Racialized Access to Reproductive Healthcare
For most people of color in the United States racialization persists in aspects of their everyday lives. Racialization, defined by Douglas Massey as “a social process by which meanings and attributions are attached to inherited characteristics, typically for purposes of exploitation and exclusion,” in combination with gendered oppression have distinct consequences for women of color. To add another layer to their oppression, female immigrants of color─Black and non-Black Latine women to be specific in this context─face several disparities due to their intersectional identities. This research will explore the particular disparities that exist in reproductive health care in the United States for Black and non-Black Latine immigrant women. It is my expectation that the sociological literature that exists on this topic will help inform, if not provide a sufficient answer to the following research question: what is the extent to which Black and non-Black Latine immigrant women do not receive adequate health care in the United States, and what are the factors that contribute to this disparity?
It is essential to contextualize the issue in which I will be discussing. The theory of the social determinants of health is defined in public health as being various factors such as race, gender identity, sexual orientation, immigration status, educational level, employment, etc. that impact an individual’s ability to receive adequate health care. These disparities show up in reproductive health care for Black and Brown non-immigrant women in the United States, and I hypothesize that the social determinants of health similarly impact immigrant women. I am assessing reproductive health care for immigrant women as the ability to access abortion services, contraception, HIV and other STD/STI testing, and maternal health care. However, reproductive health certainly extends further than the focus of this paper and is deserving of more research in the future in relation to the rights of immigrant women.
The racialization of immigrants has contributed to their being discriminated against in many spheres of life in the United States. In addition to racialization, women face “triple” marginalization as their racial/ethnic, gender, and migrant identities intersect. As a result of these multiple layers of oppression certain privileges that American citizens afford, such as that of adequate reproductive health care, are not equally afforded to immigrant women.
Defining Health Disparities
Before discussing reproductive health outcomes found in sociological and public health literature, I must consider how these sources are assessing reproductive health care in their findings. An article titled “Reproductive Health: Caribbean Women in New York City, 1980-1984” assesses reproductive health care “directly via birth outcomes, and indirectly through certain factors known to be associated with outcomes which therefore are considered to be indicators of risk” (Chavkin, et. al, 611). Another article titled “Factors Associated with Sexual and Reproductive Heatlh Care by Mexican Immigrant Women in New York City: A Mixed Method Study” notes the health belief model in its assessment of reproductive health care. The text states that, “the health belief model posits that health care behavior, including preventive care and service utilization, is driven by knowledge of illness susceptibility and severity and the benefits of receiving services in the context of personal and or socio-cultural barriers...” (Betancourt et. al, 327).
Both articles emphasize the importance of considering factors that impact both access to knowledge and access to care itself, similar to those defined in the social determinants of health model. Given these assessments I have chosen to focus my research on the social determinants of health that Black and Brown immigrant women encounter while seeking reproductive care.
Black and Brown immigrant women face a number of barriers while attempting to access reproductive care, the lack of health care being among the most prominent. For many immigrant women maternal health care is the most reliable health service they receive in the United States, but access to other aspects of reproductive care such as contraception and testing are very limited. “‘Yo No Sabía…’─Immigrant Women’s Use of National health Systems for Reproductive and Abortion Care” declares that “immigrant women encounter more obstacles to reproducitve healthcare than non-immigrant women, and access to national healthcare is a particularly important factor in abortion access” (Ostrach 2013:262). A specific health care program in the United States that is nearly inaccessible to Black and Brown immigrant women is Medicaid, a program that provides healthcare for individuals with a lower socioeconomic status. Medicaid provides several sexual health services, including providing prescription drugs for the treatment of humanimmunoeficency virus (HIV), birth control, and prenatal and pregnancy care (Planned Parenthood, n.d.).
