Reproductive Narratives of Young, Rural Appalachian Women

Background: People living in rural Appalachia face multifaceted barriers to healthcare and disparities in health outcomes when compared to people in other American communities. In particular, reproductive healthcare and family planning services are more difficult to access and of poorer quality in rural communities compared to urban areas. Issues related to the availability and affordability of healthcare are compounded by cultural norms and societal expectations in rural Appalachia, especially for young people who are still financially dependent on their parents. These barriers compound vulnerabilities for young rural women in and from rural Appalachia, threatening their reproductive health and autonomy. Despite these challenges, there is a lack of research regarding reproductive experiences within rural Appalachia’s unique cultural context.

Methods: This study used a narrative approach to explore rural Appalachian college women’s reproductive experiences throughout their life course. We recruited study participants using social media, printed flyers, and university newsletters. Participants were undergraduate college students who identified as women, were 18 to 25 years old, and had spent their formative adolescent years in rural Appalachian communities. We screened respondents for study eligibility using an online REDCap survey and then followed up with eligible participants to schedule a 1-1.5 hour confidential interview. Participants received a $10 gift card after completing an interview. Two independent researchers conducted semi-structured interviews with study participants in fall 2019 and spring 2020, recording, transcribing, and analyzing their narratives. Analyses followed Creswell and Poth’s (2017) criteria for open coding.

Results: Pilot findings suggested that the reproductive experiences of young rural Appalachian women are greatly influenced by family and community. Participants identified a lack of anonymity in rural communities to be a major barrier to accessing the reproductive healthcare they sought. All participants identified supportive parents but noted peers whose reproductive decisions were largely determined by their parents and other family members. Participants also reported conservative and faith-based values in their rural Appalachian communities to be a major barrier to accessing reproductive healthcare and making informed reproductive decisions.

Implications: These findings highlight several barriers to reproductive autonomy for young rural women in Appalachian communities, including lack of privacy and autonomy and sociocultural and religious belief systems. They also suggest disparate experiences among adolescents and young adults in these communities, based partially on parental beliefs and approaches to reproductive healthcare and family planning. These findings suggest directions for future research, including potential sources of support and barriers to reproductive health and autonomy. Challenges of recruiting members of this population for study participation are also discussed alongside insights and directions for future research with young rural women from Appalachian communities.