Latina-identified immigrants experience multiple barriers to healthcare, including contraception and reproductive care. This can result in lack of access to affordable preventive screenings, such as Pap smears, mammograms, and tests for sexually transmitted infections (STIs), according to the authors of a recent study.1

“The question I had was: ‘How do immigrant Latinas find out about and go for reproductive healthcare, generally?’” says Lucia Guerra-Reyes, PhD, MPH, MA, associate professor in the department of applied health science at Indiana University Bloomington. “Most of my prior research was in Peru, and I am Peruvian. I wanted to focus on people [in the United States] who did not have employer-based insurance, and most of them are undocumented immigrants.”

Guerra-Reyes’ broad questions were about how people learned about contraceptive options, family planning, and reproductive health. “We were just trying to understand these women,” Guerra-Reyes says. “In the literature there is a lot of information on barriers, and they tend to be structured around things that are very common when you look at Latinas in the United States.”

The new study focuses on an emergent Latino community. This is a community where there is not a large, established Latino population. “Therefore, the resources of providers who speak Spanish or culturally adaptive reproductive health services was quite low,” Guerra-Reyes says.

Investigators also studied how providers and organizations viewed Latina patients. In the first phase of the study, they identified organizations that provided reproductive health services to undocumented and uninsured Latinas. They interviewed representatives from these organizations.1

“Providers saw themselves in the preventive arena; they felt Latinas did not think about preventive care, especially for non-contraceptive care,” Guerra-Reyes says.

In the second phase, researchers interviewed immigrant Latinas in one county in which the Latino population had increased by 52.4% in 2005-2009 and 2010-2014. The women reported various barriers to seeking non-contraceptive reproductive care services. For example, a few women reported that they were unable to get a Pap smear at a Title X clinic because they had been sterilized and were no longer reproductive.

The study’s reviewers disputed this belief, saying this was not a regulation or common policy at Title X clinics, Guerra-Reyes notes.

“This is the experience of the people I interviewed, and this put some specific stress on women who were not fertile,” she says. “The women told me that because of a funding structure, the clinic could only provide sexual reproductive healthcare to women who were still potentially fertile.”

The Title X statute says that grants were made to assist the operation of voluntary family planning projects, which provide a broad range of acceptable and effective family planning methods and related preventive health services. It does not explicitly prohibit preventive health services for women who are no longer able to procreate.2

“The other thing that was important in this for women was that there were language barriers, and — to some extent — discrimination in how they felt and what they felt they could receive from the clinics,” Guerra-Reyes says. “There was an expectation that they had very little they could receive.”

The women appeared to believe that their undocumented immigrant status meant that they would receive deficient care, she adds.

Since the clinics and providers were in an emergent Latino community, and not in an area with many Spanish-speaking healthcare workers, language was a big barrier. “Not all clinics can pay for phone translation services,” Guerra-Reyes explains. “There were translators in town, but it’s sort of a free-for-all. It had reached the point that [some] clinics were asking patients to bring their own translators.”

The community had one OB/GYN provider who worked with many Latina immigrants. The doctor spoke some Spanish, but this did not resolve the language barrier. “Because he spoke some Spanish, he didn’t use a translator,” she notes.

Another limitation is the cost of services. When the women did not use a Title X clinic, whether by choice or because they were turned away, they had to find a provider they could afford and who would welcome them as patients.

“The women who wanted a Pap smear got on the road to a bigger city, where there is a medical clinic that is independent, for-profit, and is managed by a couple of doctors who are Latinos and speak Spanish,” Guerra-Reyes says. “That clinic specifically advertises in Spanish language radio.”

Although the patients had to pay out of pocket for their care, the overall cost was less than it would have been at some other facilities. The women reported that their healthcare decisions were respected at this clinic. “We had the case of one woman who got an IUD [intrauterine device], and she went to the Title X clinic and didn’t like it,” Guerra-Reyes says.

The woman had gained weight and experienced a lot of bleeding after receiving the IUD, and she asked her Title X provider to take it out. The provider refused.1

“She felt horrible,” Guerra-Reyes laments. “They told her to hang in there and it would get better, and she did not like it. She went to this other clinic, and they took it out.”

None of the women interviewed said they felt pressure to use an IUD, but several were concerned about the unwelcome side effects of IUD use.

The interviewees’ stories of not being understood or heard contributed to feelings that they were neglected by individuals who were not culturally competent. “It creates stress and a feeling that it’s not really worth my time to go to this clinic, and I might as well use my money to get care,” Guerra-Reyes adds.

Reproductive care providers should recognize their own tendency to narrowly define women’s health and what constitutes the best outcomes. “A lot of the issues that come forward on the side of immigrant communities is trying to negotiate that they would like to be understood and be tended by people who recognize that their concerns are valid,” she explains. “They want their cultural perspective on these concerns understood.”

Even when providers are not culturally prepared to care for immigrant patients, it is important that they arrange for effective translation and reflect on how their own biases might affect patient care, she adds. For instance, one cultural bias is the belief that Latinas do not want preventive reproductive healthcare and do not seek preventive care.

“In our interviews, clinicians brought this up, but the women in interviews contested that belief,” Guerra-Reyes says. “The women said they wanted preventive care, but there are a lot of barriers to getting it.”

In some medical settings, the challenge of providing healthcare to an individual who does not speak the language of a provider, the provider can call a translation service to speak to the patient.

Providers could do a better job of communicating the drawbacks to IUDs, perhaps by offering a video in Spanish. “Also, in these smaller communities, there is an opportunity for outreach, partnerships with Latino-focused organizations,” she says. “I know this is an added burden on clinics and healthcare providers.”

But organizations that are trusted by the community can help improve healthcare engagement by suggesting that women with a particular health issue go to a particular clinic or provider.

“People are people, and you need to manage this in terms of trying to get at outcomes and better science and answering people’s concerns to the best of your ability,” Guerra-Reyes says.

REFERENCES

  1. Guerra-Reyes L, Palacios I, Ferstead A. Managing precarity: Understanding Latinas’ sexual and reproductive care-seeking in a Midwest emergent Latino community. Qual Health Res 2021;1049732320984430. doi: 10.1177/1049732320984430. [Online ahead of print].
  2. Department of Health and Human Services Office of Population Affairs. Title X statutes, regulations, and legislative mandates. https://opa.hhs.gov/grant-programs/title-x-service-grants/title-x-statutes-regulations-and-legislative-mandates