“Just get rid of it.” The cultural politics of hysterectomy in a rural Appalachian county
This research explores the sociocultural and political economic contexts shaping hysterectomy experiences in the lives of women in one rural Appalachian county. The purpose of the study was to draw from and ethnographically contribute to a number of literatures focusing on women's lives and health in the rural United States and Appalachia. Specifically, one aim was to extend the current literature on reproductive technologies, medicalization, gender and the body by examining these issues from the vantage point of rural women living in an economically distressed county in Central Appalachia who have undergone hysterectomy, a surgical procedure that definitively marks the end of biological reproduction for women. Given that hysterectomy is the second most common surgery for women in the United States (next to Cesarean) and one beset with controversy regarding the appropriate indications for “necessary” surgery, an ethnographic examination of the procedure was surprisingly absent from the literature. A second aim was to respond to a serious imbalance in current hysterectomy studies, which show a noticeable bias toward the experiences of urban and middle-class populations of women in non-Southern regions. A third aim was to locate and interrogate cultural assumptions about Appalachian women, gender and reproduction, including simplistic views of Appalachian women as passive, acquiescent patients or fatalistic “missing persons” in the decisions surrounding their health and well being. By exposing how these women articulate both the meanings of and their sense of control over their reproductive bodies, health, health care, and eventual hysterectomy, this study also raises broader questions about women's active participation in medicalization processes, even when those processes are rooted in patriarchal and biomedically legitimated forms of control over the reproductive body.
To realize these goals, I applied an ethnographic approach to examine how women in a rural Central Appalachian county confront and experience hysterectomy following chronic pain and/or biomedical diagnoses of reproductive diseases. Over a period of 18 months, I lived in Coal County (a pseudonym for the research site) and gathered information using a number of ethnographic research methods, including participant observation, writing field notes, conducting in-depth interviews with women and health care providers, leading one focus group, and reviewing secondary documents. The results of this study suggest that women's hysterectomy experiences and decisions are intimately tied to gender and class relations as well as the political economy of health and health care in Coal County. The articulation of these sociocultural and political economic factors, or what I refer to as the cultural politics of Coal, shape how these women (1) conceptualize the reproductive body, (2) construct their own agency in the power dynamics surrounding their health care and hysterectomy, and (3) express the relationship between hysterectomy and their identities as women, their sexualities, and their relationships with men. Enduring the pain of reproductive illnesses as well as the often overwhelming social and political economic constraints of life in Coal, the women in this study framed their hysterectomy experiences in complicated and multiple ways, often simultaneously voicing subjection, authority, skepticism, and satisfaction.