Abstract
Reproductive health disparities in the Appalachian region may be driven by barriers to healthcare access. However, the barriers specific to accessing family planning services in Appalachia have not yet been identified from the perspectives of Appalachian community members. Moreover, it is unclear how community members might perceive elevated levels of opioid use in the region to impact family planning practices. To fill this gap in knowledge, the current qualitative study explored community perspectives about family planning in Appalachia in the context of the opioid epidemic for the purpose of developing a survey instrument based on these responses. We conducted three video call focus group interviews with community stakeholders, those who live, work and are invested in Appalachia (N = 16), and analyzed the responses using Levesque, Harris, and Russell’s (2013) five pillars of healthcare access as a framework to categorize family planning practices and perceptions of service needs in the context of regional substance abuse: (1) approachability, (2) acceptability, (3) availability and accommodation, (4) affordability, and (5) appropriateness. Subthemes within each of these five categories were also identified. Our findings highlight stakeholder concerns around a lack of knowledge about and access to family planning services in Appalachia. Community members also expressed concern around the lack of availability of substance use treatment services, which may negatively impact family planning use and access in the region.
Highlights
Ensuring access to reproductive healthcare, which includes family planning services, is essential to meeting public health goals set forth by the World Health Organization, United Nations, and Centers for Disease Control and Prevention [1,2,3]
Northern Appalachia, which includes the Appalachian counties in New York, Pennsylvania, Maryland, and some of Ohio; (2) North Central Appalachia, which includes the rest of the Ohio Appalachian counties, and most of the counties in West Virginia; (3) Central Appalachia, which includes all the Appalachian counties in Kentucky, some in Tennessee, and a handful in Virginia and West Virginia; (4)
In light of research suggesting that cultural factors influence health and that culture plays a role in both health behaviors and health outcomes in Appalachia [15], the purpose of our research was to learn more about family planning practices from the perceptions of community members who are immersed in this culture
Summary
Ensuring access to reproductive healthcare, which includes family planning services, is essential to meeting public health goals set forth by the World Health Organization, United Nations, and Centers for Disease Control and Prevention [1,2,3]. Ohio, South Carolina, Tennessee, and Virginia [8] This region is home to more than 25 million people in 420 counties across these 13 states [8]. The Census Bureau classifies urbanized areas as any incorporated area with a population of 50,000 or more, classifies an urban cluster as an incorporated area with a population of at least 2500 and less than 50,000, and classifies a rural area as any area that falls outside of the urban classifications [10] Based on these classifications, 42% of the Appalachian region’s population lives in areas classified as rural; this is more than double the percentage of people living in rural areas across the United States as a whole [8]
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