I propose to research female access to reproductive healthcare because I want to find out what explains the varying health indicators, such as abortion rates and low-birthweight rates, among immigrant populations in order to help my reader understand the importance of contraceptive education and availability.
In “Abortion rate and contraceptive practices in immigrant and native women in Sweden,” Helström et al. interviewed women who had requested abortions at the Karolinska Hospital in Stockholm. [1] Their findings established that the number of foreign-born women who requested abortions was larger than what was to be expected given their portion of the population. [2] They also found that immigrant women had less experience with contraceptives and more previous pregnancies and induced abortions that women born in Sweden. [3] Helström et al.’s findings also indicate that the foreign-born women come from a diverse group of countries, meaning that culture is not as much of a factor as are other classical factors associated with unwanted pregnancy, which a woman is more likely to exhibit if she is an immigrant. [4,5]
In “Segregation, Nativity, and Health: Reproductive Health Inequalities for Immigrant and Native-Born Black Women in New York City,” Sue C. Grady and Sara McLafferty assessed the relationship between racial residential segregation and low birthweight risk for native-born Black women and immigrant Black women in New York City (NYC). [6] Their findings suggest that, for US-born Black women, segregation was more likely to cause a lower birth weight while for immigrant Black women, their nativity had a much bigger influence than where they currently lived. [7,8]
In “Reproductive health differences among Latin American- and US-born young women,” Alexandra Minnis and Nancy Padian compared high-risk sexual behaviors and reproductive health among foreign-born Latinas, US-born Latinas, and US-born non-Latinas in the 15-24 age group. [9] Their study, conducted by interviewing females from reproductive health clinics in the San Francisco Bay Area, found that foreign-born Latinas had a higher median age of first intercourse but they used hormonal contraception and abortion less frequently, so they had a higher risk of pregnancy and childbearing. [10,11] The clash between the cultural values held by immigrant families and norms defined by US-born peers are likely to influence a young, foreign-born woman’s ability to use contraception. [12] Minnis and Padian also discuss the influence of acculturation on young women’s sexual activity, “Females aged 10-13 years from urban middle schools in northern California classified as less acculturated based on language use were more likely to have an older boyfriend, which was associated with early onset of secual activity and unwanted sexual advances.” [13]
Each of these studies attributes the variation in health indicators of immigrant women versus native born women to slightly different factors. The location of the population of the studies may make a difference. The lived experiences of both immigrant and native women in Stockholm, New York City, and the San Francisco Bay Area are likely to be quite different. In addition, immigration policies differ by country which would influence the characteristics of the immigrant women residing in each respective country. Moreover, since these studies show a difference in the experiences and health indicators of different populations, more research is needed to continue to identify themes and relationships that influence the access of women to reproductive healthcare.
The United States’ Department of Health and Human Services Centers for Disease Control and Prevention (CDC) regularly produces Abortion Surveillance reports which document the number and characteristics of women obtaining legal induced abortions using data voluntarily reported from 52 reporting areas that include all 50 states, the District of Columbia, and New York City. [14] This data is broken down by state, maternal age, gestational age, and race/ethnicity as well as possible given that there is no national standard on data collection and data is reported voluntarily. [15] Since these reports break down the data by race/ethnicity, they could prove to be useful in obtaining general statistics that can be used to help analyze abortion rates among certain populations or in certain geographical areas.
Another data set that could prove to be useful is a report from the District of Columbia Department of Health’s Center for Policy, Planning, and Evaluation entitled, “Reported Pregnancies and Pregnancy Rates in the District of Columbia 2011-2015.” [16] This report includes data on pregnancies, live births, induced abortions, and fetal deaths in DC over the given time frame. [17] Similar to the CDC Abortion Surveillance reports, data reporting is voluntary and the Department of Health does not receive any information on abortions performed in private physicians’ offices. [18] This data set provides information on the overall reproductive health trends in DC that would be helpful to compare against the trends of certain populations within DC.
Figures 4 and 5 of the report show that births to teenage mothers are disproportionately concentrated in Wards 7 and 8. [19, 20] The percentage of the population of Wards 7 and 8 that were foreign-born in 2011 are 2.8% and 2.7%, respectively. [21] This creates a puzzle of sorts because, in Minnis and Padian’s study, foreign-born young women had a higher risk of pregnancy than their US-born counterparts. [22] The Pew Research Center estimates that there are 25,000 unauthorized immigrants in the District of Columbia. [23] There is a lack of data on the reproductive health experiences and indicators on immigrant populations in the District.
It is important to note that obtaining data on undocumented populations can be very difficult. Reed et al. conducted a study on the maternal health of undocumented women in Colorado by merging Medicaid claims data linked to birth certificate data with the Colorado Birth Record for the years in question. [24] Since undocumented women can qualify for emergency Medicaid coverage for labor and delivery services, it is possible to utilize this data in conjunction with the birth certificate data to identify important maternal health information without identifying any individual patient. [25] Another study conducted in Switzerland was able to obtain information from undocumented populations by conducting surveys at a health clinic that is well known in the undocumented community. [26]
Reproductive health care encompasses contraceptives and abortion, but also obstetrics and gynecology. Different populations have different experiences with obtaining reproductive health care and the information needed to make informed sexual decisions. Understanding the driving factors behind this disparity would allow for more informed policies from both government officials and health care professionals. This is a topic area that disproportionately affects women’s everyday lives and deserves more research on to further promote gender equality.
