Rural Women Research Articles

Twirl Store: pioneering sustainable textile practices by closing the loop

Learning outcomes After completion of the case study, the students will be able to make strategic decisions for social entrepreneurship and carry out a sustainability and social impact analysis, assess the benefits of a circular economy-based retail model and investigate ways to preserve these benefits and recognize the ethical and sustainable issues facing the fast fashion sector and how social enterprises are addressing them. Case overview/synopsis The culture of fast fashion had proven to be dangerous for the environment as it had promoted a culture of consumerism and materialism. It had also increased the landfills in different countries. The need of the hour was to upcycle used and unwanted clothes into new innovative items. This idea had been practically implemented by Mrs Sujata Chatterjee of the Twirl Store, the protagonist of this case study. Chatterjee was a social entrepreneur who recognized the environmental and social problems caused by rapid fashion and abandoned apparel in landfills. She launched the Twirl Store, a social enterprise with the mission of advancing circular economy and sustainability practices in the textile sector. Rural women were economically and culturally empowered by the enterprise’s upcycling of used clothing using their abilities, and a sustainable source of income was created. Finding abandoned clothing, sorting and processing it effectively and locating clients who share her commitment to sustainability were difficult tasks for Chatterjee. Despite the difficulties, the Twirl Store served as an example of how circular economy concepts, cultural sustainability and women’s empowerment might be combined, highlighting the importance of social entrepreneurship in addressing global concerns and fostering positive social effects and economic impact. Complexity academic level This case study is applicable for undergraduate as well as post graduate students of management studies. Supplementary materials Teaching notes are available for educators only. Subject code CSS 3: Entrepreneurship.

Inadequacy of antenatal care attendance and its determinants amongst pregnant women in Ethiopia based on the 2019 Mini-Ethiopian demographic health survey: secondary data analysis

BackgroundInadequacy of antenatal care (ANC) utilization is a prominent public health problem, causing poor pregnancy outcomes. In developing countries, including Ethiopia, having ANC coverage, many pregnant women do not achieve the first ANC visits in the first trimester and receive at least four ANC visits. Therefore, this study aimed to examine the magnitude and identify determinants of inadequacy of antenatal care attendance amongst pregnant women in Ethiopia.MethodsInadequate ANC attendance was defined as combining starting ANC visits after the first trimester and having fewer than four visits together. The study used secondary data from the 2019 mini-demographic and health survey. A weighted sample of 3927 pregnant women was included in this study. Data management and further analysis were performed using STATA 14 software. A multivariable generalized estimating equation analysis was used to identify determinants associated with inadequacy of antenatal care attendance. The Adjusted odds ratio with a 95% confidence interval was used to identify significant variables for inadequate antenatal care visits.ResultOverall, 78.5% of pregnant women did not attend adequate antenatal care visits during pregnancy. In multivariable generalized estimating equation analysis, women aged 25 to 34 years (AOR = 0.77, 95% CI: 0.61–0.95), being educated (AOR = 0.31; 95% CI: 0.22–0.45), and being wealthier index (AOR = 0.67, 95% CI: 0.51–0.88) were less likely to inadequate antenatal care attendance. Whereas being rural residents (AOR = 1.49; 95% CI:1.08–2.07), no television exposure (AOR = 1.51; 95% CI:1.1–2.06), having more family members in the household (AOR = 1.81; 95% CI: 1.11–2.95), and women from semi-peripheral region (AOR = 1.92; 95% CI: 1.42–2.59) were higher odds of being associated with inadequacy of antenatal care attendance.ConclusionsThe prevalence of Inadequate antenatal care attendance amongst pregnant women in Ethiopia is still High. The study identifies significant variables that could be positively and negatively associated with inadequate antenatal care visits. Health education interventions should target uneducated, poorer, and rural women to attend early antenatal care and use at least four antenatal care utilization for early detection of complications during pregnancy and delivery.

