less than 92%. Public health experts warn that this trend increases the risk of vaccine-preventable diseases. “These diseases are not gone. They are still here, and vaccines remain our most effective protection at preventing disease outbreaks,” Shaffer said. Both Kansas and Missouri require several vaccines for children in school or child care, including but not limited to measles, mumps, rubella, whooping cough, polio and varicella (chickenpox). There are additional vaccines that are not required for school in every state, but that public health experts strongly recommend to prevent illness, including COVID-19, hepatitis A (required in Kansas), HPV and flu vaccinations. Many local health departments offer walk-in or extended hours for immunizations, so parents and caregivers can bring in their children when it’s convenient for them. Some health departments are on or near RideKC bus routes. Jackson County Public Health offers free rideshare passes and Wyandotte County Public Health offers free transportation to and from appointments. If a parent does not have health insurance or if their insurance does not cover vaccines, the Vaccines for Children program offers vaccines at no cost to eligible children through health care providers enrolled in the program. Parents can find out more about the recommended immunization schedule by contacting their health care provider or local health department. Below is a list of back-to-school vaccination clinics in the region. Jackson County, Missouri Jackson County Public Health 3651 NE Ralph Powell Road, Lee’s Summit, MO 64064 Appointments only: Monday - Thursday 7:30 a.m. to 4:30 p.m. Fridays 8 a.m. to 4 p.m. Parents can make an appointment online or by calling 816-404-6416. Jackson County Public Health also offers free Lyft passes to allow clients a complimentary round-trip ride to and from their appointments. An adult must accompany anyone under 17. Kansas City, Missouri City of Kansas City, Missouri, Health Department 2400 Troost Ave., Suite 1400, Kansas City, MO 64108 Currently filling appointments Monday through Friday with extended hours on Wednesdays to accommodate busy schedules: Monday, Tuesday, Friday: 7:30 a.m. - 6 p.m. (check-in by 5:30 p.m.). Wednesdays (July 10 through Aug. 28): 7:30 a.m. - 8 p.m. (check-in by 7:30 p.m.). Thursday: 7:30 a.m. - 4 p.m. Please call 816-513-6108 to schedule an appointment. To meet the community’s needs, the Kansas City Health Department is also hosting several Saturday vaccination clinics throughout July and August. These clinics are open to all parents, guardians and children needing vaccinations for school, with no appointments necessary: Saturday, July 27 KCPS Central High School, 3221 Indiana Ave., 10 a.m. to 2 p.m. Saturday, Aug. 3 KCPS Fest at East High School, 1924 Van Brunt Boulevard, 10 a.m. to 2 p.m. The Saturday before school starts: Aug. 17 2400 Troost Ave. from 8 a.m. to 2 p.m. Appointments are necessary due to high demand.  by Tara Sallee, MS, RD, LD, Hy-Vee Corporate Dietitian Intermittent fasting, a dietary approach that has gained popularity, is being hailed for its potential health and weight loss benefits. As Hy-Vee dietitians, we know eating isn’t one-size-fits-all. Let’s explore what intermittent fasting involves, its underlying mechanisms, potential health benefits, who should abstain from it and practical advice for those contemplating this dietary approach. A Closer Look at Intermittent Fasting In contrast to many conventional diets that prescribe what foods to consume, intermittent fasting is more concerned with the timing of food consumption. This dietary approach incorporates a fasting period into each day or week. Several popular intermittent fasting methods exist, including alternate-day fasting, the 5:2 fasting method with two days per week and daily time-restricted fasting. Unpacking the Mechanics of Intermittent Fasting Intermittent fasting reduces the overall intake of calories. For many people, this approach may be easier than counting calories. Additionally, intermittent fasting may promote metabolic flexibility after exhausting the calories from your most recent meal as the body switches to utilizing fat for energy. Exploring the Potential Health Benefits Snacking, especially up until bedtime, is a practice that has become common with the abundance of snack foods and now 24/7 entertainment, which may not be as beneficial to our bodies as once