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

This ethnographic doctoral dissertation project investigates the cultural, political and historical factors that influence access to obstetric care in rural areas of the Southern Appalachian United States. Obstetric services are being eliminated in the rural United States, marginalizing and causing negative birth outcomes for approximately 30 million American women and their communities (Hung et al. 2017). Service closures have a magnified impact on rural mountainous areas located in the US South and Appalachia due to histories of marginalization, local demographics and economics, geographic barriers, and insufficient health infrastructures (Douthit et al. 2015). The proposed dissertation research explores how women in rural Southern Appalachia navigate pregnancy and birth when faced with structural and economic barriers associated with obstetric closures. Ethnographic fieldwork will take place in the High Country of North Carolina. I will employ methods of participant observation, obstetric care facility mapping, semi-structured interviewing, and birth histories and narratives to elucidate the everyday experiences of pregnancy in rural regions. Specifically, this project involves collecting narrative-driven data from the perspectives of pregnant women, mothers, physicians and midwives, and non-profit and public health workers in the region. The primary objective of this dissertation research is to examine how women living in rural Appalachia access obstetric healthcare and cope with a lack of resources resulting from their social and geographic positionality that exacerbate the complexity of pregnancy. Within the experiences of rural women giving birth, I will also investigate differentiated experiences via intersectionality. Appalachia is a region which is widely depicted as homogenous (Bell 2008). This project will complicate that stereotyped narrative through the lens of pregnancy. During a 12-month period in the rural and mountainous High Country of North Carolina, I will work amongst maternal health professionals, care providers, and pregnant women and mothers employing several ethnographic methodologies including participant observation, interviewing, shadowing, birth histories and narratives, participatory mapping, and obstetric service mapping. The primary research question at the core of this project is: How does living in a rural area affect women’s pregnancy and birth experiences amid increasing closures of obstetric and birthing facilities?