Perceptions of Reproductive Autonomy Among Women in Rural Appalachia

Background and purpose: Reproductive autonomy is defined as the ability to decide and control contraceptive use and pregnancy intention. Supporting reproductive autonomy is in line with social work’s professional ethics and stance on reproductive health. Individuals in rural communities often face barriers to reproductive health. Individuals in rural communities have lower household incomes, report higher rates of pregnancy complications, have an infant mortality rate twice the national rate, receive fewer reproductive health services, are less likely to seek medical care due to the cost and lack of health insurance, have less access to abortion care, and are more likely to have an unintended pregnancy compared to those living in more urban areas. The purpose of this qualitative study is to examine how women in rural communities experience and perceive reproductive health and autonomy.

Methods: Purposive snowball sampling was used to recruit and conduct semi-structured interviews with 10 participants who identified as female and lived in a rural community (defined by the U.S. Census Bureau as a community with fewer than 50,000 residents). Participants had a mean age of 37.1 years, parented an average of 2.2 children (range 0-5), and had seen a health care provider in the last year. Interviews were audio recorded and transcribed verbatim. A modified version of van Kaam’s descriptive phenomenological methods were used to analyze the data. Interview transcripts were read in their entirety, and relevant data were identified, and participants’ repetitive and vague expressions were eliminated. The remaining data are organized into thematic categories and organized by descriptions of experiences with and perceptions of reproductive autonomy.

Results: Results will presented thematically with representative quotes from participants. While the rurality of communities did present with less access and fewer options around reproductive health providers, participants describe strengths of their rural communities on their reproductive autonomy. Participants describe reliance on an informal system of sexual and reproductive health education, which heavily influenced their understanding of reproductive health and decisions around acceptable contraceptive use. This informal system is deeply influenced by the dominant Christian faith, regardless of the participant’s faith. Shame appears to influence several aspects of reproductive autonomy, and is present in interactions with healthcare providers, considerations around mistimed or unwanted pregnancy, and sexual behavior outside a heterosexual marriage. The idea of a hypothetical potential pregnancy is further described with ambivalence.     

Conclusions and Implications: Faith communities provide significant influence over many aspects of reproductive autonomy for participants in our rural sample. This is in line with previous research noting the significant and varied roles faith plays in rural communities. Practitioners should work in partnership with faith organizations to promote reproductive autonomy and education.  Social work practitioners should also work with healthcare providers to reduce the potential for coercion when discussing contraception and reproductive health with patients. Future research should further explore the role of religion on reproductive autonomy within rural communities.