When rural Scots-Irish, Ulster Scots, and English colonized Appalachia, they brought with them their traditions — among these was knowledge of medicinal plants and healing practices passed down from mothers to daughters. Colonists exchanged knowledge with local Indigenous nations such as the Cherokee and Choctaw, and with enslaved and freed African-Americans in the region. The fusion of healing practices and regional botanical knowledge formed the new Appalachian medicinal tradition (Ward 2017). Women’s midwifery and healer work as part of community care were invisibilised and de-legitimized by society because the women lacked a “formal” education. However, they provided a necessary community service due to the long distances to the nearest urban hospital (Ward 2017; Hooper 2020) — this still holds true in many parts of Appalachia that have “maternal care deserts” (Brill et al. 2023). Patients could barter with the midwives as payment, making the service more affordable than service given by male physicians who would charge fees (Ward 2017). Because of the distance to the nearest market / urban center even since the early settlements from 1730 to 1860, Appalachians relied on a subsistence-barter-borrow ecosystem (Diver et al. 2019). Reliance on subsistence continued even into the 20th century, especially for Appalachian women (Wilkerson 2019b).
Community service provided by Appalachian women extended beyond midwifery. Appalachian women served in communal kitchens during the coal mine strikes (Smith2014). They’ve also helped build community centers and libraries as part of anti-poverty activism (Wilkerson 2019a). Communal acts such as these form a commoning-community (Sato and Alarcon 2019) as they shared responsibility for the care of common resources. Care is treated as a common good and the women’s community work pooled resources together for the community, otherwise known as “commoning reproduction” by Silvia Federicci (Tummers and McGregor 2019). For Appalachian women, caregiving was a key aspect of their politics and activism, not because of some innate biology, but because of gendered expectations from a patriarchal society (Wilkerson 2019b).
During the boom, mining was the best paying work — at least for union workers —- but after the crash in 1980, Appalachians were left with a weakened economy with low-wage service jobs. Then in the 1990s when the Aids to Families with Dependent Children Act was dismantled, more pressure was placed upon Appalachian women to fill the gaps (Wilkerson 2019b).
Women are seen as the “backbone” of Appalachian society. According to Lynn Lovdal, the representative for the Appalachian Women’s Health Fund, “the success of our families and our region depends on keeping women healthy…emphasizing women’s health supports strong families, close communities, and a successful workforce” (Foundation for Appalachian Ohio 2018). Women face societal expectations to perform a triple role: productive labor (formal employment), reproductive labor (domestic work), and community labor (Moser 1993). Appalachian women have had to complete farm and/or home chores and take care of the children, while also tending to gardens and foraging in the woods for food. Even in the 1960s, some Appalachian women already also began working in formal jobs, but especially after the mining job crash, women picked up mostly service jobs to help provide for their families. According to a study by Penny L. Burg (1983), women spent 18 hours a week cooking, 16.5 hours cleaning, and 9.6 hours doing laundry in a week. According to Kochhar, Jain-Chandra, and Newiak (2017), women universally “spend 2.5 hours more of unpaid work regardless of the employment status of spouses” and “four times as much on childcare.” Because women are expected to do more of the unpaid reproductive work, they often have less opportunities in the job market, especially in regards to advancing their career. As such, women face higher risks of poverty.
In 1964, the government passed War on Poverty Initiatives. A year later, they specifically formed the Presidential Appalachian Regional Commission (now known as just Appalachian Regional Commission, or ARC) after passing the Appalachian Regional Development Act (ARDA). ARC was formed by Appalachian State Governers and the Federal Government as a unique federal-state partnership utilizing anti-poverty development policies internally. As written in ARDA: “Congress finds and declares that the Appalachian Region of the United States, while abundant in natural resources and rich in potential, lags behind the rest of the nation in its economic growth and that its people have not shared properly in the nation’s prosperity” (“Appalachian Regional Commission - Investing in Appalachia’s Economic Future.” n.d.). ARC focuses on developing the region through funding, lobbying, and supporting Local Development Districts, or LDDs (the in which Southeast Ohio is located is called the Buckeye Hills Regional Commission). ARC puts out reports each year to show economic growth progress. According to the a report by ARC (Black, Pollard, and Sanders 2007), income levels and economic rates improved from 1960 to 2000 but still lagged behind the rest of the nation. They attributed the growth in income to Appalachian women entering the workforce. In Central Appalachia, just 10 percent of women ages 25-64 were employed year-round in 1960. By 2000, the percent had increased to 40 percent of women. Employment for Central Appalachian men started at 57 percent in 1960 and rose to 72 percent by 1980, but with the regional economic crash, employment rates for men went back down to 58 percent by 2000 with the loss of mining and manufacturing jobs in the region. Even with the loss in employment for men, they still had higher rates than the women.
Several of the Appalachian women interviewed in the study in 1983 by Penny L. Burg did not hold “formal” jobs or had part-time jobs while their husbands worked so they could care for the children and let the husbands make the decisions. Burg offered solutions to increasing the women’s financial independence and satisfaction: education, agriculture career training, and job market skill training; networking and participation in community organizations and educational institutions; providing access to agricultural and home economics extensions; and educating both the husbands and wives about collaborative and mutual family decision making methods.
