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

在美国农村，产科和产妇保健服务正在迅速取消，这使得产妇保健更加难以获得，并导致3000万美国妇女及其社区的不良生育后果。由于系统性不平等、地方经济边缘化、地理障碍和卫生基础设施不足的历史，服务关闭在一些农村地区的影响放大。这项研究调查了生活在阿巴拉契亚农村的妇女是如何克服这些障碍的。这项研究的结果将与主要的区域和国家农村卫生政策和实践利益攸关方分享，包括政府和非政府组织、医生和助产士以及公共卫生专业人员。此外，研究人员将组织社区会议，以加强当地关于这一问题的知识基础，并让卫生专业人员和孕妇相互联系。这一博士论文研究项目调查了关闭农村产科保健服务的政策和资金决定对这些地区的孕妇和母亲的影响。该项目采用人种学方法，包括产妇保健环境中的参与者观察、产科护理机构地图绘制、基于社区的参与性地图绘制以及对孕妇、母亲和护理提供者的半结构化访谈，以探索北卡罗来纳州西部农村山区的妇女在面临产科服务的结构性和经济障碍时如何应对怀孕和分娩的足智多谋的方式。这项研究通过研究州和联邦公共卫生政策与经济和社会被剥夺公民权地区的健康和福祉之间的关系，增加了当代社会科学和生殖人类学的内容。此外，该项目将培养人们对阿巴拉契亚地区孕妇、母亲和农村卫生专业人员如何驾驭该地区复杂的产科护理领域并创建支持和知识共享网络的创新和足智多谋的理解。该奖项反映了NSF的法定使命，并通过使用基金会的智力优势和更广泛的影响审查标准进行评估，被认为值得支持。

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.