‘I need to know the lay of the land’ – a profoundly rural expression and a highly appropriate one to describe this chapter, as it explores the research and policy landscape for rural women’s health in Canada since the mid-1990s.

Why begin with research and policy? It has been said that research defines a discipline, not only by generating new knowledge but also by framing the very ways in which questions are asked and by delineating what is not known. The quantity, breadth, and depth of scholarship also point to the level of enthusiasm and investment in a particular field of...

Prairie Women’s Health Centre of Excellence (PWHCE) is a policy-oriented research centre with fifteen years’ experience fostering, developing, and creating new research with community and academic partners. It has a mandate for the provinces of Saskatchewan and Manitoba, but PWHCE’s work is often national or international in scope. There is some overlap among the organization’s four primary areas of focus – women in poverty; Aboriginal women; women who live in rural, remote, and northern communities; and gender in health planning – but there has been a considerable number of new projects in each of these areas. It is through research at PWHCE...

Rural women experience unique and significant physical, mental, and social health challenges. Physical health issues include increased incidence of cancer (Brophy et al., 2006), shorter life expectancies (Canadian Institute for Health Information [CIHI], 2006), increased risk of violence and abuse (Hornosty & Doherty, 2003), and physical health issues related to lack of health resources, low income, rural stress, hunger, and homelessness (Kubik & Moore, 2003). Mental health issues of rural women include depression, despair, and psychological distress related to rural socio-economic circumstances and isolation, and limited availability and lack of anonymous mental health resources (Leipert, 2006; Sutherns, McPhedran, & Haworth-Brockman,...

This chapter discusses the health concerns of rural women in the United States. It is important to emphasize that women cannot be viewed as isolated entities. Families, children, and significant others are an integral dimension of a woman’s life, as are her health behaviours. In turn, a woman is integral to the health and well-being of her family and her community. The reader is reminded this is an infinitely broad topic and there is wide diversity among rural communities and the health status of women who live there. It is, therefore, with utmost caution that this author undertakes a discussion...

The environment is increasingly being seen as a significant determinant of rural women’s health, globally and nationally. Brophy, Keith, Watterson, Gilbertson, and Beck discovered, in their work in occupations and health, that farm life has had significant effects on the health of women who grew up there, and specifically a higher incidence of breast cancer in these women as a result of their early farm years. Clearly more research is needed to fully understand and prevent these serious long-term environmental impacts on the health of rural girls and women.

McIntyre and Rondeau discuss the beliefs, obligations, and actions of farm...

Does farming in Ontario increase breast cancer risk? Our research suggests there may be a causal link. We have learned that farm women, through their residential and work environments, have been exposed to an array of agricultural chemicals – often beginning at childhood. These early exposures may be of particular concern because immature breast tissue is especially vulnerable to genetic damage that might result in cancer later in life (Brody et al., 2007).

There is limited research on the effects of farming on women’s health (Zahm & Blair, 2003). As Kubik and Fletcher note in chapter 7, farm women do not...

Given the inextricable link between food and health (World Health Organization, 2012), much research has been dedicated to understanding the determinants of food choices and food consumption patterns in order to improve the health and nutritional status of individuals and populations. Why people eat what they eat is a complex process that is influenced by historical, physical, social, cultural, environmental, and economic conditions, in addition to individual factors (DeVault, 1991; Furst, Bisogni, Sobal, & Falk, 1996; Mead, 2008; Schubert, 2008). This chapter focuses on the relationship between food and health by exploring the experience of a unique rural population – farm...

The long-term sustainability of wholesome food, along with its clear links to health, are becoming issues of global concern. In the current context of increasingly commercial agriculture and rapid climate change, food sustainability and food security issues are putting Canadians at a strategic crossroads in their food production decisions. In Canada, farm women hold the key to a healthier and more sustainable food system; however, their livelihoods and health are being jeopardized by the very system that threatens food sustainability and food security around the world. With the dire predictions about the effects of climate change and the resulting consequences...

Romantic visions of the healthy pastoral life have more recently had to take into account the reality that many rural communities face serious problems related to air, soil, and groundwater contamination (see Brophy et al., chapter 5). This chapter examines how Old Order Mennonite (OOM) women in one Ontario community see environmental risk in the context of their orthodox religious beliefs, their agricultural way of life, and the health of their families. Our exploratory research demonstrates that health effects related to environmental risks are experienced and understood contextually and are not clear cut. Results of our study call for varied...

