Reclaiming Choice, Broadening the Movement

By Courtney Chappell

Abortion, teenage pregnancy, and comprehensive sexuality education are the primary topics that guide the national dialogue about reproductive rights in America. Yet, the intersection of reproductive rights and other critical factors that influence sexual health is often missing from the debate. Many of these issues – including immigration, health care, welfare reform, and environmental justice -- intimately impact the reproductive and sexual health of women, including women of color like Asian Pacific Americans.

The Asian Pacific American (APA) population includes individuals whose heritage or origins derive from Asia or the Pacific Islands, a region stretching from Hawaii to India, and from China to Australia. The APA population is extremely diverse, and is comprised of more than 30 ethnic subpopulations that speak over 200 languages and dialects. Asian Americans and Pacific Islanders represent over four percent of the total U.S. population, or nearly 12 million people -- by 2050, that figure is expected to double to 8 percent of the population (a projected 33.4 million people). Four percent of women in the U.S. are Asian Pacific Americans (139 million women), of whom 50 percent are of reproductive age.

• “Asian American” refers to Chinese, Filipinos, Japanese, Koreans, South Asians (individuals whose heritage or origins derive from Bangladesh, Bhutan, Myanmar, India, and Maldive Islands, Nepal, Pakistan, and Sri Lanka), and Southeast Asians (individuals from Cambodia, Indonesia, Laos, Malaysia, Thailand, and Vietnam.)
• The term “Pacific Islander” refers to individuals from the thousands of islands in the Pacific Ocean that are classified as Micronesian (Marshal Islands, Kiribati, Guam), Melanesian (Fiji, Papua New Guinea, Vanuatu), and Polynesian (Hawaiians, Tongans, Samoans.)

  Despite the millions of APA women who need sexual and reproductive care, a very small number of studies specifically document trends and needs among APA women and girls. Only two percent of all published reproductive and sexual health care articles include APA women, the lowest percentage for all racial/ethnic groups. Even fewer studies disaggregate APA data by ethnic subpopulations, such as Hmong, Chinese, Vietnamese, or Native Hawaiian groups. APAs are either overlooked in research studies, or lumped together despite the broad differences that exist among subpopulations. Insufficient and inadequate research on APAs prevent both the public and health care providers from understanding sexual and reproductive health care issues that shape APA women’s lives.

  Moreover, the ‘model minority’ stereotype (which views Asians as successfully assimilating and trouble-free) inhibits recognition of APAs as individuals facing very real challenges and reproductive health care needs. In reality, the few studies that include APA populations present a very different and alarming picture of these women’s overall health risks and outcomes. For example:

• The incidence of cancer is steadily increasing among particular APA ethnic subpopulations. The rate of cervical cancer among Vietnamese American women is five times higher than Caucasian women’s, and is the highest rate among all racial and ethnic groups.
• Between 1994--2000, abortion rates fell for all groups except APA women; over one-third (35 percent) of APA pregnancies end in abortion, the second highest percentage for all racial/ethnic groups.
• Laotian American teenagers have the highest teenage birth rate in California; almost 19 percent of California’s teen births were to Laotian American teens, compared to 12 percent for Caucasian teens.
• Although less than one percent of reported U.S. HIV cases are among APAs, the number is steadily increasing, particularly among Filipino Americans and Native Hawaiians.
• Prolonged exposure to phthalates (chemicals used in many cosmetics and highly concentrated in nail polish) is a serious occupational hazard that has been linked to cancer, birth defects, and spontaneous abortions. Over 40 percent of U.S. nail technicians are APAs; in California, 80 percent of the industry workers are Vietnamese immigrant women.

  Why do APA women have poor health outcomes and suffer health disparities compared to other women in the U.S? One of the primary reasons is their lack of access to health care services and insurance coverage. Legal restrictions on providing health care services to undocumented workers, the high cost of obtaining private health insurance, and the lack of employment-based health benefits are among the primary reasons that APAs are uninsured. Currently, 36 percent of all APA women under age 65 are uninsured; 12 percent of school-age APA children are uninsured (compared to 7 percent of White children). Over half of APA men (52 percent) have not met the minimum standard of adequate doctor visits, as defined by the American Medical Association. Korean Americans are the least likely of all racial and ethnic groups to be insured.

  Moreover, even APA women who have insurance coverage and access to health care services face barriers to obtaining appropriate care. Language differences create enormous challenges to receiving high-quality and effective care. Approximately 60 percent of APAs are foreign-born (APAs make up a quarter of the U.S. foreign-born population). The U.S. Census Bureau has found that 79 percent of APAs speak a language other than English at home; 40 percent of APAs are limited in English proficiency, or speak English less than “very well.” It can be intimidating, if not impossible, for women to discuss their sexual and reproductive health when they do not share a common language with their provider, or when a family member or stranger are the only available interpreters.

  Further, studies have found that the cultural stigmatization of disease (including cancer) and lack of culturally competent health care prevent many APA women from seeking preventive reproductive health care services. For instance, one survey found that Vietnamese American women reported lower rates of preventive cervical cancer care because they avoid the test because of fear of a positive diagnosis, and/or because they harbor misconceptions about the Pap test. Another focus group with South Asian American women revealed that many were uncomfortable asking South Asian health providers for sexual or reproductive health guidance or services, because they feared the doctors would bring cultural biases to their practices or violate their confidentiality.

  Inspired by women of color organizations that have long mobilized around reproductive justice, the National Asian Pacific American Women’s Forum (NAPAWF) has developed a national action agenda on APA women’s sexual and reproductive health care issues. This action agenda outlines eight legislative priorities for national and grassroots advocacy, and offers recommendations for policymakers, advocates, allied organizations, and community leaders.

  NAPAWF’s eight priorities include: providing access to health care for all APAs; promoting linguistic and cultural competence in health and human services; demanding the collection of community-relevant sexual and reproductive health data and research; protecting and expanding sexual and reproductive rights; eliminating all forms of violence against women; increasing comprehensive sexuality education; linking women’s reproductive health to environmental justice; and ending gender discrimination and the promotion of sex selection technologies.

  By promoting this broad sexual and reproductive justice framework, NAPAWF seeks to broaden the pro-choice framework beyond the constitutional right to access abortion and provide APA women with real choices in their sexual and reproductive health care decisions. What is “choice” if a woman can’t talk to her doctor confidentially, understand her provider’s recommendations, access preventive care because of immigration restrictions, or is endangered by her workplace? NAPAWF hopes to work with other national and grassroots organizations to create change so that every woman and girl’s life, including Asian Pacific Americans’, is lived in dignity and equality.

  To learn more about these issues, get involved in the advocacy efforts, or to receive a copy of Reclaiming Choice, Broadening the Movement: Sexual and Reproductive Justice and Asian Pacific American Women, A National Agenda for Action, please visit NAPAWF’s website: www.napawf.org.

  Courtney Chappell is the Policy Director at NAPAWF, where she conducts legislative advocacy at the national level around sexual and reproductive justice. She received her law degree from American University Washington College of Law and is a recipient of a Georgetown Women’s Law and Public Policy Fellowship and a New Voices Fellowship.