Participation Type
Panel
Session Title
Contested Reproduction in Appalachia: Stigma, Substance Use, Social Institutions, Race, Criminalization, and Navigating Care
Session Abstract or Summary
Reproduction and caregiving are heavily surveilled, stigmatized, and constrained by public and social policies throughout the United States, but more so in Appalachia, particularly for people identified as working-class or low-income, of color, substance-using, and any combination of these. The researchers and community activists on this panel will share accounts and analyses from their ethnographic and organizing work about ways that people in Appalachian experience, navigate, and respond to structural constraints that shape pregnancy, parenting, and caregiving landscapes, including: regional eugenics movements; Western systems of health and medicine, substance use treatment in Eastern Kentucky and Western North Carolina; legislative policies and child protective services contexts governing custody in Tennessee, Kentucky, and North Carolina; and, other conflicting messages about what it means to be a “good” or “bad” parent, woman, or even Appalachian.
Presentation #1 Title
Cherokee and Latinx Futurities in WNC: Borderlands Theory, Birth Justice, and a Reorientation of Southern Appalachia
Presentation #1 Abstract or Summary
This paper foregrounds Borderlands theory to examine Latinx, Indigenous, and Latinx-Indigenous human locations in southern Appalachia. To be non-white in southern Appalachia is a continuity. It is also a contradiction. For thousands of years, the Eastern Band of Cherokee Indians have called the mountains of western North Carolina home. Southern Appalachia’s agriculture-based economy gestures to a past of enslaved labor (Black) and a present of migrant labor (Latinx). Yet in the collective American conscious Appalachia is white. This destructive misinformation has a utility: to claim a mythological white ancestor and thus naturalize claims to land. It also enforces borders of belonging. I use Gloria Anzaldúa’s Chicana feminist concept of the Borderland to examine how imagined social boundaries—those not defined by state-lines and those which are fuzzy and porous—fracture the human condition and inscribe an unstable relationship to place. Central to this study is the work of birthing. In western North Carolina, birth rates are uneven across racial populations with people of color having the highest mortalities. My research’s interlocutors are migrant farmworkers from Mexico, Central and South America as well as tribal members of the Eastern Band of Cherokee Indians (EBCI). These interlocutors seek to use doulas and midwifes with knowledge of their respective material and spiritual traditions for the healthy birth of their children. Through this study I ask, how do southern Appalachia’s Latinx, Indigenous, and Latinx-Indigenous peoples practice a politic of well-being to negotiate birth justice amid racial, cultural, and medical hostilities? How does birth transfer and transform the psychic life of borders? Furthermore, how can Anzaldúa’s framework spark a new ontology for Appalachia that disrupts an entrenched whiteness and pushes open the interstitial location of Latinx, Indigenous, and Latinx-Indigenous humans?
At-A-Glance Bio- Presenter #1
Danielle Dulken is a reproductive justice activist from the mountains of Western North Carolina. She sits on the board of the Carolina Abortion Fund, a financial support system for people whose income limits their access to healthcare. She’s also a birth doula. As a PhD candidate in the Department of American Studies at UNC-Chapel Hill, Danielle studies how communities of color in southern Appalachia practice a politic of well-being to nurture their reproductive lives.
Presentation #2 Title
Save the White Children: Understandings of Place, Ethnicity, and Gender in Central Appalachian Substance Use Treatment Programs
Presentation #2 Abstract or Summary
The discourse of Appalachia as a place that needs saving is raced, as Appalachians are erroneously presented as all white and in need. Race and place come into arguments for refocusing responses to drug use from criminalization to treatment. Using ethnographic data, I demonstrate how women in Central Appalachia qualify for and at times are coerced to use particular state-funded and regulated substance use treatment services because of their gender, race, class, and motherhood status. Some women want these services because they self-identify as addicted; others are caught in state systems because of different violations of what is deemed acceptable. If women do not adequately perform their motherhood role according to white, middle-class norms, they risk losing child custody and receiving misdemeanor and felony records. With these records, women not only lose their children, but also access to food, housing, and employment. Even when women are successful in evidence-based treatment, such as buprenorphine programs, they may face state agencies that do not recognize this as a success and continue to penalize treatment participants.
