Immigrant Women's Health a Casualty in the Immigration Policy War

By Aishia Glasford and Priscilla Huang

As the immigration policy battles rage in legislatures and presidential primaries and state elections throughout the country, there’s been little attention to a serious casualty in these skirmishes: immigrant women’s health. Immigrant women are facing serious threats to their health, and in the most dire cases, have even lost their lives as a result of problems in this broken system. Rosa Isela Contreras-Dominguez and Victoria Arrellano died in Federal custody awaiting deportation to Mexico; Contreras-Dominguez was 38 and pregnant at the time of her death, and Arrellano who had AIDS, deteriorated steadily in a San Pedro, California prison, eventually dying there at the age of 23.¹ In another tragic loss, Jiang Zhen Xing, pregnant with twins miscarried when Immigration and Customs Enforcement officials tried to forcibly deport her.² Among the estimated 37.5 million foreign-born people living in the United States, there are probably tens of thousands more women experiencing serious health and reproductive health problems that are being made worse by the violence, discrimination, and hurdles that U.S. immigration policy perpetuates.

The National Coalition for Immigrant Women’s Rights (NCIWR) was formed in 2006 to bring a gender perspective to the immigration debate and to advocate for a truly comprehensive reform of the broken immigration system that is devastating the lives of women like Contreras-Dominguez, Arrellano, and Jiang and their families. One of NCIWR’s goals is to bring to light the harm being done to immigrant women and their children’s health as they attempt to secure the most basic rights, such as access to health care and reproductive health services.

Welfare, Immigration Reform and Immigrant Women’s Health Care

In 2006, approximately 12.5 percent of the total U.S. population was foreign-born.³ (The term “foreign-born” describes anyone who is a naturalized citizen, legal permanent resident, or undocumented immigrant.⁴) About 53 percent of the U.S. foreign-born population immigrated from Latin America, 25 percent from Asia, and 14 percent from Europe.⁵ Foreign-born women, who represent five percent of the total U.S. population, are twice as likely as their male counterparts to be widowed, divorced, or separated.⁶ They are also more likely than U.S.-born women to live in poverty, be unemployed, and lack health insurance. Approximately 42 percent of immigrant women are of reproductive age (between 25-44 years of age), compared to 26 percent of native-born women.⁶

U.S. immigration laws and policies have restricted the mobility, status, and livelihood of immigrant women since the country began regulating its borders. In fact, the United States’ first immigration law, the 1875 Page Law, targeted Asian women, particularly Chinese women. While the law specifically prohibited the entry of Chinese prostitutes, in practice it was intended to prevent wives and prospective brides of Chinese laborers from joining their husbands in the U.S. (Notably, many immigration scholars cite the 1882 Chinese Exclusion Act as the nation’s first U.S. immigration law, however, the Page Law pre-dated this Act.)

Until the mid-1990’s, immigrants were generally eligible for public benefit programs, such as Medicaid, on the same basis as their native-born counterparts. In 1996, however, the Welfare Reform Act (formally called the “Personal Responsibility and Work Opportunity Reconciliation Act of 1996,” P.L. 104-193) and Illegal Immigration Reform and Immigrant Responsibility Act (IIRIRA) both made it increasingly difficult for immigrant women to flourish in their new homeland by creating barriers to accessing social services such as health care.

One of the Welfare Reform Act’s most onerous provisions narrowed Medicaid eligibility criteria by imposing a “five-year bar” to access on most new immigrants. Thus, immigrant women who enter the country after August 22, 1996 must continuously reside in the U.S. for five years before becoming eligible for Federally funded health programs. Consequently, State and local governments which value the importance of a social net of services for both immigrant and U.S.-born residents must now use their own funds to extend public health programs to new immigrants. In addition, IIRIRA made it more difficult for immigrants to establish their income eligibility for Medicaid, even after reaching the five-year barrier. The law requires new immigrants with sponsors to include (or “deem”) their sponsors’ income when applying for Federal benefits. Thus, deeming and sponsor liability rules often render many immigrant women ineligible for services even after they have been in the U.S. for the required five years.

Both Acts restrict newly arriving, low-income immigrant women from accessing Federal benefits, and compound the financial strain and hardship that many immigrant families face when they first enter the country. (It is important to specify that neither welfare nor immigration “reform” laws changed the eligibility requirements for undocumented immigrants, who have always been ineligible for Medicaid and most other entitlement benefits.)