Using the theoretical domains framework to identify the sociocultural barriers and enablers to access and use of primary and maternal healthcare services by rural Bangladeshi women: a qualitative study

In Bangladesh, increasing the use of primary healthcare (PHC) and maternal healthcare (MHC) services is the main focus of achieving the United Nations Sustainable Development Goal-3, ensuring healthy lives and wellbeing for all. However, little is known about the sociocultural barriers and enablers to accessing and using PHC and MHC services among rural Bangladeshi women. This qualitative study aimed to identify sociocultural barriers and enablers to accessing and using PHC and MHC services among Bangladeshi rural women by using the Theoretical Domains Framework (TDF). This exploratory qualitative study used focus groups and interviews to collect data from women (28), their husbands (8) and healthcare providers (18). Data were analysed using Framework approach underpinned by the TDF. Four main themes emerged from data analysis, of which key barriers were summarised in three themes: (i) family barriers including lack of family reinforcement, (ii) social barriers including gender of healthcare providers, and (iii) cultural barriers including superstition to access and use of healthcare services. The remaining theme, sociocultural support, included information about key enablers, such as family support, neighbourhood connection and media influence. Several key behavioural constructs that aligned with the TDF need to be targeted when developing an intervention to promote access and use of PHC and MHC services.

“She” power: role transition and self-empowerment of women in rural tourism

It is widely believed that participation in tourism empowers women, particularly by providing direct employment and income generation. However, this perspective frequently overlooks women’s agency and self-actualization. This study examines the Tingsong Cultural Community (TCC) in northeast China, integrating self-empowerment with role theory to focus on female participation in tourism. Utilizing multiple data collection strategies, both primary and secondary data were gathered between July 2019 and December 2022. Through inductive thematic analysis, the research unpacks the role transitions of Chinese rural women within tourism practices and the dynamics of self-empowerment. The findings reveal that: (1) role transition is a dynamic process involving exploration, identification, and obligation, marked by an enhanced sense of self-empowerment; (2) self-empowerment arises from awareness and interaction, benefiting from economic, cultural, and subjective dimensions; and (3) external support is essential for empowerment, ideally starting with vulnerable individuals to allow self-empowerment to develop organically. This study refines the concepts of role theory and self-empowerment while establishing the relationship between rural women’s role transitions and self-empowerment, contributing to existing knowledge. The practical implications related to external investment, endogenous development, and digital engagement are insightful for the sustainability of similar destinations.

Acceptability and validity of HPV self-sampling for cervical cancer screening among women living in different ecological settings in India.

India records one fifth of global cervical cancer burden. Unlike human papillomavirus (HPV) self-sampling, other screening methods may cause discomfort and embarrassment. This study aimed to investigate attitudes, acceptability, barriers, predictors, effective modality of instructions, and validity of HPV self-sampling among Indian women residing in varied settings and different literacy levels. This is community-based interventional study among Indian women 30-55 years, residing in urban slums (500), urban non-slums (500), and rural (600) settings with varied washroom facilities and privacy, to collect self-samples. Each group was subdivided into two arms; in one women received education with pamphlets and other with health education program (HEP). Study involved enlisting eligibles, obtaining informed consents and conducting personal interviews to collect baseline data. Self-samplers were distributed with instructions (pictorial pamphlets in one group and HEP in other) regarding usage, storage and return. Willingness to use self-samplers, refusals, experiences, and so forth were captured. Post-intervention knowledge, attitudes, practices was recorded. HPV reports were distributed. Women with positive result on either test were offered further management. Acceptance rate of self-sampling was 99.2%, 97%, and 98.8% and HPV positivity was 7%, 7.8%, and 8.5%, respectively among urban non-slum, urban slum and rural women. Agreement rate between health personnel collected and self-collected samples was 96.5% in pamphlet and 93.2% in HEP arm. Major barriers of self-sampling were lack of confidence about performing self-test correctly, fear that test would be painful and anxiety about test results. HPV self-sampling has good acceptability among Indian women and good agreement with health personnel collected samples.