thought. Time-restricted fasting methods, such as fasting from 7 pm to 7 am, can help curb late-night snacking, which may lead to lower blood sugar and insulin levels, aiding in weight loss. Moreover, fasting has been shown to help reduce inflammation, a benefit that could prove significant for conditions such as Alzheimer's disease, arthritis, asthma, multiple sclerosis and stroke. When to Refrain from Intermittent Fasting Intermittent fasting is not a one-size-fits-all solution and is not suitable for everyone. For example, individuals under the age of 18, those who are malnourished, people with a history of eating disorders, pregnant or breastfeeding women, and those with certain medical conditions should avoid intermittent fasting. Furthermore, intermittent fasting can have negative repercussions for women, given the effects of caloric restriction on female hormones, fertility, and bone health. It may not be advisable for individuals who have irregular sleep patterns, irregular menstrual cycles, thyroid issues, or are under high levels of stress. Practical Advice for Intermittent Fasting For those contemplating intermittent fasting, it's important to stay hydrated during fasting periods with water and other functional low-calorie beverages such as Liquid IV Sugar-Free, Hop Wtr, Remedy Kombucha, and Smartwater. If your health care provider gives you the green light, you might start by fasting for just 12 hours overnight. Aim to consume three balanced meals of protein, high-fiber carbohydrates and healthy fats spread evenly throughout your designated eating window. It's important to remember that fasting is a tool, not a rigid diet plan. Monitor your hunger and fullness signals closely. If you begin to experience symptoms such as fatigue, mood swings, reduced energy, lack of concentration or loss of menstrual cycle, it may be time to revert to a more regular eating schedule. Meeting with a registered dietitian can be beneficial in determining the optimal foods to consume when not fasting and whether supplements could be beneficial in addressing potential nutrient deficiencies. If breakfast is not a meal you're accustomed to eating, consider starting your day with Core Power, a portable, easy-to-consume protein beverage to break your fast and sustain energy levels throughout the day. This will provide 26g of high-quality protein to build muscle and electrolytes to help hydrate. Then, make your next meal of the day balanced with protein and fiber. Try this Tequila-Spiked Salmon Bowls recipe. Cooking with alcohol intensifies the aromas and flavors of food by binding fat and water molecules that don’t usually mix. This unique reaction enhances the taste and smell of food in ways that cooking with water, broth, butter, and oil cannot. As Hy-Vee dietitians, we believe food should not only provide nutrition, but meals should also be enjoyable and taste good! Tequila-Spiked Salmon Bowls Serves 4 All you need: 4 (4 to 6 ounce) Fish Market frozen Alaskan sockeye salmon fillets, skin removed cut into 1-inch cubes ½ cup plus 2 tablespoons Lawry’s 30-minute Caribbean jerk with papaya juice marinade, divided ½ cup blanco tequila, divided 2 small jalapeno peppers, thinly sliced, divided 2 cups Hy-Vee Short-Cuts pineapple chunks, cut into ½ inch cubes ¼ cup fresh lemon juice ½ small red cabbage, trimmed; leaves separated 2 medium carrots, peeled and cut into julienne strips Hy-Vee olive oil cooking spray 2 (8.5 ounce) packages Hy-Vee microwavable jasmine rice 1 medium avocado, seeded, peeled and thinly sliced 2 medium red radishes, thinly sliced 2 yellow mangoes, pitted, scored and inverted All you do:
Shop all of these ingredients at Hy-Vee Aisles Online. Ready to spend more time fasting in a healthy way with help from your Hy-Vee dietitian? Check out Hy-Vee’s Balancing Your Blood Sugar program for tips on becoming more metabolically flexible while prioritizing nourishing meals. This group program aims to help reduce cravings and hunger by focusing on protein and fiber at each meal. Clients often report feeling more satiated between meals and before bed, allowing more time spent in a fasted state. Register online now. The information is not intended as medical advice. Please consult a medical professional for individual advice. This content was made possible with the paid support of our sponsors Liquid IV, Hop Wtr, Remedy Kombucha, Smartwater and Core Power. Missouri among