Impact on Immigrant Women

In 1996, when immigrants and native-born citizens had similar eligibility for public benefit programs, immigrants represented just 9 percent of the U.S. population and 15 percent of all welfare recipients.(7) By 1999, the number of immigrant welfare recipients dropped to 12 percent.⁷ The number of low-income, immigrant children and parents receiving Medicaid fell by 7-8 percent between 1995—2000, while the same population experienced a 6-7 percent increase in un-insurance rates during the same period.⁷

The decline in welfare and Medicaid utilization by immigrant women was partly due to the increased restrictions imposed by the 1996 reforms. In addition, these policies created a chilling effect that discouraged Medicaid use even by immigrants who were eligible for, and needed, such services. As a result, thousands of eligible immigrant women and children have not accessed public programs and services for which they are eligible -- including Medicaid and the State Children’s Health Insurance Program (SCHIP) -- and must either pay out-of-pocket for care or go without it altogether.⁸

The situation is far worse for undocumented immigrants. These individuals are eligible for services under Emergency Medicaid, but treatment is limited to serious health emergencies such as labor and childbirth. Therefore, most undocumented women forgo routine health care, including prenatal care and other preventive reproductive health services.

The Impact of Immigration Status, Economic Injustice, and Violence on Immigrant Women

Many immigrant women who wish to obtain a viable path of entry and citizenship to the U.S. face bleak prospects. Many U.S. citizens do not realize that obtaining a visa for entry to this country is a far more complicated and lengthy process than obtaining a passport or a driver’s license. Applicants are routinely denied visas to travel to the U.S. Immigration procedures for both entry to the U.S. and citizenship are long, arduous, and extremely expensive. It takes many months of paperwork, large administrative and legal fees (up to thousands of dollars), and intense interviews with foreign consulate and immigration officers before one can get a visa or become a legal permanent resident (the first step to becoming a citizen). This process requires immigrant women to navigate a system that many trained immigration attorneys have difficulty fully understanding. The system’s challenges mean that many immigrant women enter the U.S. without immigration documents (e.g., a visa).

Many other immigrant women enter the U.S. with some form of immigration status, such as a student, work, or tourist visa. Yet, they can easily lose this immigration status and become undocumented when their visa expires. This is common, because the U.S. immigration system is slow to notify visa holders and citizenship applicants of changes in their immigration status and/or relevant immigration rules.

For many immigrant women, the lack of documented immigration status and/or confusion over their status is a huge obstacle to accessing care, because access to publicly funded programs is now usually contingent upon one’s immigration status. Moreover, lacking (or losing) immigration status endangers immigrant women because it makes them vulnerable to manipulation, coercion, and exploitation at the hands of employers, traffickers, smugglers, or intimate partners. Women who lack (or are unsure they have) immigration status are often forced to accept low-paying jobs where they are easily exploited. Domestic service, child care, agricultural work, nail salons, sweatshops, and forced sex work are a few industries in which exploitation can occur.

Immigrant women’s working conditions are often deplorable and sometimes illegal, and may expose them to toxic chemicals, pesticides, poor ventilation, and dangerous equipment. Many immigrant women work long hours for little pay, without health benefits, and with no job security. For example, in 2001, 41 percent of immigrant women did not have health insurance.⁹

In 2000, 85 percent of migrant and seasonal farm worker women were uninsured,¹⁰ of whom only 42 percent accessed prenatal care during their first trimester of pregnancy, compared to 76 percent of pregnant women nationally.¹¹ Exploitative working conditions are a covert form of violence, as these workers are exploited precisely because they tend to be undocumented. Immigrant women also experience overt violence including physical, emotional, and/or sexual abuse by their employers, traffickers, and/or intimate partners. Immigrant women may be raped or harassed by those who have power over them. Women may also be forced to remain in abusive relationships or employment when their undocumented status is used to intimidate them from reporting abuse to the authorities.

