Women residing in rural areas are less likely than urban women to receive preventive reproductive health care, but reasons for this disparity remain largely unexplored.
In 2010, semistructured interviews were conducted with 19 rural primary care physicians in central Pennsylvania regarding their experiences in two domains of preventive reproductive health—contraceptive care and preconception care. Major themes were identified using a modified grounded theory approach.
Physicians perceived that they had a greater role in providing contraceptive care than did nonrural physicians and that contraceptives were widely accessible to patients in their communities; however, the scope of contraceptive services they provided varied widely. Participants were aware of the importance of optimal health prior to pregnancy, but most did not routinely initiate preconception counseling. Physicians perceived rural community norms of unintended pregnancies, large families, and indifference toward career and educational goals for young women as the biggest barriers to both contraceptive and preconception care, as these attitudes resulted in a lack of patient interest in family planning. Lack of time and resources were identified as additional barriers to providing preconception care.
Rural women’s low use of contraceptive and preconception care services may reflect that preventive reproductive health care is not a priority in rural communities, rather than that it is inaccessible. Efforts to motivate rural women to engage in reproductive life planning, including more proactive counseling by providers, merit examination as ways to improve use of services.
Cynthia H. Chuang is associate professor of medicine and public health sciences, and associate director for research, Division of General Internal Medicine. Jennifer S. McCall-Hosenfeld is assistant professor of medicine and public health sciences Lara Rosenwasser is a student. Carol S. Weisman is distinguished professor of public health sciences and obstetrics and gynecology—all at Penn State College of Medicine, Hershey, PA. Sandra W. Hwang is an undergraduate student at Cornell University, Ithaca, NY. Marianne M. Hillemeier is associate professor of health policy and administration, and associate director, Population Research Institute, Penn State University, College Park, PA.