Under Pressure: Appalachian Women's Experiences of Coercion Around Family Planning

Background and Purpose: Appalachia is a large geographic region of the Eastern United States that follows the Appalachian mountain chain from New York to Mississippi. While not monolithic, the region is known to share a common, place-based culture and regional health disparities. Reproductive health is understudied in the region. As such, the purpose of this study was to examine Appalachian women’s perceptions of their experiences with being pressured into choosing surgical sterilization, or birth control in general, as a method of family planning.

Methods: In this study, a sample of women ages 18-49 (N=632), residing in an Appalachian zip code, were recruited using targeted advertisements via the Facebook social media platform, to complete a survey on reproductive health that included questions about family planning coercion. Interested participants clicked on a link that took them into the Redcap electronic survey platform. Participants were compensated with a $10 retail gift card. Analysis of the data was conducted using SPSS.

Results: Results indicate that out of the 632 survey participants, 141 reported feeling pressured to get sterilized, with women of color reporting higher rates of perceived coercion: 43.5% of Black/African American respondents, 39.1% of Native American/American Indian respondents, 28.6% of Asian/Pacific Islander respondents, 22.2% of Latinx respondents, and 21.4% of White respondents. Of the women who reported having undergone sterilization (n=59), 35.6% of them reported feeling pressure to become sterilized. Regarding pressure to use birth control, 36.2% of respondents reported feeling pressured with results again suggesting women of color were disproportionately impacted: 69.6% of Black/African American respondents reported feeling pressured to use birth control, compared with 40.9% of Native American/American Indian respondents, 35.7% of White respondents, 33.3% of Latinx respondents, and 16.7% of Asian/Pacific Islander respondents reporting pressure. Of those that reported feeling pressured to use birth control, 67.4% of respondents reported that pressure coming from healthcare providers, 57.8% reported feeling pressured by family, 51.1% reported feeling pressured by their partner, and 14.2% reported pressure from their religious community. Over 22% of respondents reported feeling pressured to not use any birth control: 39.1% of Black/African American, 30.4% of Native American/American Indian respondents, 22.2% of White respondents, 14.3% of Asian/Pacific Island respondents, and 11.1% of Latinx respondents. Of those that reported feeling pressured not to use birth control, 51.1% of respondents reported that pressure coming from their partner, 44.7% reported feeling pressured by their religious community, 37.9% reported feeling pressured by family, and 27% reported pressure from their healthcare provider.

Conclusions and Implications: Our study suggests that pressure to be sterilized was surprisingly common in this sample of Appalachian women and this population faces pressure regarding family planning in general. Although the sample contained small sizes of racial and ethnic minority groups, women of color appear to face coercion at higher rates, especially in regards to sterilization and to use birth control. Findings have implications for health and social service providers working in Appalachia, and suggest that educational programs that are in line with reproductive justice principles may be beneficial for the region.