The Lack of Information on Immigrant Women’s Reproductive Health Disparities

Compared to native-born women, immigrant women are more likely to have lower incomes, educational attainment, and acculturation levels; they are more likely to be uninsured and to lack awareness about preventative care and physician referrals. In addition, approximately 30 percent of immigrant households are linguistically isolated (defined by the U.S. Census Bureau as “a household in which all members 14 years old and over speak a non-English language and also have difficulty speaking English”)¹² Linguistic isolation creates significant barriers to accessing reproductive and maternal health services. Studies have found that linguistically isolated individuals receive far fewer preventative services than English-speakers (including Pap tests, mammograms, and prenatal care).¹³ These factors play important roles in if, how, and when immigrant women access health care.

While the consequence of the broken immigration system, economic exploitation, and violence is a multitude of reproductive health disparities for immigrant women, these negative outcomes remain hard to see because they are not adequately captured by current research. Statistical data on reproductive health disparities are not disaggregated by race, ethnicity and immigration status; thus, existing data are likely to be skewed and to under-report immigrant women’s health problems. This means that an Afro-Latina immigrant woman may be categorized as African-American rather than as an immigrant or as Latina. The lack of specific information about foreign-born women is important because, as noted, immigrant women experience different constraints than native-born women, (including native born women of color) and require different strategies to increase their access to preventive and reproductive health care. Without such strategies we will continue to see in States, for example, with large Latina immigrant populations, disparities in access to services such as prenatal care: in 2002, 87.2 percent of White women in Arizona began prenatal care in the first trimester, compared to just 66.7 percent of Latinas who did so.¹⁴

The paucity of data on foreign-born women’s health outcomes makes it hard to assess either the number of women who receive appropriate reproductive health services or strategies to improve their access to needed care. This problem is compounded by the fact that policymakers have failed to support funding and opportunities to study immigrant women’s health in order to identify and address these disparities. Without such research, it is impossible to develop policies and programs that provide immigrant women with the care needed to protect their own and their children’s health.

Policy Recommendations

In order to address the legal and reproductive health needs of immigrant women and their children, NCIWR advocates several policy recommendations:

• Comprehensive immigration reform must include legal and safe immigration options for undocumented men, women, and children; and a path to citizenship that allows immigrant women to obtain work permits, travel internationally, and access higher education and Federal financial aid.
• Reproductive health care coverage that is financed through public funds must be provided to all immigrant women regardless of their legal or economic status.
• Equitable access must be guaranteed to confidential and non-coercive family planning services; and to linguistically, culturally competent, and medically accurate reproductive health care services.
• Funding must be provided to research specific data on the reproductive health disparities, needs, and services for immigrant women, as well as for outreach to engage immigrant women and their children in care.
• Federal policy should impose a moratorium on immigration raids, and ensure better access to medical and legal services for immigrant women held in detention centers.

The National Coalition for Immigrant Women’s Rights is working to eradicate discriminatory practices in public policies that impact the reproductive health and well-being of immigrant women. As part of the Coalition’s principles of defending and protecting the well-being of immigrant women, their children, and their communities, NCIWR will tackle immigration reform, reproductive health and wellness, and labor policies and practices. NCIWR seeks to highlight not only immigrant women’s lives but also U.S. policies and practices that impact these women’s lives. In doing so, the NCIWR will also confront a society that has, for too long, contributed to the violence perpetrated against immigrant women, and advocate for enforcement policies and a judicial system that treats immigrant women with respect and dignity.

For further information about the NCIWR, please contact Aishia Glasford at Aishia@latinainstitute.org, or Priscilla Huang at phuang@napawf.org.

Aishia Glasford is the Senior Policy Analyst at the National Latina Institute for Reproductive Health and works on emergency contraception and the impact of immigration policy on the reproductive health access of Latinas.

Priscilla Huang is the Policy and Programs Director at the National Asian Pacific American Women’s Forum, where she oversees their reproductive justice, anti-trafficking, and emerging immigrant rights programs.

REFERENCES

1. Fears D, “Three Jailed Immigrants Die in a Month,” The Washington Post, August 15, 2007, page A02. Retrieved September 10, 2007 from http://www.washingtonpost.com/wp-dyn/content/article/2007/08/14/AR2007081401690.html

2. Huang P, “Which Babies Are Real Americans?” TomPaine.com, February 20, 2007. Retrieved September 10, 2007 from http://www.tompaine.com/articles/2007/02/20/which_babies_are_real_americans.php.