Only one of the four chapters included in this section is focused on women’s experiences of violence (Dyck, Stickle, and Hardy), but in keeping with the determinants-of–population-health framework, life course analysis, and gender-based analysis, together the four reveal the central role that experiences of gender-based violence (GBV) over the lifetime play in women’s health and well-being. For rural women, personal experiences of violence and their responses are shaped by the rural geography and the availability of supportive social networks and social supports, including appropriate and gender-sensitive and safe services. Dyck, Stickle and Hardy, for instance, note that leaving home...

In this chapter, we draw on a three-generational, comparative life story study that focused on Newfoundland and Labrador women’s experience of their reproductive lives. We understood reproductive lives more broadly than as simply being about women’s reproductive health, but rather as also encompassing family relations, learning about sex, attitudes to marriage and heterosexuality, body image, and much else. This broad focus also enabled us to approach how women themselves understood the events of their reproductive experience in the overall context of their lives. Women do not separate out either the events and processes in their biological reproductive lives or their...

Intimate partner violence (IPV) poses significant health challenges for Canadian women residing in rural and northern (R&N) communities. Factors such as geographic isolation, longer emergency response times, limited or no public transportation, unique financial situations, limited health care resources, limited access to women’s shelters, lack of privacy, and cultural factors have the potential to exacerbate the significant problems encountered by women in violent relationships.

This chapter provides readers with a summary of literature on IPV in R&N Canada, including prevalence, consequences, risk factors, barriers to accessing services, prevention, and intervention. Unique aspects of this chapter include incorporation of personal observations...

Post-traumatic stress disorder (PTSD) is being referred to more frequently than ever before by this generation of health practitioners in rural and northern Canada and by their research counterparts. The author believes that this is a reflection of a more informed health system as much as it is a result of more circumspect inquiry into the serious and tenacious social and medical ills that are endemic to remote Aboriginal communities, particularly in Canada’s North.

In an effort to increase awareness of both the prevalence and the intensity of PTSD amongst women in remote Aboriginal communities, I have chosen to write...

Although the majority of Canadian young and adult women are housed, 2.1 million females, or 16%, live in accommodations that are below national adequacy, suitability, or affordability standards (Canada Mortgage and Housing Corporation [CMHC], 2002a). Women with health challenges, and particularly those in rural locations, were more likely to experience housing needs (CMHC, 2002a, 2002b). The relationship between women’s health and housing in rural areas is complicated by a number of related social and health issues. In addition to rural women’s experience of intimate partner violence (IPV) as presented in chapters 10 and 11 of this volume, evidence also exists...

In each of the chapters in this section, women defined their health broadly as a combination of social, physical, spiritual, and psychological well-being. Not surprisingly, then, the intersection of gender with other determinants of a populations’ health becomes clear. These chapters highlight the need to consider these when developing health promotion and public health interventions. We see that macro-level policies have an impact on our everyday life. Restructuring of the rural economy is gendered and therefore has differential impacts on women and men that are hidden in apparently gender-neutral policies. Heather, Skillen, Cross, and Vladicka note that the paid and...

From 2001 to 2003, Skillen, Heather, and Cross researched rural Alberta women’s lives after restructuring in health care services and agriculture. Their findings form the basis for this chapter, which investigates how rural expectations and practices of gender, in a social context of change and uncertainty, affect the health of farm women who are also working off-farm as nurses.

During the 1990s rural women’s work and home environments were radically changed by the reorganization of federal and provincial agriculture and health care policies. Farmers had already responded to new technology, and the rise of more accessible global markets, with new...

Despite harsh economic times, brutal weather extremes, and disappearing rural populations that have resulted in loss of community members and greater isolation for others, many farm people continue to survive. The first author, a farm stress specialist (1995, 1998) and community psychologist, wanted to understand more about how they managed to survive under these conditions ‘Resiliency’ is a term in the academic literature that seems to apply to these people’s survival, but questions remained. What is resiliency, exactly, and what are the barriers to and enhancers of resiliency in rural populations? What strategies can be developed to become more resilient?...

In the last decade, rural health has emerged, sometimes sporadically, on research, community, and political agendas (DesMeules, Pong, et al., 2006). Interest in gaining a better understanding of rural women’s health has spawned new research (Leipert & George, 2008). While there is recognition that rurality creates health challenges for many women, including compromised health status and restricted access to services, limited attention has been paid to the experiences and needs of ethnically diverse rural women (Kisely, Terashima, & Langille, 2008). Aboriginal women and recent immigrants are sometimes included in research on rural health in Canada (Sutherns, McPhedran, & Haworth-Brockman, 2003),...