worst states for women’s overall health, reproductive care, study findsby Anna Spoerre, Missouri Independent Missouri women have more limited access to health care and worse outcomes than any other state in the Midwest, a new study of the nation’s health care system found. Missouri ranks 40th out of 51 states plus the District of Columbia on the 2024 state scorecard on women’s health and reproductive care, published by the Commonwealth Fund, a private foundation focused on health care issues. The study assessed and compared 32 pieces of information derived primarily from public data sources in 2022, which was after most of the major effects of COVID had been felt, but before most abortion bans had really started to impact data findings, the creators of the scorecard said. Missouri continues to see maternal and infant mortality rates, breast and cervical cancer death rates, preterm births, congenital syphilis and depression leading up to or during pregnancy at rates that are higher than the national average. There are more women in Missouri between the ages of 18 and 44 reporting they hadn’t seen a doctor in the past year because of the cost than all but 10 other states. “One thing is absolutely clear,” Joe Betancourt, president of the Commonwealth Fund, told reporters when the study was published last week. “Women’s Health in the U.S. is in a very fragile state.” Missouri ranked among the states with the lowest low-risk c-section rates, postpartum depression and up-to-date pneumonia vaccines for post-menopausal women. But it fared among the worst nationally for breast and cervical cancer deaths, up-to-date pap smears, and mental health among women ages 18 to 64. It also ranked poorly when analyzing access to abortion clinics. Nearly every abortion became illegal in Missouri in 2022. A citizen-led ballot measure is hoping to enshrine abortion rights in the Missouri constitution. “We are seeing a deep and likely growing geographic divide in U.S. women’s ability to access vital health services and maintain their health,” said Sara Collins, a co-author on the Commonwealth Fund study. “Particularly among women of reproductive age.” Ashley Kuykendall, director of service delivery for the Missouri Family Health Council Inc., a nonprofit working to strengthen health care access across the state, said one of the most stark findings of the report was the combination of lack of access to wraparound care paired with poor health outcomes. But solutions exist, she said. One such solution:a women’s health omnibus bill that failed to pass in the statehouse this year despite widespread bipartisan support, that would have expanded birth control coverage, increased congenital syphilis testing and eased access to mammograms and STI testing. “The state legislature has an incredible power and responsibility to support better care for people across the reproductive health spectrum,” Kuykendall said. “Especially, as this report highlights, for folks who are pregnant or postpartum.”
Health and reproductive care outcomes
Missouri ranked 43 of 51 for this category, which includes maternal and infant mortality and physical and mental health issues. Some data was analyzed using the Centers for Disease Control and Prevention’s Pregnancy Risk Assessment Monitoring System. Missouri is among 33 states who participate in this federal program. Of those states, Missouri had the highest percentage of women who recently gave birth and reported experiencing intimate partner violence before, during or after their pregnancy. Missouri has some of the highest pregnancy-associated maternal mortality rates in the United States, which already ranks worst among countries of similar economies for high maternal deaths. In Missouri between 2018 and 2020,women on Medicaid were 10 times more likely to die within a year of pregnancy than women on private insurance, according to a 2023 report from the state’s Pregnancy-Associated Mortality Review. Black mothers were three times more likely to die within a year of pregnancy than white mothers. Of the 210 pregnancy-related deaths over those three years in Missouri, the majority were deemed preventable. Mental health conditions were the leading underlying cause of death, including due to suicide and substance use. The latest study found Missouri had one of the highest percentages of women between the ages of 18 and 64 who reported poor mental health, landing 48 of 51.
