Policy attention to growing rural “health care deserts” tends to identify rural distance as a primary spatial barrier to accessing care. This paper brings together geography, health policy, and ethnographic methods to instead theorize distance as an expansive and illuminating concept that highlights place-based expertise. It specifically engages rural women's interpretations of rural distance as a multifaceted dimension of accessing health care, which includes but is not limited to women's health services and maternity care. Presenting qualitative research with 51 women in a rural region of the U.S., thematic findings reveal an interpretation of barriers to rural health care as moral failings rather than as purely spatial or operational challenges, along with wide communication of negative health care experiences owing to spatially-disparate but trusted social networks. Amid or owing to the rural crisis context, medical mistrust here emerges as a meaningful but largely unrecognized barrier to rural women's ability—and willingness—to obtain health care. This underscores how a novel interpretation of distance may inform policy efforts to address rural medical deserts.
Distance-physical, material distance-is an obviously spatial concept, but one rarely engaged by legal or feminist geographers. We take up this oversight in relation to the 2016 U.S. Supreme Court decision in Whole Woman's Health v. Hellerstedt, which adjudicated the constitutionality of a Texas law that imposed new regulations on abortion providers. Because half of the state's abortion providers were unable to meet these regulations and thus closed, the distance that many Texas women had to travel for abortion services increased dramatically. In part because of these increases, the Supreme Court ultimately determined that the Texas laws imposed an unconstitutional "undue burden." Bringing together case law and ethnographic data, this article traces the process by which distance is made legally "legible" in the context of reproductive in/justice. In so doing, it confronts more uneasy realities of distance, including the discursive dismissal of social and literal im/mobility and isolation; contradictory readings of "emptiness"; and the material
Rural state and tribal court judges in the upper US Midwest offer an embodied alternative to prevailing understandings of "access to justice." Owing to the high density of social acquaintanceship, coupled with the rise in unrepresented litigants and the impossibility of most proposed state access to justice initiatives, what ultimately makes a rural courtroom accessible to parties without counsel is the judge. I draw on over four years of ethnographic fieldwork and an interdisciplinary theoretical framework to illuminate the lived consequences and global implications of judges' responses, which can be read as grassroots-level creativity, as resistance, or simply as "getting by." "Of the people in court today, I know every single one of them… I had two calls at home last night about 'your case tomorrow.'" The judge shook his head and looked around his chambers. "On my very first day on the bench, a guy in the back of the courtroom stood up, shouted my first name, and said, 'How the fuck are ya?'" My jaw dropped. "No." He nodded, laughing. It had been a three-hour drive north, through long stretches of national forest and into the county seat. It was a northern paper-mill town that smelled like it, tiny houses lining the shady streets and the mill spouting steam up ahead. Between 2013 and 2017, the average per capita income here was $23,000, with 25% My heartfelt thanks to the editors, anonymous reviewers, and Larry Nesper for their insightful and enthusiastic feedback on this manuscript. This article also benefitted greatly from collegial and expert engagement at the 2020 Law & Humanities Junior Scholars Workshop and the University of Minnesota Law School's Faculty Works in Progress forum. I am grateful for these stimulating conversations. Special thanks to Riaz Tejani and Robin West for discussing the paper and offering such compelling and even moving critiques. My thanks as well to Jon Bredeson for his indispensable research assistance. And finally, I am humbled by the profound generosity of the judges whose work I detail here. To be so welcomed by very different-and very busy-individuals is something I could never anticipate. I hope this manuscript helps shed light on their important commitments. This research is supported by the National Science Foundation's Law and Sciences Program (award #1729117).
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