Intersectionality, a concept coined by Kimberlé Crenshaw, shows how different aspects of a person’s identity can overlap and create unique challenges for individuals facing various forms of inequities and/or discrimination. As the Principal Strategist for the Women’s Employment Portfolio, and in parallel with Women’s History Month, it is my pleasure to present this three-part blog series that also features blogs on the intersectionality of women and faith, motherhood, and geographic location highlighting how these connections may influence a woman’s experience.

Women in Rural Landscapes

For women, the intersectionality of gender and geographical context significantly influences the rural living experience. It is critical that we examine these intersections as NIH serves many rural communities in the United States. What are the challenges faced by women in rural settings? What is NIH doing to help mitigate those challenges?

According to the U.S. Census Bureau, a rural area is one that does not encompass densely developed territory and has a population of less than 5,000 people. In 2018, 63 million people, or 19% of the population, lived in rural areas, which comprise about 97% of the total land area in the United States.

As we look at the impact of rural living on women, it is important to consider the following factors:

• Limited Health Care Access – women living in more rural areas experience poorer health outcomes than women in urban areas due to lack of financial resources, lack of health care, inadequate access to public transportation, and limited availability of women’s health services.
• Educational Inequities – rural schools struggle to fill teaching positions, which results in significant decreases in the overall teaching force. This decrease is driven by high teacher turnover, particularly before retirement and due to poor working conditions. Internet access in rural areas can also be sparse, making it harder for women and girls to learn.
• Economic Disparities – poverty rates in rural areas are higher than those in urban areas. This is especially true for rural areas in the South. Concentrated poverty has been linked to higher crime, higher dropout rates, and poor housing. These factors may hinder women on their path to success.

It is critical to note that for White women, these obstacles may prove difficult to overcome, but for women of color – these obstacles can be insurmountable. Structural racism plagues the rural health care system, educational infrastructure, and economic outcomes – and women of color are impacted the most.

The Connection of Health as a Starting Point

When women and girls are healthy, they are much more likely to advance in their education. A January 2024 report by the World Economic Forum and the McKinsey Health Institute suggested that investments in women’s health would boost the world economy. Improving women’s health in rural communities can have a profound impact on educational and economic outcomes due to several interconnected factors. These include:

• Reduced Health-related Barriers to Education. When women and girls are healthier, they are more likely to attend school regularly and participate actively in educational activities.
• Increased Educational Attainment. Better health leads to increased school attendance and retention. Healthier women are more likely to complete their education and enhance their skills and qualifications for better job opportunities./li>
• Empowerment and Decision-Making. Healthier women often have more control over their lives, including decisions related to their career goals.
• Reduced Maternal Mortality and Morbidity. When mothers survive childbirth and are in good health, it positively impacts the entire family. Children are more likely to attend school, and mothers can actively engage in both household and economic activities.
• Economic Opportunities. Healthier women are better positioned to take on various roles in the workforce, including formal employment and entrepreneurship.
• Breaking the Cycle of Poverty. Healthier women are better equipped to support their families economically, leading to improved living standards and increased investments in education for future generations.
• Community Development. Women are often key contributors to community development. When they are healthier, they can influence policies that can positively impact education and economic opportunities within the community.

NIH Uplifting Rural Health Initiatives

As one of the nation’s most lauded medical research centers, NIH is doing its part to improve health access and medical services to women in rural areas. NIH’s National Center for Advancing Translational Sciences has a Clinical and Translational Science Awards (CTSA) Program that aims to address the disparities and burdens that disproportionately impact rural communities.

Some CTSA initiatives include:

• The Appalachian Translational Research Network promotes inter-institutional sharing of research expertise, experiences, and resources to improve the health of individuals living in Appalachian communities.
• The Washington, Wyoming, Alaska, Montana, and Idaho Region Practice and Research Network is helping enhance primary care clinical practices across the region and improve patient health.
• Peer-Based Retention of People Who Use Drugs in Rural Research is an ongoing study that addresses opioid prescribing, injection drug use, overdose, and infectious disease transmission in rural America. It tests an innovative peer-retention approach that combines elements of peer navigator models for outreach and uses peer recruitment to improve study retention.
• The Penn State Clinical and Translational Science Institute is investigating how socioeconomic factors have worsened health and wellbeing in the U.S., especially in rural areas.
• The Collaboration to Enhance Naloxone Distribution in Rural Areas is a partnership between the CTSA program and the University of New Mexico to increase distribution of naloxone in rural and underserved communities.

The link between women’s health, education, and economic outcomes in rural communities is complex and multifaceted. Improving one aspect can have a cascading, positive effect on others, contributing to overall community development and wellbeing. This underscores the importance of intersectional, integrated approaches that address health, education, and economic empowerment in a holistic manner.

To read the other blogs in this series, please visit Women of Faith and The Motherhood Penalty.

Do you have a story idea for us? Do you want to submit a guest blog? If it's about equity, diversity, or inclusion, please submit to edi.stories@nih.gov.

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