Determinants of rural women economic empowerment: the Case of Bahir Dar Zuria Woreda in Amhara Region, Ethiopia

The issue of women's empowerment has been a topic of ongoing discussion in developing countries, considering the complex socio-demographic and cultural factors at play. Women tend to face disadvantages compared to men across various human development indicators. Therefore, it is crucial to thoroughly examine the different factors that influence women's economic empowerment within the specific context of Ethiopia. This study examines the factors that contribute to the economic empowerment of women in rural areas of Bahir Dar Zuria Woreda in the Amhara Region of Ethiopia. The research employed multi-stage probability sampling techniques to achieve its objectives, resulting in a sample of 382 rural women randomly selected from seven selected kebeles. Descriptive statistics and binary logistic regression were used to analyze the collected data. The study found that more than half of the women achieved a medium level of economic empowerment. The results revealed that age, educational status, income contribution, and ownership of property positively influenced rural women's economic empowerment. In addition, opening a savings account, information access, mobile phone accessibility, and membership of women's associations positively and significantly affect women's economic empowerment in the study area. Conversely, marital status, hours spent on unpaid work, and early age at marriage negatively.

Individual and community-level factors associated with adequate antenatal care service utilization in sub-Saharan Africa

BackgroundSub-Saharan Africa (sSA) continues to rank among the regions in the world with the highest rates of maternal mortality and the lowest rates of utilization of maternal health care. The risk of death for women in sSA is 268 times higher than that of women in high-income nations. Adequate antenatal care (ANC) services utilization is essential to the mother's and the baby's survival and well-being. This study aimed to identify both individual and community-level factors associated with adequate antenatal care services utilization in sSA.MethodWe used data from the most recent Health and Demographic Surveys (DHS), which were carried out between 2012 and 2022 in 33 sSA countries. A total of 240,792 women were included in this study. The two-level mixed-effects logistic regression model was used to identify the individual and community-level factors associated with the use of adequate ANC service.ResultsThe pooled prevalence of adequate ANC service utilization in sSA was 55.48% (95% CI: 55.28–55.68). The study showed that secondary and above-educated women (AOR = 2.13, 95% CI 2.07–2.19, secondary and above-educated husbands (AOR = 1.55, 95% CI 1.51–1.60), rich women AOR = 1.26, 95% CI 1.24–1.29), women 35–49 years of age (AOR = 1.36, 95% CI 1.32–1.41) and distance to a health facility is not a big problem (AOR = 1.13; 95% CI 1.11–1.16) was significantly and positively correlated with the use of adequate ANC services. However, rural women (AOR = 0.80; 95% CI 0.78–0.82), not having mass media access (AOR = 0.74, 95% CI 0.72–0.75), 5 and above birth order (AOR = 0.73, 95% CI 0.68–0.78) were significantly and negatively correlated with the use of adequate ANC services. Additionally, the random effects model showed that variables at the community and individual levels were responsible for approximately 62.60% of the variation in the use of adequate ANC services.ConclusionThe sSA countries had a low prevalence of adequate utilization of ANC with a significant variation among countries. Moreover, public health initiatives should focus on rural women, poor women, and uneducated women to enhance maternal health services utilization. Furthermore, policies and programs that address cluster variations in the utilization of adequate ANC services must be developed, and their implementation must be vigorously pursued.