Coverage, access and affordability
Missouri ranked slightly better — 39 of 51 — in this category, which includes insurance coverage and health care affordability and access. Of the 33 states that provided data around health insurance coverage, Missouri ranked third-worst for women uninsured the month before becoming pregnant, and sixth-worst for women who didn’t have health insurance during a recent pregnancy. This is despite Missouri legislators’ decision to expand postpartum Medicaid coverage from 60 days to a year in 2023. A better-funded, better-staffed and more accessible public health safety net is also critical, said Kuykendall. This summer, Gov. Mike Parson signed into law a bill ending Medicaid reimbursements to Planned Parenthood, including for patients who go to the clinic for preventive exams, family planning and STI testing. Those opposed to the bill warned such a law would strain the state’s already fragile public health safety net. “The need for these services far outweighs the current capacity for the safety net to provide them,” Kuykendall said. “Any funding cuts to those providers not only limits patients’ ability to access care, but also puts further strain on the health care workforce and will undoubtedly worsen these outcomes.” Recent surveying by the health care nonprofit found that wait times across the state’s overburdened safety net clinics averaged between five and seven weeks. These 68 clinics receive Title X funding and do not turn anyone away, regardless of their ability to pay. The study found that approximately 5.6 million women across the country live in counties that are considered maternity care deserts. In Missouri, 41% of counties are designated maternity care deserts, meaning there are no maternity care providers or birthing facilities. Missouri’s rate is higher than the national rate of 32%, according to a separate 2023 report from the March of Dimes. Across the state, 10% of women do not live within 30 minutes of a birthing hospital. In the last decade, 19 hospitals across Missouri have closed, according to the Missouri Hospital Association. “There is an issue of access that’s very real,” Kuykendall said. The authors of the study were also deliberate in considering outcomes in states with abortion bans and restrictions. “There’s concern that abortion bans or limits will further reduce the number of providers offering maternity care owing to increased risk of legal action that provider’s face,” said David Radley, a senior scientist with the Commonwealth Fund. “Especially when states’ laws are ambiguous.” A recent study showed states with abortion bans saw a significant decrease in the number of medical residents applying to be in their OB-GYN programs.
Missouri saw a 25% drop in applicants since 2022, the highest drop in the nation second only to Arizona. “These inequities are long standing, no doubt, but recent policy choices and judicial decisions restricting access to reproductive care have and may continue to exacerbate them, Commonwealth Fund president Betancourt said of the study’s findings when related to states with abortion bans. “It also serves as a glaring reminder that where you live matters to your health and health care.”
Health care quality and prevention
Missouri landed in slot 35 of 51 for this category, which includes c-section rates, preventative care, pre and post-partum care and mental health screenings. In better news, Missouri ranked 15 of 51 among states with the lowest rates of c-sections during low-risk births, which Kuykendall attributed in part to the state health department’sincreased focus on doula programs. Missouri was slightly below the national average for the percentage of women eligible for mammograms who underwent the breast cancer screening in the past two years (75%), and the percentage of women ages 21 through 65 who had a pap smear, which screens for cervical cancer, in the past three years (78%). Among the more concerning data points to Kuykendall was a report that 19% of women between the ages of 18 and 44 in the past 12 months had put off seeing a doctor because of the cost. This data resonates with what she hears often from Missourians, who say it can be difficult to access even the most basic health care for reasons including cost, lack of transportation and lack of options. “It was a positive step that Missouri expanded Medicaid,” Kuykendall said, “And I think we have a long way to go in terms of ensuring everyone who should have access to care in that new environment actually does.” Missouri Independent is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Missouri Independent maintains editorial independence. Contact Editor Jason Hancock for questions: [email protected]. Follow Missouri Independent on Facebook and X. 
