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There are over 3 million seasonal and migrant farmworkers in the U.S. agricultural industry with a significant percentage of farmworkers documented or native to the United States. Migrant farmworkers live below the federal poverty levels at high rates and experience low health care access and utilization. Guided by the fundamental cause theory, the purpose of this phenomenological study was to examine the lived experiences of migrant farmworkers and identify the factors impacting their health care access and utilization. Face-to-face interviews were conducted with 12 migrant farmworkers who had worked in Southwest Texas agricultural stream. Data were analyzed and coded to identify themes. Findings indicated that although lack of health insurance was a decisive factor in whether migrant farmworkers accessed or utilized health care services, distance to services, inflexible working hours, and cultural factors related to seeking care also influenced participants' lack of access to and utilization of health care services. Results may be used to aid local, state, and federal agencies in assisting migrant farmworkers in bridging the gap in health care and obtaining needed services.

In this dissertation, I aim to examine how policy packages focusing on improving reproductive conditions impact adverse maternal outcomes at the local level. I use the National Institute of Reproductive Health’s Local Reproductive Freedom Index (NIRH LRFI) to advance scholarship and policy advocacy on how policies included in that index may lessen the overall maternal mortality rate while also perhaps diminishing the disparity in maternal mortality between women of color and white women in 50 major U.S. cities. I argue that policy may be an effective—though under-studied—avenue for reducing the risk of maternal mortality because policies can be used to target specific social factors that research has demonstrated place individuals at higher risk of a negative outcome. However, these policy avenues usefully can be considered as interconnected policy packages rather than merely as single-policy interventions. Additionally, current research in this area suggests that there is a clear need for more research that combines SDH with policies aimed at improving health outcomes for reproducing individuals, particularly for communities of color (Creanga et al. 2015b; Kozhimannil, Vogelsang, and Hardeman 2015; Osypuk et al. 2015). As such, I situate maternal mortality, and specifically racial disparities in maternal mortality, among social determinants of health. Overall, I argue that to successfully decrease aggregate maternal mortality rates and lessen racial disparities in reproductive health, it is essential to center the experiences and needs of women of color and use a critical lens when evaluating measures assessing reproductive freedom.

<p>This dissertation, broadly, examines how power dynamics manifest during clinical interactions related to vague and gendered medical symptoms, such as pelvic pain. To examine this issue, I approach my research questions through multiple methods including a critical discourse analysis of the medical discourse on pelvic pain, a survey experiment administered to healthcare workers in the US, and a narrative analysis of pelvic pain patient experiences. While the focus of this research is on pelvic pain, the analyses presented here reach far beyond ideas of power dynamics and pelvic pain. Rather, the findings from this research speak to theoretical discussions medical sociologists have been having for decades. Specifically, findings provide new insight on: 1) the limits of evidence-based medicine as a biomedical paradigm, 2) how fundamental causes of health inequality intersect with each other as well as other factors, such as gender, important in predicting health outcomes and 3) how discussions of metamechanisms in fundamental cause theory can inform our understanding of the accumulation of cultural health capital. In providing such insight, this dissertation uses the case of pelvic pain to integrate multiple perspectives and theories in medical sociology to drive the field forward in a way that acknowledges the many ways power is simultaneously constituted in the clinical interaction. From the role of gender, race, and class in power relations, to the ways medical knowledge, discourse, and authority dictate the clinical interaction, this research covers a wide range of sociological theories and concepts. In doing so, this dissertation sheds new light on current understandings of power in the clinical interaction and its relationship to inequitable health outcomes in the US.</p>

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