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Power and Injustice: Exploring the Factors that Limit Women's Access to Maternal Health Care in Rural Pennsylvania
Restricted (Penn State Only)
Doctor of Philosophy
Date of Defense:
May 16, 2019
Carolyn Sachs, Dissertation Advisor
Carolyn Sachs, Committee Chair
Kathryn Brasier, Committee Member
Leland Glenna, Committee Member
Jill Wood, Outside Member
Erin Heidt-Forsythe, Committee Member
Declining access to medical care is a crucial aspect of the ongoing maternal health care crisis in the U.S. Public discourse and existing research focus on a shortage of obstetricians, and hospital closures, as two of the primary factors that limit women’s access to maternal health care. Declining access to care places a disproportionate burden on rural women, who must travel longer distances to care, causing them increased physical, psychological, and financial stress and contributing to negative pregnancy and birth outcomes. Expanding on existing literature, this multiple methods research identifies myriad factors that limit rural women’s access to care, explores how those factors interact to affect women’s broader lives, and critically analyzes how medicine’s hegemonic power contributes to declining access to care. Applying a new conceptual model for health care access, the research design combines spatial analysis, feminist ethnography, and case studies to uncover women’s experiences accessing maternal health care while living in four rural areas of Pennsylvania. Two case studies focus on hospital deserts – counties that contain no hospitals, and the other two are based in Critical Access Hospitals – hospitals federally designated as such because of their remote locations and small size. Interviews with women, health care providers, and others coalesce to provide a more comprehensive picture of the complexity of health care access in rural areas, and emphasize the roles of extreme weather events, medical insurance constraints, and concentration of specialized care as barriers to care. Grounding my work in both social and feminist theory, I weave the findings from the case studies with my analysis of health care system policy and the lack of policy regarding home birth midwifery in Pennsylvania. I identify fourteen access barriers, highlight how they interact to affect women’s lives, and argue that medicine’s hegemonic power contributes to declining access by operating at three scales of social life. I employ the reproductive justice framework as articulated by SisterSong to assert the need for new and improved public policy that will increase rural access to maternal health care, and underscore the potential for legal home birth midwifery to fill some of the gaps left by declining access to medical maternal health care.
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