A study of Rural women’s financial literacy and awareness level towards financial products and services in Kerala perspective with Special reference to Malappuram District

Financial literacy is crucial in empowering individuals, particularly rural women, to make informed financial decisions and achieve economic well-being. This study explores the financial literacy and awareness levels of rural women in the Malappuram district, focusing on the relationship between socio-demographic factors and financial literacy. The research, conducted through a cross-sectional descriptive study among 100 women, reveals that most respondents are young, educated, and possess a moderate level of awareness and knowledge of financial tasks and products. The study highlights significant barriers to financial literacy, including social and cultural issues, lack of education, income constraints, and gender discrimination. Despite these challenges, the penetration of financial products like bank accounts, debit cards, and mobile banking is relatively high among the participants. The study finds a significant relationship between age and financial literacy but no significant correlation between education or income levels and financial literacy awareness. The findings underscore the need for targeted financial education programs to enhance financial literacy among rural women, addressing identified barriers and focusing on age-specific strategies to improve their economic participation and contribute to national economic development.

Exploring the impact of digitalisation on rural women's socio-economic status: A bibliometric and scoping study

The rapid development of digital technologies has the potential to accelerate the socio-economic change of rural women. This study provides insights obtained from a thorough scoping assessment and bibliometric analysis of the current literature on the topic. The study focuses on the diverse digital tools and platforms that have played a crucial role in improving the economic involvement, education, health, and social standing of women living in rural areas. The key findings suggest that digitalization enables rural women to easily access markets, financial services, and educational resources. As a result, it promotes entrepreneurial activity and self-employment among them. In addition, the study uncovers important recurring themes, specific geographic areas of interest, and key individuals who contribute significantly to the subject. This demonstrates a worldwide interest in utilizing digitalization for the advancement of gender equality and rural development. Notwithstanding the favourable results, there are still enduring hurdles in the form of limited digital skills, inadequate infrastructure, and socio-cultural obstacles. The digitalisation can challenge these persistent inequalities through its vast potential for education, financial inclusion, and health care access, also in entrepreneurial ways. In addition, services such as mobile banking or digital payment systems means that women now have better tools to manage their own finances and gain access to microloans for e-commerce. Education platforms and e-learning resources can improve literacy and develop skills to help women become more effective in employment. The study highlights the necessity of implementing focused policies and programs that tackle these difficulties to guarantee development that is both inclusive and sustainable. Proposed future research aims to enhance the comprehension of how digitalization affects the socio-economic transformation of rural women.

Stories of women's marriage and fertility experiences:Qualitative research on urban and rural cases in Bali, Indonesia.

As a Hindu-majority province in Indonesia, Bali presents a unique and distinctive culture. Patrilocal ( purusa) marriage and patrilineal inheritance as a continuation of the patriarchal system puts a male in the key role of family representative and successor. Having a son is a priority for a married couple in Balinese society. As a consequence, Balinese women experience several constraints related to their economic productive, reproductive, and adat (ritual) roles. When a family does not have a male heir, their daughter is pressed to find a spouse willing to accept sentana (daughter succession) marriage. This secondary form of marriage brings another complication for Balinese-Hindu women and does not necessarily relieve their submissive position. This study analyzes Balinese-Hindu women's perspectives on their marriage experiences and fertility decisions in patrilineal society in changing rural and urban conditions. The data was collected in two areas representing rural (Gianyar) and urban (Denpasar) locations in Bali Province, Indonesia from November 2019 to February 2020. Primary data was based on in-depth interviews of six rural and six urban married Balinese-Hindu women. This qualitative inquiry into Balinese women's experience of the marriage system and fertility options in urban and rural Bali revealed varying degrees of social expectation to provide male descendants for their families. At the same time, economic burdens still haunted them in this development era and manifested conflicting implications for family size. Their stories of purusa and sentana marriage were complex because it has strongly associated with customary law ( adat) in traditional society. Paradoxically, this study found that it was predominantly rural women who opted for the sentana arrangement and expressed a preference for smaller family sizes. This study explores women's fertility aspirations, notably regarding son precedence. It problematizes the sentana marriage alternative as a potential solution to alleviate the expectations and burdens placed on women.