At-A-Glance Bio- Presenter #2
Dr. Buer is a recent graduate from the Department of Anthropology at the University of Kentucky. An applied medical anthropologist, her dissertation research focused on women’s encounters with substance use treatment in Central Appalachia. In her current position in East Tennessee, she supports regional public health efforts related to syringe exchange program access, additional harm reduction services, housing insecurity, and food insecurity. She will be completing a book, Rx Appalachia, based on her dissertation research this year.
Presentation #3 Title
“I didn’t want to be on Suboxone at first…:” Ambivalence in perinatal substance use treatment
Presentation #3 Abstract or Summary
We will present findings from recent qualitative research with patients in a combined perinatal substance use treatment program in Central Appalachia. We describe and analyze participants’ ambivalence about medication-assisted treatment for opioid use disorder in the context of widespread societal stigma and judgement. We conducted research in a comprehensive outpatient perinatal substance use treatment program serving a large rural, Central Appalachian region. The program specifically offers medication treatment to perinatal patients diagnosed with opioid use disorder. As a project designed using medical anthropology methods, we purposively and opportunistically sampled patients receiving prescriptions for buprenorphine or buprenorphine-naloxone dual product, along with prenatal care and other services. Through participant-observation, semi-structured interviews, and a triangulation focus group, we gathered qualitative data from 27 participants, for a total of 31 interviews. We analyzed the data using modified Grounded Theory. We found that participants in the comprehensive perinatal substance use treatment program value supportive, non-judgmental care, but report ambivalence about medication within structural and institutional contexts of criminalized, stigmatized substance use and close scrutiny of their pregnancies. Women are keenly aware of the social consequences for themselves and their parenting if they begin or continue medication treatment for opioid use disorder. Overall, stigmatized, criminalized, and surveilled patients in perinatal substance use treatment report ambivalence about medication treatment. Substance use treatment providers and policymakers should consider the social consequences of medication treatment for patients and substance users who may not seek treatment, particularly in Appalachia and rural regions.
At-A-Glance Bio- Presenter #3
A medical anthropologist by training with a clinical background in women’s health, Dr. Ostrach’s research background and continuing interests are in sexual and reproductive health, birth, structural inequality as it affects access to care, health inequalities, syndemics, publicly funded health systems, stigma, and social support. She is currently developing qualitative research projects on patient and provider perceptions of human-centered design for intimate partner violence screening and substance use treatment in prenatal care.
Cherokee and Latinx Futurities in WNC: Borderlands Theory, Birth Justice, and a Reorientation of Southern Appalachia
This paper foregrounds Borderlands theory to examine Latinx, Indigenous, and Latinx-Indigenous human locations in southern Appalachia. To be non-white in southern Appalachia is a continuity. It is also a contradiction. For thousands of years, the Eastern Band of Cherokee Indians have called the mountains of western North Carolina home. Southern Appalachia’s agriculture-based economy gestures to a past of enslaved labor (Black) and a present of migrant labor (Latinx). Yet in the collective American conscious Appalachia is white. This destructive misinformation has a utility: to claim a mythological white ancestor and thus naturalize claims to land. It also enforces borders of belonging. I use Gloria Anzaldúa’s Chicana feminist concept of the Borderland to examine how imagined social boundaries—those not defined by state-lines and those which are fuzzy and porous—fracture the human condition and inscribe an unstable relationship to place. Central to this study is the work of birthing. In western North Carolina, birth rates are uneven across racial populations with people of color having the highest mortalities. My research’s interlocutors are migrant farmworkers from Mexico, Central and South America as well as tribal members of the Eastern Band of Cherokee Indians (EBCI). These interlocutors seek to use doulas and midwifes with knowledge of their respective material and spiritual traditions for the healthy birth of their children. Through this study I ask, how do southern Appalachia’s Latinx, Indigenous, and Latinx-Indigenous peoples practice a politic of well-being to negotiate birth justice amid racial, cultural, and medical hostilities? How does birth transfer and transform the psychic life of borders? Furthermore, how can Anzaldúa’s framework spark a new ontology for Appalachia that disrupts an entrenched whiteness and pushes open the interstitial location of Latinx, Indigenous, and Latinx-Indigenous humans?