Without access to Medicaid Black and Brown immigrant women have difficulty finding such critical services. In focus groups administered by the authors of “Factors Associated with Sexual and Reproductive Heatlh Care by Mexican Immigrant Women in New York City: A Mixed Method Study,” “women said that pregnancy was often their first introduction to SRH (Sexual and Reproductive Health) care services in this country.” One woman in the focus group stated, “‘when you’re pregnant, it’s easier because everything is explained to you...but they don’t tell you how to get health services for yourself or how to pay for it, like birth control or PAP exams’” (Betancourt et. al, 329). Family planning resources, PAP smears, and pelvic exams are equally important in reproductive care as maternal health care, and immigrant women are typically unable to access either in the United States. This lack of access indicates a discrepancy in Black and Brown immigrant women’s ability to evaluate their reproductive health as non-immigrants are able to.
The Social Determinants of Health for Black and Brown Immigrant Women
As mentioned previously, the social determinants of health are the conditions that affect one’s ability to live healthily. According to the literature reviewed, the determinants that are most common in contributing to reproductive health care disparities among Black and non-Black Latine women are race, gender, class, language barriers, education level, employment, and immigration status.
An article titled, “Trauma, Immigrantion, and Sexual Health Among Latina women: Implications for Maternal-child Well-Being and Reproductive Justice,” makes a statement about Latine immigrant mothers specifically and how they “face consequences of gender, class, racial oppression, and consequently poverty, resulting in poor access to protective systems of social support and mental health services which could otherwise mitigate posttraumatic stress and revictimization” (Fortuna et. al, 2019:644). Many immigrant women experience posttraumatic stress as a result of their migration to the United States in which they may encounter various sexual abuses, including sexual assault in detention facilities and even sex trafikking (Anon 2009). Without access to mental health and reproductive care, these women are further oppressed while in the United States.
The authors of this article also note how immigration status limits one’s ability to obtain healthcare from federal programs. The text states that, “while the Patient Protection and Affordable Care Act (2010) expanded coverage for preventive healthcare such as family planning and screening for sexually transmitted diseases and domestic violence, it excluded undocumented immigrants from these benefits” (Fortuna et. al, 2019:644). Immigration status as a determinant of health illustrates how racialization and “crimmigration” affect access to services that American citizens or other groups of immigrants have.
Language is also a significant barrier to obtaining sufficient reproductive health care. Black and non-Black Latine female immigrants speak several languages, from Spanish to French Creole to Portuguese. If they encounter a physician that does not speak their language or who does not have a translator available it can be incredibly difficult to communicate needs or gather information about healthcare. An article titled, “Barriers to HIV Testing in Black Immigrants to the U.S.” writes, “primary language other than English, lower education, and low income have previously been associated with barriers to assessing health care services among immigrants in the U.S...not surprisingly, we found that these factors are associated with barriers to HIV testing” (Ojikutu et. al). HIV testing is an essential aspect of reproductive healthcare that is not equally distributed among immigrant communities, furthering disparities in sexual health care.
Betancourt et. al offers data that supports the presentation of language, education, income, and employment as social determinants of reproductive health as stated in Ojikutu et. al’s article. Betancourt et. al writes, “compared to other Latin groups in NYC, Mexican immigrants have the lowest rate of English proficiency, least amount of formal education, lowest employment rates for women, and lowest per-capita income” (Betancourt et. al, 331). All of these factors serve as obstacles for Mexican immigrant women when seeking reproductive healthcare. Similarly, Haitian immigrant women face many of the same barriers as Mexican immigrant women. “An Exploratory Study of Acculturation and Reproductive Health Among Haitian and Haitian-American Women in Little Haiti, South Florida” reports that:
“Haitian women in this study represent an underprivileged group with high unemployment rates and low rates of health insurances - two established structural barriers that can limit access to primary health care. Limited access to primary care, including family planning, is a common finding among this immigrant group” (Cyrus et al. 2016:671).