Small-town and rural Saskatchewan looks different today than it did as recently as fifty years ago (Butala, 2003; Gerrard, Kulig, & Nowatzki, 2004). At one time, every small town boasted any amenity that one could possibly want, and agriculture still formed the primary economic base in the province (Butala, 2003). Farms were single-family operations, most of which did not exceed a section¹ in size. Today, however, farms are much larger and, out of necessity, are run much like corporations (Cushon, 2003; Warnock, 2003). The authors of chapter 13 in this book discuss similar changes occurring in rural Alberta.

Many rural...

The health of pregnant women and their unborn babies is pivotal to community vitality and to the health of future societies. The Northwest Territories (NWT) is home to a diverse population of Aboriginal, immigrant, and non-Aboriginal northern women who share the land and the experience of pregnancy in the Arctic and sub-Arctic. Little has been written of the contexts and the lifeways of pregnant northern women and the way these influence their health and well-being. This chapter will enhance our understanding about the complexity of circumstances surrounding the experience of pregnancy and childbirth for northern women and provide considerations for...

This chapter describes research undertaken in an effort to respond to Janzen’s (1998) identification of the ‘health needs and determinants of rural women’ (p. iii) as one of the ten key gaps in research on Canadian women’s health. In a rural Nova Scotia community we refer to by the pseudonym ‘Hampshire,’ we employed an interdisciplinary approach tempered with caution (Giacomini, 2004) and a community-based participation research model (Neuman, 2003; Penzhorn, 2002) in an effort to ‘hear’ (Gubrium & Holstein, 1998) what the women of Hampshire, a rural, Nova Scotia, inland, post-industrial community, were ‘saying’ about their health and leisure. The...

In this section the contributors explore innovative theoretical directions for understanding relationships among health, space, and gender. The chapters thus provide a way of thinking about where research into gender, rurality, and health may go in the future, providing some new theoretical foundations for future research. The first two chapters of this section introduce a comparative dimension as well as employing new theoretical framings. Jo Little examines the trend towards locating alternative therapeutic services in rural settings, raising new questions about the relationships among health needs, service provision, and constructions of particular kinds of space. She argues that new therapeutic...

Research on rural women’s health in developed countries has to date tended to focus either on the prevalence of particular medical conditions or on the availability and quality of health-related services (Brown, Young, & Byles, 1999; Leipert & Reutter, 2005). Such work has helped to make explicit the spatialization of health and well-being in terms of both illness and treatment and at the same time highlighted the challenges facing service providers and policy makers in meeting the needs of those living in remote areas. For example, it has been important in establishing the vulnerability of rural women to particular medical...

This chapter brings a rural dimension to the literature on women and chronic illness by drawing on the story of an Australian rural woman who has chronic fatigue syndrome, or myalgic encephalomyelitis (ME). Integral to this literature is Moss and Dyck’s (2002) book-length exploration of the lives of forty-nine women who had been diagnosed with either ME or rheumatoid arthritis (RA), along with their other writings on the topic (e.g., Dyck, 1995a, 1995b; Moss 1997; Moss & Dyck, 1996, 1999a, 1999b, 2001). In framing the chapter around this collective scholarship we focus on three interrelated themes it has emphasized and...

While Canadians perceive universal health care as constitutive of national identity, economic globalization and the decline of the welfare state bring into question if, and how, the right to health care should continue. Governments employ a neoliberal ideology to rationalize service cuts and for-profit care through deploying market principles of economic efficiency; they represent the intrusion of profit regimes as offering ‘choice’ for all Canadians and reconstitute patients as customers and consumers. Through framing social policy in neoliberal discourses, care giving is depoliticized and citizens’ right to health care is marginalized (Rylko-Bauer & Farmer, 2002; Pini & Soldatic, chapter 2...

Inspired by sociologist Simon Williams’ provocative question, this chapter examines how emotion is a productive resource, both as a theoretical lens and as an under-examined material feature of care giving, health, and well-being, when considering rural women’s health research. Through a discussion of emotional geographies, the discursive figuring of rural spaces as spaces for feeling, and the ongoing production of feeling subjects, I argue for a closer attention to emotion as ‘a complex aspect of social life’ (Fullagar, 2008, p. 48). Bringing emotion into the frame highlights a new and meaningful way to generate detailed considerations of rurality, gender, and...