From Stethoscope to Street: Medical Student Pursuing Doctorate in Sociology Researches Pregnancy Health in Rural Areas

By Richard LeComte 

Anna Hansen’s path to an M.D./Ph.D. at the University of Kentucky is taking her into the rural areas of Kentucky, where she is investigating issues surrounding pregnancy and birth. She’s working between her second and third years of medical school to earn a doctorate in sociology – quite an unusual undertaking for a would-be clinician studying in the College of Medicine. 

“The College of Medicine gives students the opportunity to pursue a Ph.D. in any department that they want, as long as they can make a good argument for it,” Hansen said. “Most other universities require that a student gets a Ph.D. within the college of medicine, so you have to go through a medical graduate department.” 

That flexibility allowed her to stretch all the way into the Department of Sociology in UK’s College of Arts & Sciences. As part of her doctoral dissertation, she’s interviewing healthcare workers in rural hospitals, exploring why illnesses and death rates among pregnant women are higher in these areas.  

“Rural American women are more likely to die, either in pregnancy, at delivery or in the postpartum, year,” she said. “So we see these complications occurring – especially blood transfusions – at a disproportionately high rate in rural communities across the state. As far as what's leading to those complications, that’s what my dissertation is driving to find out.” 

Although she’s in the first stages of data collection, Hansen already has some ideas about what’s causing these problems for rural women. They’re more prone to certain morbidities, and they may have trouble getting care since they are further away from such urban centers as Lexington or Louisville.  

“We've heard a lot about chronic disease in rural states, such as hypertension, diabetes, chronic anemia, or poor nutrition,” she said. “But then we've also heard about complications in their delivery. So these women might not have had access to the same level of care as a woman in Lexington immediately when a complication occurs.” 

Risk factors such as high blood pressure and gestational diabetes can have dire consequences when women give birth; the higher rates of these problems in rural women contribute to higher rates of mortality during and immediately after childbirth. Hansen said populations in more urban centers may be getting more attention, but these problems are apparent in Appalachia as well.  

“Diabetes is not helpful, and hypertension is not helpful,” she said. “We’re looking at how those risk factors combined with geographic area are influencing health.”  

In addition to analyzing data on pregnancy and birth morbidities and mortalities from previous studies, Hansen is heading to rural hospitals to talk with doctors, nurses and other care providers. This kind of qualitative research is aimed at telling the full story of pregnancy care. 

“We’re talking to anybody who meets the eligibility criteria,” she said. “If you're practicing in an Appalachian hospital and you're caring for rural women, you'll have these sorts of experiences. We're really hoping to hear from you.” 

Hansen has enjoyed getting out into the country and talking to people who are dealing with women and their health – a great primer for her eventual career as a physician. 

“It has been really exciting so far,” she said. “We're doing all these interviews with health care providers with ob/gyn, emergency medicine physicians, family medicine physicians -- whoever is encountering pregnant women and the crises that women experience.”  

Hansen’s research has the backing of a F30 Fellowship from the National Institute of Child Health and Human Development, sponsored by Nancy Schoenberg and Carrie Oser. Her dissertation advisers are Oser and Mairead Eastin Moloney, associate professors of sociology.  

“Anna is truly one of the most exceptional young scholars I have ever had the pleasure of working with,” Moloney said. “Her work ethic is impeccable, and it has been my honor to work with her both inside and outside of the classroom. I've enjoyed collaborating with Anna on a research project aiming to reduce preterm birth among Appalachian women led by Dr. Niraj Chavan. She is an incredibly quick study when it comes to research protocol and data analysis, and her productivity level is already well beyond that of many assistant professors.” 

Hansen earned her undergraduate degree in biology at Pomona College in California. She realizes the time she’s spending away from medical school is a choice most prospective doctors don’t make.  

“Every time you say yes to something you say no to something else,” she said. “I know I have this gap between my first two years and my clinical rotations. But my Ph.D. years will contribute to my ability to serve as a clinician. And the broad scope of my research potentially might be valuable to patients as well.” 

And her adviser says Hansen’s research will benefit her future practice and the Appalachian women she wants to help. 

“Anna's commitment to highlighting the social determinants of health -- particularly among vulnerable rural populations --will undoubtedly lead to carefully constructed, effective interventions for those at highest risk,”  Moloney said. “By excelling in both theory-driven sociology and the practice of medicine, she is well-poised to help individuals in both the short and long term. I have no doubt that Anna is going to be a top-notch clinician; we're fortunate to also claim her as a medical sociologist.” 

Research reported in this publication was supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health under Award Number F30HD103319. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.