While both groups of immigrant women are socialized differently in the United States, an argument may be made that anti-Black attitudes distinctly impact Black female immigrants and their access to not only reproductive care, but healthcare in general. West Indian and African immigrants have various approaches to health and wellness that may make it difficult to communicate certain needs, and that may alter the healthcare providers' reception of those needs. “Barriers to Healthcare Access Faced by Black Immigrants in the US: Theoretical Considerations and Recommendations” supports this discrepancy by stating that, “such challenges [to healthcare] include lack of health insurance, lack of interpreters, discrimination based on race or accent, and lack of understanding on the part of doctors regarding African and Caribbean perspectives on illness” (Walufa and Snipes 2014:689). The way Black immigrants are racialized in the U.S. requires specific attention in assessing their access to healthcare.
Latine immigrants have been at the center of recent anti-immigrant arguments and rhetoric, especially during Donald Trump’s presidency. As we have studied in literature like Protective Serve and Deport: The Rise of Policing as Immigration Enforcement by Amada Armenta, Latine immigrants have been disproportionately targeted by the police during “routine” traffic stops and other interactions with law enforcement that criminalize immigration. For immigrant women whose identities already subject them to increased risk of sexual violence, interacting with immigration enforcement can be dangerous. The article “‘I’m Going to Look for You and Take Your Kids’: Reproductive Justice in the Context of Immigration Enforcement” describes “the fear and anxiety of an immigration raid is now a common sentiment among individuals living in mixed-status immigration communities” and that “these expanded immigration detention efforts have resulted in some undocumented immigrants and family members being unwilling to risk deportation to seek health and social services” (Fleming et. al, 2019:9). Such services include seeking reproductive care─a major service needed for women who are migrating to the U.S. with children or with child, and who also are at high risk of sexual assault.
Limitations and Contradictions
Most of the literature reviewed in this paper has supported my expectations of health disparities in reproductive health care based on racialized immigrant identity. Nonetheless, there are some limitations to the hypothesis that are both addressed in the literature itself and some that are implied.
The first limitation is that of the immigrant paradox, which claims that recent immigrants in the United States actually have better health and education outcomes than immigrants who have lived in the country longer. This theory is reflected in the article, “Exploring Knowledge, Belief and Experiences in Sexual and Reproductive Health in Immigrant Hispanic Women,” when the authors write that:
“women saw an opportunity for transformation when they arrived in the U.S., empowering them in their decisions about reproductive health. Women expressed that through health care providers in the U.S., they have obtained information about sexuality, contraception, and sexually transmitted diseases” (Quelopana and Alcalde 2014:1005).
The above quote does not directly speak to better health outcomes, but it does speak to improved conditions in seeking reproductive health care that can lead to improved outcomes. This contradiction suggests that the proposed hypothesis cannot be generalized to all Black and Brown immigrant women, and that there is more nuance in its argument.
Moreover, some of the data shows inconsistencies in drawing conclusions about certain immigrant populations. An article titled, “Reproductive Health Differences Among Latin American and US-Born Young Women” speaks on the limitations of their own study of the reproductive health Latine women: “the inconsistent findings we observed highlight the complexities of investigating the effects of ethnicity and foreign birth on reproductive health outcomes” (Minnis 2001:634). This is an inconsistency seen in my own research in which I was only able to find ethnicity-based data on Haitian and Mexican women, although the categories of Black and non-Black Latine women include several other ethnic populations. That said, this research shows that it is difficult to assess outcomes based on the experiences of individual groups and instead has informed more generalizable conclusions that do not address the nuances across communities.
There also seems to be a lack of numerical data that relate Black and Brown immigrant women to lower reproductive health outcomes, as most of the data supports that lack of access is qualitative and explanatory. Further studies may consider collecting quantitative data to observe how the health disparities presented affect immigrant women and their health.
Black and Brown immigrants women’s access to reproductive health care is primarily affected by the social determinants of health and the lack of health insurance afforded to these women based on their immigration status. Racial and gender based oppression make it difficult for immigrant women to obtain necessary services in the United States, demonstrating how racialized citizenship─or lack thereof─greatly alters the way in which immigrant women maintain their health.
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