Date of Award

2022

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Graduate Group

City & Regional Planning

First Advisor

Lisa Servon

Abstract

Mothers and children living in rural U.S. communities experience a ‘rural mortality penalty’; maternal mortality is rising and infants born in rural counties are less likely than their peers to celebrate their first birthday. Counteracting this inequity requires broad investment in community-based infrastructure, investments which planners may be well-situated to support. Yet, planners often aren’t familiar with maternal and child health (MCH), and decisions about rural planning often bypass perspectives of those most affected – low-resource mothers. I join literature in rural planning with maternal health, arguing that planners have a role in improving MCH. I use a mixed-method approach to identify areas for planning action, doing so by centering the knowledge of low-resource women in rural Pennsylvania. First, I co-create and pilot an index, the Community Need Index for Maternal and Child Health (CNIMCH) that helps planners visualize how health-related indicators within their professional charge are part of a larger ecosystem that supports mothers and children. Then, I contextualize the CNIMCH by partnering with rural mothers to explore, through photovoice, how they perceive place, environment, and community in shaping health, and what they want to convey about improving health. I arrange photos and narratives around eight themes, each visited through the experience of one mother, then traced through the larger photo archive. I link the photos to the CNIMCH, reflecting on the interplay of social context, environment, and time in driving health. I position participant’s imaginative futures in relation to structural influences, including geopolitical and economic forces, that shape education, social services, employment, retail, and healthcare in rural Pennsylvania. These findings contribute to dialogue on planners’ role in addressing MCH through three interlocked conversations: the importance of narrative and story-building for rural places and those left out of public decision making, the structural influences on MCH in a rural post-industrial resource extractive region, and the role and power of rural planning. I underscore the causal pathways between social and structural determinants and MCH, nudging planners to consider where our core values and skills influence these determinants and how we can reimagine our role in supporting rural communities where families thrive.

Embargoed

Available to all on Saturday, July 05, 2025

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