Assessment of indoor air pollution in causing respiratory illness among women residing in rural areas of Mysuru

Introduction: The use of inefficient and harmful fuels and technology within and outside the home is the primary cause of indoor air pollution. Approximately 2.4 billion people on the planet still cook over open flames and inefficient stoves using solid fuels and kerosene. The availability of cleaner cooking options varies more in rural than in metropolitan settings. Therefore, there is a need to determine the prevalence of indoor air pollution among rural women, its association with respiratory disorders, and the frequency of respiratory illnesses among rural women residing in houses with or without indoor air pollution. Materials and methods: This analytical cross-sectional study was done for a period of six months from June to November 2020. The study conducted in 210 households living in the rural field practice areas of JSS Medical College, Mysuru. For the selection of villages, a multistage random sampling technique was used. Three villages are selected from the rural setting: Suttur, Hadinaru, and Kadakola. The households were included by probability proportionate to the size sampling technique. Pre-tested, semi-structured, phase and content validated questionnaires were used to obtain the details on socio-demographic characteristics, meter values of indoor air pollutants like Particulate Matters (PM1, PM2.5, PM10) and Volatile Organic Compounds (VOCs), respectively with the factors affecting respiratory illness and the episodes of the illness. Data was entered in Microsoft Excel and analyzed using descriptive and inferential statistics using SPSS V.26. Results: The prevalence of indoor air pollution in the present study was 13.3%. In the homes of rural women, there was a statistically significant variation in the concentration of the three particulate matter sources that cause indoor air pollution. Additionally, among the women living in rural families, there was a statistically significant difference in the concentration of PM10 that caused respiratory disease. Conclusion: The current study demonstrated the higher concentrations of pollutants such as PM10, PM2.5, and PM1.0, as well as their significant relation with indoor air pollution in rural families. To prevent indoor air pollution and its health risks, clean energy must be used for household needs.

Exploring the Persistent Challenges of Reproductive Health Management: Analyzing Use of Contraception Among Wives Across Four Provinces in Pakistan Utilizing MICS Data

This study examines factors influencing contraceptive use among married women aged 15-49 in Pakistan using data from the Multiple Indicator Cluster Survey (MICS). This research aims to identify the demographic, economic, and sociocultural factors contributing to this disparity, focusing on the four provinces (Punjab, Sindh, KPK, and Balochistan). The study employs secondary analysis of data from over 103,000 women, exploring the association of CPR with variables such as age, education, economic status, fertility preference, and internalized patriarchy. Geographically, 40.9% of the sample was from Punjab, 23% from KPK, 18.8% from Balochistan, and 17.3% from Sindh, with 72.3% residing in rural areas and 27.3% in urban areas. Findings contribute to understanding provincial disparities and highlight the need for localized, culturally sensitive family planning strategies in Pakistan. The study calls for targeted interventions to improve birth control use among rural, less-educated, and poorer women, especially in Sindh and Balochistan.

Reducing farmland abandonment by raising women’s education levels: Evidence from China

With the rapid industrialization and the growing demand for male labor in urban industries, agricultural production in many developing countries presents obvious feminization features. Accordingly, improving the education level of rural women is the key to increasing farmland return and reducing farmland abandonment. Using data from the China Labor-force Dynamics Survey (CLDS), this study examines the effect of rural women’s education on farmland abandonment. The results reveal that for each increase in the education level of a hostess in a rural household, the abandoned farmland of that household decreases by 40 m2. The increase in women’s education level can promote the use of the Internet, help households access credit, and better control the costs of agricultural production, thus curbing farmland abandonment. In addition, women’s education can play a stronger role in reducing farmland abandonment for rural areas where the land rental market is well developed, as well as for families whose male hosts go out to join non-farm work.

