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

在美国农村，产科和孕产妇保健服务正在迅速消失，使孕产妇护理更加难以获得，并对3 000万美国妇女及其社区造成负面的生育结果。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产生了更大的影响。这项研究调查了生活在阿巴拉契亚农村的妇女如何克服这些障碍。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，以加强当地对这一问题的知识基础，并使卫生专业人员和孕妇能够相互联系。本博士论文研究项目调查政策和资金决策的影响，关闭农村产科保健服务的孕妇和母亲生活在这些地区。该项目采用人种学方法，包括参与观察孕产妇保健设置，产科护理设施映射，社区参与式映射，和半结构化的采访孕妇，母亲和护理人员，探索足智多谋的方式妇女在西部北卡罗来纳州农村山区导航怀孕和分娩时，面临结构和经济障碍的产科服务。这项研究通过研究州和联邦公共卫生政策与经济和社会权利被剥夺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。此外，该项目将培养孕妇，母亲和农村卫生专业人员在阿巴拉契亚地区导航产科护理的复杂地形的创新和足智多谋的方式的理解，并创建支持和知识共享网络。该奖项反映了NSF的法定使命，并已被认为是值得通过使用基金会的智力价值和更广泛的影响审查标准进行评估的支持。

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.