General Question: What explains the disparity in reproductive health indicators between immigrant and native female populations?
Specific Question: What explains the increase in teen pregnancies in Wards 7 and 8 in DC despite the low foreign-born populations?
Footnotes:
[1] Lotti Helström et al. “Abortion rate and contraceptive practices in immigrant and native women in Sweden,” Scandinavian Journal of Public Health 31, 6 (December 2003), 405-410.
[2] Ibid, 405.
[3] Ibid.
[4] Ibid.
[5] Ibid, 410.
[6] Sue C. Grady and Sara McLafferty. “Segregation, Nativity, and Health: Reproductive Health Inequalities for Immigrant and native-born Black Women in New York City,” Urban Geography 28, 4 (2007), 377.
[7] Ibid, 391.
[8] Ibid, 392.
[9] Alexandra Minnis and Nancy Padian. “Reproductive health differences among Latin American- and US-born young women,” Journal of Urban Health 78, 4 (December 2001), 627.
[10] Ibid.
[11] Ibid, 633-634.
[12] Ibid, 634.
[13] Ibid, 635.
[14] Tara Jatlaoui et al. “Abortion Surveillance–United States, 2014,” Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report 66, 24 (November 2017), 1.
[15] Ibid.
[16] Department of Health Center for Policy, Planning, and Evaluation, Reported Pregnancies and Pregnancy Rates in the District of Columbia 2011-2015, Nikhil Roy. (District of Columbia: Government of the District of Columbia, 2017), 1-22.
[17] Ibid, 1.
[18] Ibid.
[19] Ibid, 13.
[20] Ibid, 14.
[21] District of Columbia Office of Planning. “District of Columbia Foreign-Born Population: 2011,” District of Columbia State Data Center Fact Sheet, Minwuyelet Azimeraw et al. (2011).
[22] Minnis and Padian, 633-634.
[23] Pew Research Center. “Estimated unauthorized immigrant population, by state, 2014,” <http://www.pewhispanic.org/interactives/unauthorized-immigrants/> (Accessed: 9/30/18).
[24] Mary Reed et al. “Birth outcomes in Colorado’s undocumented immigrant population,” BMC Public Health 5, 1 (January 2005), 100-107.
[25] Ibid, 102.
[26] Hans Wolff et al. “Undocumented migrants lack access to pregnancy care and prevention,” BMC Public Health 8, 1 (March 2008), 2.
Bibliography:
Department of Health Center for Policy, Planning, and Evaluation, Reported Pregnancies and Pregnancy Rates in the District of Columbia 2011-2015, Nikhil Roy. (District of Columbia: Government of the District of Columbia, 2017), 1-22.
District of Columbia Office of Planning. “District of Columbia Foreign-Born Population: 2011,” District of Columbia State Data Center Fact Sheet, Minwuyelet Azimeraw et al. (2011).
Grady, Sue C. and Sara McLafferty. “Segregation, Nativity, and Health: Reproductive Health Inequalities for Immigrant and native-born Black Women in New York City,” Urban Geography 28, 4 (2007), 377-397.
Helström, Lotti et al. “Abortion rate and contraceptive practices in immigrant and native women in Sweden,” Scandinavian Journal of Public Health 31, 6 (December 2003), 405-410.
Jatlaoui, Tara et al. “Abortion Surveillance–United States, 2014,” Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report 66, 24 (November 2017), 1-44.
Pew Research Center. “Estimated unauthorized immigrant population, by state, 2014,” Pew Research Center, November 3, 2016 <http://www.pewhispanic.org/interactives/unauthorized-immigrants/> (Accessed: 9/30/18).
Reed, Mary et al. “Birth outcomes in Colorado’s undocumented immigrant population,” BMC Public Health 5, 1 (January 2005), 100-107.
Wolff, Hans et al. “Undocumented migrants lack access to pregnancy care and prevention,” BMC Public Health 8, 1 (March 2008), 1-10.
October 2, 2018 at 10:50 pm
Overall this is a very good foundation for your research, Megan. Both the empirical information as well as the preliminary insights into the theoretical debates that you provide here indicate that you are very much headed in the right direction. As you continue your research and think about these debates at the level of theory/explanation (the debates among scholars that help establish that the empirical patterns really are a *puzzle* to be explained) where do you see the main lines of debate now? You note some general differences in the lines of explanations offered by various scholars, and then observe that “…more research is needed to continue to identify themes and relationships that influence the access of women to reproductive healthcare.” Have you identified more precise explanations and, importantly, debates in the scholarship that would inform your own work?
October 3, 2018 at 10:30 pm
As I comb through the literature, two general areas of scholarship are beginning to emerge. One group explains the different health indicators and experiences by emphasizing classical factors of poor reproductive health (poverty, low education, unemployment, etc.) exacerbated by immigration, while the other emphasizes immigration issues such as documentation and cultural influences. Something I need to do more reading on is the ‘healthy migrant’ theory. [1] I would generally place this theory under the ‘immigration issues’ category of scholarship but it varies from other scholarship in that category in that it provides an explanation for the better health outcomes of immigrant women than native woman that sometimes occur.
[1] Margaret Kelaher and Dorothy Jones Jessop. “Differneces in low-birthweight among documented and undocumented foreign-born and US-born Latinas,” Social Science & Medicine 55, 12 (December 2002), 2173-2174.