Access to reproductive health services in rural Central Appalachia

Introduction: Despite the unique experiences rural women may have in accessing reproductive health, there is a limited research exploring women’s experiences accessing care. Women in rural areas are less likely than urban women to use contraceptive services. The infrastructure to support reproductive health care in rural communities is subject to the general health workforce barriers common to more specialized health services (e.g. dental and vision). Literature suggests that access to stigmatized services (e.g. mental health and substance abuse) is even more limited.

Methods: This study includes 45 in-depth interviews with women are residents of rural counties of Central Appalachia, sampling three groups of women: (1) women who are presently accessing specialized reproductive health services, recruited at points of service in urban areas (2) women who are presently accessing general reproductive health services, recruited at primary health care centers located in rural counties, and (3) women who are not presently accessing any reproductive health services, recruited at centers of commerce in rural counties. Interviews are recorded, transcribed verbatim, and coded/analyzed using an inductive approach, with support Nvivo software. The study approved by the Harvard School of Public Health Institutional Review Board.

Results: Themes emerging from participant narratives will be presented within the Andersen Model of Health Care Utilization (1995). Case studies of different reproductive health needs will be compared, noting shared and unique facilitators and barriers, with specific attention to how stigma influences access.

Conclusion: Women living in rural communities have experience both unique from and similar to their urban peers.