The methods taken to tackle poverty in the region, including income inequality based on gender focused on a combination of efficiency and anti-poverty approaches. NGOs and government officials were focused on tackling the underdevelopment of the region. Like seen in the report by ARC, the progress in income levels were attributed to the growth seen in women joining the workforce (efficiency approach). More anti-poverty focused policies used funds to help support regional small businesses and needs-based programs, such as shelters (Moser 1993; “Appalachian Regional Commission - Investing in Appalachia’s Economic Future.” n.d.). These, however, failed to account for Appalachian women’s triple role.
During the War on Poverty and subsequent government actions to develop Appalachia top down, women have lead and allied themselves with grassroots movements like the Anti-Poverty Movement and Civil Rights Movement. They fought for “redistributive economic policies, guaranteed income, access to health care, [and] welfare as a right of citizenship” and for their equality (Wilkerson 2019a). Through theirs and other Appalachians efforts, they influenced local and regional legislation and, also have left an impact on the culture. Groups like Athens Birth Circle make a difference for their local community. As they say, “building and nurturing parental support networks cultivates a sense of reciprocity and generosity. By offering our own support and guidance to fellow parents, we not only strengthen our bonds with others but also experience the profound joy that comes from giving back to our community” (“Athens Birth Circle” 2025).
Works Cited:
“Athens Birth Circle.” 2025. Athens Birth Circle. 2025. https://www.athensbirthcircle.org/.
“Appalachian Regional Commission - Investing in Appalachia’s Economic Future.” n.d. Appalachian Regional Commission. https://arc.gov/.
Brill, Seuli Bose, Lisa A Juckett, Erin Chandler, Jordyn Brown, Nikki Thomas, Chasmine Flax, Laura Miles, Mequeil Howard, Stephen Thung, and Kathryn Mishkin. 2023. “Implementing the Better Starts for All Pilot Mobile and Telehealth Intervention in Ohio Appalachia: Improving Access to Maternal Healthcare.” Journal of Health Care for the Poor and Underserved 34 (3): 1037–50. https://doi.org/10.1353/hpu.2023.a903061.
Black, Dan A., Kelvin M. Pollard, and Seth G. Sanders. 2007. “The Upskilling of Appalachia: Earnings and the Improvement of Skill Levels”, 1960 to 2000. Appalachian Regional Commission. Washington, DC: Appalachian Regional Commission. https://www.arc.gov/wp-content/uploads/2020/06/UpskillingofAppalachia.pdf.
Burge, Penny L. 1983. “Triple Roles of Appalachian Farm Women: Household, Farm and Wage-Earning.” Research in Rural Education 2 (2): 69–72.
Diver, Sibyl, Mehana Vaughan, Merrill Baker-Médard, and Heather Lukacs. 2019. “Recognizing ‘Reciprocal Relations’ to Restore Community Access to Land and Water.” International Journal of the Commons 13 (1): 400. https://doi.org/10.18352/ijc.881.
Foundation for Appalachian Ohio. 2018. Review of Appalachian Women’s Health Fund Opens at FAO. Foundation for Appalachian Ohio. October 2, 2018. https://appalachianohio.org/2018/10/appalachian-womens-health-fund-opens-at-fao/.
Hooper, Morgan 2020. “A Hereditary Connection to Early Midwifery in Appalachia.” The Sylva Herald. February 12, 2020.. https://www.thesylvaherald.com/history/article_cdb102c0-4dc5-11ea-91dc-bf3e2eef0577.html.
Kochhar, Kalpana, Sonali Jain-Chandra, and Monique Newiak. 2017. “Introduction.” Women, Work, and Economic Growth: Leveling the Playing Field, edited by Kalpana Kochhar, Sonali Jain-Chandra, and Monique Newiak, 3–12. Washington DC: International Monetary Fund.
Moser, Caroline O. N. 1993. “Third World Policy Approaches to Women in Development” Pp. 55-79 in Gender Planning and Development: Theory, Practice and Training. New York: Routledge.
Sato, Chizu, and Jozelin María Soto Alarcón. 2019. “Toward a Postcapitalist Feminist Political Ecology’ Approach to the Commons and Commoning.” International Journal of the Commons 13 (1): 36. https://doi.org/10.18352/ijc.933.
Smith, Barbara Ellen. 2014. “Another Place Is Possible? Labor Geography, Spatial Dispossession, and Gendered Resistance in Central Appalachia.” Annals of the Association of American Geographers 105 (3): 567–82. https://doi.org/10.1080/00045608.2014.924731.
Tummers, Lidewij, and Sherilyn MacGregor. 2019. “Beyond Wishful Thinking: A FPE Perspective on Commoning, Care, and the Promise of Co-Housing.” International Journal of the Commons 13 (1): 62. https://doi.org/10.18352/ijc.918.
Ward, Beth. 2017. “The Long Tradition of Folk Healing among Southern Appalachian Women.” Atlas Obscura. Atlas Obscura. November 21, 2017. https://www.atlasobscura.com/articles/southern-appalachia-folk-healers-granny-women-neighbor-ladies.
Wilkerson, Jessica. 2019a. “The Radical History of Appalachian Women Activists”. Boston 50 Review. July 9, 2019. https://www.bostonreview.net/forum/elizabeth-catte-finding-future-radical-rural-america-2/jessica-wilkerson-radical-history-appalachian-women/.
Wilkerson, Jessica. 2019b. “You Can’t Eat Coal, and Other Lessons from Appalachian Women’s History”. Southern Spaces. March 12, 2019. https://southernspaces.org/2019/you-cant-eat-coal-and-other-lessons-appalachian-womens-history/.
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