Cultural Practices of Mothers and Babies during the Postnatal Period: A Qualitative Study in Rural Bangladesh

This study describes the experiences of women in rural Bangladesh, and the cultural practices related to how they take care of themselves and their babies, in the early postnatal period. Data were gathered through immersion in the field for six months, participant observation, document collection and in-depth interview techniques to gain a deep understanding of women’s everyday lives and practices during the postnatal period. In-depth interviews were undertaken with 28 mothers who had had at least one live child within the five years before the date of data collection, in Purba Sharifabad village of the Barisal Division in Bangladesh. The key findings of this study highlight the role of culture in the experiences of women during the postnatal period, and reveal that cultural practices, beliefs and traditions are deeply embedded in the lives of rural women. This study focuses on cultural practices which have an effect on the choices of women regarding care and support from healthcare facilities. Culture, together with poverty and low levels of education, leads them to resist healthcare from a skilled birth attendant and encourages them to believe in and trust traditional care practices during the postnatal period. Therefore, the findings of this study may contribute to future policies, planning, programs and research in Bangladesh by providing an understanding of the importance of culturally and socially rooted traditional beliefs and cultural practices. These need to be addressed for maternal and newborn healthcare initiatives to be effective, particularly in rural Bangladesh.

Risk assessment of non-communicable diseases (NCDs) in rural Maharashtra, India

The research question I addressed was - “To what extent do socioeconomic factors influence the risk of developing lifestyle diseases such as Obesity, Hypertension and Type II Diabetes Mellitus in Rural and Urban Indian women aged 35-55 years?”. Having lived in the urban parts of India for the majority of my life, this opportunity exposed me to healthcare in rural India and language barriers due to the diversity of subIndian cultures.

Constraints Faced by Rural Women in Changing Livelihoods in Bangladesh: A Study on the Impact of Microcredit through PDBF

The main purpose of the study is to determine the extent of the constraints faced by the women beneficiaries of Palli Daridro Bimochon Foundation (PDBF) on their socio-economic development and to explore the relationship between the socio-economic characteristics of the beneficiaries and their constraints. A total of 3436 women beneficiaries of three upazilas under 55 districts of PDBF constituted the population of the study. A face-to-face interview survey was conducted to collect data from the randomly selected 346 respondents. Among the 13 selected problem items, ‘high rate of interest’ was ranked first (70.81%), ‘more savings have to be deposited while taking the loan’ was ranked second (68.69%) and third (68.40%) was ‘various income generating activities and social development training are inadequate’ The findings revealed a significant relationship between training exposures, decision-making ability, savings deposit, income-generating activities, communication & network, and constraints faced by PDBF beneficiaries. Therefore, the PDBF authorities should consider significant factors in reducing the constraints faced by rural women to change their livelihoods.

Determinants of nutrition security status of women in rural households in Northwest Ethiopia

The nutrition security of women is critically important for society’s well-being. Therefore, this study was conducted to determine the determinants of the nutrition security status of rural women in Northwest Ethiopia. Data collected from rural women in 197 randomly selected households were analyzed using a binary logit regression model. The results show that 72.6% of the women are nutritionally insecure. The determinants that significantly affect nutrition security status are family size (a negative effect), women’s daily feed frequency, milk consumption, feeding habits of fruits and vegetables, feeding habits of animal products, and women empowerment (all positive effects). The weight, height, and BMI of nutritionally insecure women were significantly lower than those of nutritionally secure women. These findings reveal the need for government and other stakeholders’ interventions to increase access to nutritious food products and to provide training on feeding culture and dietary diversity to women. The findings of this study can help the Government of Ethiopia to focus on the significant determinants to achieve its National Development Priorities focusing on the Sustainable Development Goals (SDGs) of the UN, particularly Goals 2, 3, and 5.

