Punitive laws, particularly against people who enter the U.S. at the Mexican border, may lead to poor newborn health. Multiple studies show that threatening immigrants with deportation or barriers to citizenship if they use social services creates reluctance to get medical care, including around pregnancy, which can lead to infants with low birth weight.

“In some racial and ethnic groups, immigrants can have better birth outcomes than people born in the United States,” said LDI Senior Fellow Diana Montoya-Williams, “but policies that criminalize immigration have a chilling effect on immigrants’ willingness to seek health care, which could erode that advantage.” With Senior Fellows Senbagam Virudachalam and Scott Lorch, Montoya-Williams worked with members of the Latine community (a gender-inclusive term for Latino and Latina) to develop policy recommendations that encourage prenatal care.

The researchers recruited 24 currently or recently pregnant Latine immigrants from clinics and community-based organizations around Philadelphia. Participants were mainly from Mexico and Central America. Of the 18 who voluntarily discussed their immigration status, 16 implied they were undocumented. During phone interviews in Spanish, researchers asked about prenatal care experiences and suggestions that would make their experience more welcoming.

Positive and Negative Experiences with Prenatal Care

Positive experiences included:

●  Help from friends and family in navigating the health system and finding trusted providers.

●  Use of Spanish interpreters and greetings in Spanish from providers, even if only a few words.

●  Respectful and encouraging care, prompting patients to continue visiting the clinic.

Negative experiences included:

●  Community rumors that immigrants are ineligible for care or that getting care might lead to deportation.

●  Perceived discrimination and racism after overhearing demeaning comments from medical personnel or being treated in ways that hurt or were uncomfortable.

●  Delaying care because of fear about the impact on immigration status, worry about mistreatment, concerns about paying for care, and language barriers.

Ideas for Meeting Immigrants’ Prenatal Needs

When asked to brainstorm ways to improve prenatal care for immigrants, participants had these recommendations:

●  Address immigration-related fears directly. Participants suggested clinics have signs welcoming immigrant clients, but also wanted providers to initiate conversations that reassured patients about their right to care and privacy.

●  Provide accurate information about health care through trusted community members and communication channels. Participants wanted information about immigrant health care rights through social media, television, billboards, and materials in shops, churches, and community centers.

●  Increase interpretation capacity. Participants also welcomed bilingual health navigators who could assist with clinic tasks such as filling out forms.

●  Acknowledge worries about costs. Providing information about health insurance might mitigate these concerns.

Supporting the Ideas with Policy Changes

Montoya-Williams and colleagues incorporated participants’ ideas into policy recommendations.

Add training in immigrant rights to medical education. Before providers can relieve patients’ concerns about how care affects their immigration status, they must learn to comfortably have those conversations, Montoya-Williams said. “I talk with colleagues all the time who say, ‘I don’t know enough about immigration politics.’”

Health care professionals already learn about social determinants of health, such as food insecurity, and receive training in having difficult conversations about diagnoses. “Immigration policies are political determinants of prenatal care,” Montoya-Williams said, “and should be part of the curriculum for all medical professionals in a country with a growing immigrant population.”

Work with immigrant advisory groups on information about patient rights and insurance. Clinic signs on immigrant rights could be low-cost and informative if developed with immigrant patient advisory groups, according to Montoya-Williams. These groups could also develop financial education programs to address fears about paying for care.

Expand interpreter services. Clinics that do not receive federal funding are not required to have interpreters and even places like Penn Medicine with well-resourced interpreter programs use them mainly for planned visits. “People need interpreters from their first call through follow-up,” Montoya-Williams said. “Most communications are with staff like schedulers, receptionists, and aides who take blood pressure.” Study participants said they don’t return to clinics if they can’t communicate with the staff.

Support community health worker programs. These trained lay health workers could potentially address needs for trusted information about rights and insurance, assist in navigating health systems, and possibly provide interpreter services. Montoya-Williams advises that to be effective they must be part of the community they serve and be recommended by community partners. Some health workers may be able to add interpretation to their role, with training and testing, and if they are properly compensated.

Community health worker programs and interpreter services are ripe areas for development and reimbursement reform, Montoya-Williams said. “They can help Medicaid fulfill its intended function—with a return on investment.”

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The study, “Philadelphia Latine Immigrant Birthing People’s Perspectives on Mitigating the Chilling Effect on Prenatal Care Utilization,” was published on June 1, 2024 in Medical Care. Authors include Diana Montoya-Williams, Alejandra Barreto, Alicia Laguna-Torres, Diana Worsley, Kate Wallis, Michelle-Marie Peña, Robin Ortiz , Lauren Palladino, Nicole Salva, Lisa Levine, Angelique Rivera, Rosalinda Hernandez, Elena Fuentes-Afflick, Katherine Yun, Scott Lorch, and Senbagam Virudachalam.

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