Doctoral Dissertation Research: Navigating Structural Barriers to Obstetric Services in Rural America

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Obstetric and maternity health services are being rapidly eliminated in the rural United States, making maternal care more difficult to access and causing negative birth outcomes for 30 million American women and their communities. Service closures have a magnified impact in some rural regions due to histories of systemic inequalities, local economic marginalization, geographic barriers, and insufficient health infrastructures. This research investigates how women living in rural Appalachia navigate these barriers. The findings from this research will be shared with key regional and national rural health policy and practice stakeholders including governmental and non-governmental organizations, doctors and midwives, and public health professionals. Additionally, the researcher will organize community meetings to strengthen the local knowledge base on this issue and allow health professionals and pregnant women to connect with one another. This doctoral dissertation research project investigates the impact of policy and funding decisions to close rural obstetric health services on pregnant women and mothers living in these regions. This project employs ethnographic methods including participant observation in maternal healthcare settings, obstetric care facility mapping, community-based participatory mapping, and semi-structured interviews with pregnant women, mothers, and care providers to explore the resourceful ways women in the rural mountains of Western North Carolina navigate pregnancy and birth when faced with structural and economic barriers to obstetric services. This research adds to contemporary social science and the anthropology of reproduction by studying the relationship between state and federal public health policies and health and well-being in economically and socially disenfranchised regions. Additionally, this project will cultivate understanding of the innovative and resourceful ways pregnant women, mothers, and rural health professionals in Appalachia navigate the complex terrain of obstetric care in the area and create support and knowledge sharing networks.This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.