The State of Missouri announced the launch of a comprehensive needs assessment survey of older adults, adults with disabilities and unpaid caregivers. Postcards inviting eligible residents to take the survey were sent to over 158,000 randomly selected households across the state of Missouri. Households that receive an invitation are asked to follow the enclosed instructions and complete the survey. In addition, all Missouri residents who are age 50+, living with a disability or providing unpaid care to another adult are encouraged to take the survey online by visiting polco.us/missouri24. This survey will be available online in English, Spanish, simplified Chinese, German, French and Arabic. Anyone unable to complete the survey online can call 855-773-0665 to submit responses over the phone, request a paper survey, or schedule time to complete the survey with in-person assistance. “We encourage all eligible residents to take the survey. The more people who participate, the better data we will have to inform state and regional planning,” MARC Aging and Adult Services Director Kristi Bohling-DaMetz said. “This is an opportunity for older residents, those with a disability and caregivers in our community to share their thoughts and shape the future of aging in the Kansas City region and across Missouri.” The survey, developed in collaboration with National Research Center at Polco, gathers insight into residents’ experiences with accessibility, physical and mental health, employment and financial hardship, housing, transportation and other factors affecting their ability to live and age with dignity. Survey results will help identify the greatest challenges and needs for older adults, adults with disabilities and unpaid caregivers in each area. This public input will inform Missouri’s Master Plan on Aging and the development of related policies, initiatives and community programs throughout the state. For more information on the master plan, visit health.mo.gov/seniors/masterplanaging. All residents are encouraged to share the survey with their local networks to ensure these upcoming plans meet the needs of Missouri’s entire population. Participants’ responses will be kept confidential, and personal information will be securely stored by Polco. Residents’ individual data and votes are never shared.
Time to rethink your summer drink! Hydration is essential, especially during the hot summer months. This is because water plays a vital role in every body function, making up about 60% of your body. So, it’s important to prioritize getting enough fluids every day. But how much is enough? According to the National Institute for Health, the standard fluid needs of women are 9 cups (72 oz.) a day and 13 cups (104 oz.) a day for men. Drinking water is undoubtedly a great way to meet these daily fluid needs, but other fluids can also count! Herbal teas, decaf coffee, 100% juice, sports drinks, broth and even popsicles can all count toward your daily fluid goal to help keep you hydrated. However, it is important to be mindful of calories in some of these drinks, as beverages won’t satisfy like food will. This can lead to consuming more calories than your body needs. If you are looking to add some excitement to your hydration routine, here are five dietitian-approved beverage suggestions perfectly paired to go along with your favorite summer activities:
Now, are you up for a hydration challenge? Join Hy-Vee dietitians for a 4-week Functional Hydration Challenge! During these four weeks, Hy-Vee dietitians will provide weekly tips and guidance to help you meet your daily hydration goals! Be one of the first 150 participants to sign up and receive a complimentary beverage starter kit! Thanks to our generous sponsors – Liquid IV, Hop Wtr, Remedy Kombucha, Smartwater and Core Power. To sign up for the challenge, visit https://www.hy-vee.com/healthnew/dietitians. The information is not intended as medical advice. Please consult a medical professional for individual advice. This content was made possible with the paid support of our sponsors: Liquid IV, Hop Wtr, Remedy Kombucha, Core Power and Smartwater. The Missouri Department of Health and Senior Services (DHSS) has introduced “My Life, My Quit,” a free tobacco cessation service for Missouri teens who want to quit using electronic cigarettes, vape products, cigarettes and smokeless tobacco. “More Missouri teens now vape than adults who smoke cigarettes,” Abby Newland with the DHSS Tobacco Prevention and Control Program said. “This is significant given that Missouri has one of the highest national smoking rates.” Teens 13-17 who enroll in “My Life, My Quit” will receive confidential and personalized support from a trained quit coach who helps them build a quit plan to become free from nicotine. The program provides coaching sessions over text, live chat or phone. Teens earn incentive items along their journey and receive a completion certificate. Find Missouri-specific cessation information on the Tobacco Prevention and Control Program’s (TPCP) website here. Ways to enroll in My Life My Quit:
The program also includes resources and information for guardians, educators and healthcare professionals, which can be found on the "My Life, My Quit" website and through an online referral portal. HIPAA-covered and non-HIPAA-covered entities can refer youth to this resource with the teen's consent to participate. Order free “My Life, My Quit” promotional materials, including posters, rack cards and info cards on the order form. Copies of materials can be downloaded for digital distribution through the "My Life, My Quit" website as well. For additional information on the “My Life, My Quit” program, contact the DHSS Tobacco Prevention and Control Program at [email protected] or (573) 522-2820.  |
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