Examining multidimensional health poverty and determining factors among rural women of childbearing age in ningxia, china

BackgroundThe multidimensional health poverty afflicting rural women of reproductive age bears profound implications for the sustainable development of families, societies, and healthy villages. Elucidating vulnerable groups at risk of multidimensional health poverty and delineating its determinants can inform refinements and implementation of health-poverty alleviation policies.MethodsBased on the 2022 "Health Status and Health Service Utilization" survey data in rural Ningxia, China, this study analyzes the dimension of health status, capacity for health service utilization, health expenditure and security using the A-F dual-threshold method, logit model, and probit model. It comprehensively evaluates multidimensional health poverty and analyzes its determining factors among rural women of childbearing age.ResultsWith k set at 0.3, the health multidimensional poverty index, incidence, and intensity among rural women of reproductive age were 0.021, 0.053, and 0.392, respectively. Chronic illness, capacity for free gynecological examination utilization, health examination utilization, and borrowing due to illness contributed significantly to multidimensional health poverty. Risk factors for multidimensional health poverty among rural women of childbearing age include age, unemployment, family size, and lack of sanitary toilets. Protective factors include being married, educational level, non-farm or student occupation, receiving government support, separate housing and kitchen, owning a television and computer.ConclusionsEven with the elimination of absolute poverty, the multidimensional health poverty situation among rural women remains important from a gender perspective. It is recommended to strengthen economic assistance and health service support for these groups, improve the level of rural health services from a gender perspective, and enhance housing structure and sanitation toilet usage in rural areas. Efforts should be made to narrow the digital divide in rural areas and promote digital health education. Pre-interventions on multidimensional health poverty can provide new pathways for the development, empowerment, and well-being of rural women of childbearing age.

Exploring Sustainable Initiatives for Rural Women: Analysis of Economic Transformation of Women and Community Empowerment

Bangladesh, a developing nation in South Asia, has been struggling with various challenges such as poverty, corruption, overpopulation, climate change, and violence against women ever since its independence. Half of Bangladesh's entire population consists of women, with a significant majority residing in rural areas and not participating in any economic activities. Excluding this portion of the population from participating in economic activity results in a fifty percent reduction in the development of the country. Several initiatives have been undertaken to enhance the economic well-being of women in these rural communities. This study investigates the actual circumstances of women, finds obstacles to their economic participation, and suggests measures that foster their involvement in income-generating activities. The study employed a combination of qualitative and quantitative research methods, directing the rural women of Lalmonirhat district through structured interviews and focus group discussions. Result shows that the rural women residing in this community possess inadequate levels of education and are subject to numerous prejudices. Consequently, they do not participate in any economic activities, and their fate remains unchanged by any sustainable development efforts. To improve their situation, the women in this area should increase their involvement in vocational education and gain access to information, communication, and technology. This will enable them to engage in income-generating activities and bring about sustainable improvements in their lives.

Perceptions of Rural Access to Prenatal Care in the United States by Patients, Nurses, Midwives, and Physicians: An Integrative Review.

Despite substantial investments in maternity care, the United States continues to experience higher maternal mortality rates than most high-income countries. Rural regions lack adequate prenatal care services, a contributing factor to disparate maternal health outcomes. This integrative review on patient, nurse, midwife, physician, and community perspectives on accessing prenatal care in rural areas of the United States follows Whittemore and Knafl's integrative review framework, including a systematic literature search in various databases from January 1, 2010, to May 1, 2024. Eligible articles were published in English, peer-reviewed, and focused on subjective accounts of accessing prenatal care in rural areas of the United States. Seven articles met inclusion criteria and were assessed for quality using the Joanna Briggs Institute checklists. Three major categories influencing access to prenatal care in rural areas were developed. Individual factors included transportation, family support, motivation, and work commitments. Socioeconomic factors encompass health insurance, rurality, income, and housing. System factors involved the qualities of nurses, midwives, physicians, the clinic environment, and collaboration within the health care system. The findings emphasized the complexity of rural prenatal care access. Understanding patient and care giver perspectives on accessing prenatal care in rural areas is crucial for addressing the factors influencing maternal outcomes. Rural pregnant women face unique challenges, contributing to an increased risk of maternal morbidity and mortality. Further research is needed to explore their experiences and develop interventions to improve access and outcomes in rural areas.