3. U.S. Census Bureau, 2006 American Community Survey Data Profile Highlights, Washington, DC: US Census Bureau, 2006. Retrieved September 12, 2007 from http://factfinder.census.gov/servlet/ACSSAFFFacts?_event=&geo_id=01000US&_geoContext=01000US&_street=&_county=&_cityTown=&_state=&_zip=&_lang=en&_sse=on&ActiveGeoDiv=&_useEV=&pctxt=fph&pgsl=010&_submenuId=factsheet_1&ds_name=DEC_2000_SAFF&_ci_nbr=107&qr_name=DEC_2000_SAFF_R1010®=DEC_2000_SAFF_R1010%3A107&_keyword=&_industry=.

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5. U.S. Census Bureau, 2006 American Community Survey Origins and Language, Washington, DC: U.S. Census Bureau, 2006. Retrieved September 12, 2007 from http://factfinder.census.gov/servlet/ACSSAFFPeople?_event=&geo_id=01000US&_geoContext=01000US&_street=&_county=&_cityTown=&_state=&_zip=&_lang=en&_sse=on&ActiveGeoDiv=&_useEV=&pctxt=fph&pgsl=010&_submenuId=people_8&ds_name=null&_ci_nbr=107&qr_name=DEC_2000_SAFF_R1010®=DEC_2000_SAFF_R1010%3A107&_keyword=&_industry=

6. Greico E, U.S. in Focus: Immigrant Women, Washington DC: Migration Policy Institute, May 2002. Retrieved January 6, 2008 from http://www.migrationinformation.org/USFocus/display.cfm?ID=2.

7. Levinson A, U.S. in Focus: Immigrants and Welfare Use, Washington DC: Migration Policy Institute, August 2002. Retrieved January 6, 2008 from http://www.migrationinformation.org/USfocus/display.cfm?ID=45.

8. SCHIP is a Federal public health program that provides health coverage for many documented immigrant children and pregnant women. States have the option to use SCHIP funds to cover prenatal services for undocumented immigrant women, an option implemented in 2002 to provide much-needed services for pregnant immigrant women in several states. Yet, the added coverage comes at the cost of reproductive freedom: in order to receive prenatal care, the Centers for Medicare and Medicaid Services (CMS), which administers SCHIP, defines the undocumented pregnant woman’s fetus as a “child,” and therefore extends health care coverage by giving personhood status to the fetus. Ensuring that undocumented immigrant women receive prenatal care coverage is a step in the right direction, but the change should not have come at the cost of taking away women’s ability to make autonomous reproductive health decisions.

9. Maternal and Child Health Bureau (MCHB), Women’s Health USA 2003, Rockville, MD: MCHB, 2003, page 58. Accessed September 20, 2007 from http://mchb.hrsa.gov/pages/page_58.htm.

10. National Latina Institute for Reproductive Health (NLIRH), Fact Sheet: The Reproductive Health of Migrant and Seasonal Farm Worker Women, New York, NY: NLIRH, December 2005, page 1. Accessed February 5, 2008 from http://www.latinainstitute.org/pdf/MgrntFrmwkrs-4.pdf.

11. Rosenbaum S and P Shin, Migrant and Seasonal Farm Workers: Health Insurance Coverage and Access to Care, Washington, DC: Kaiser Commission on Medicaid and the Uninsured, April 2005, page 2. Accessed on February 5, 2008 from http://www.kff.org/uninsured/upload/Migrant-and-Seasonal-Farmworkers-Health-Insurance-Coverage-and-Access-to-Care-Report.pdf

12. U.S. Census Bureau, Summary File 3: 2000 Census on Population and Housing, Technical Documentation, Washington, DC: Census Bureau, 1997, Appendix (B-32). Accessed January 28, 2008 from http://www.census.gov/prod/cen2000/doc/sf3.pdf.

13. Leighton Ku, Reducing Disparities in Health Coverage for Legal Immigrant Children and Pregnant Women, Washington, DC: Center on Budget and Policy Priorities (CBPP), April 2007, page 3. Accessed February 5, 2008 from: http://www.cbpp.org/4-20-07health2.htm#_ftn3.

14. NLIRH, Policy Brief: Prenatal Care Access Among Latina Immigrant Latinas, New York, NY: NLIRH, December 2005, page 1. Accessed February 6 2005 from http://www.latinainstitute.org/publications/index.html.