Montoya-Williams and her co-authors interviewed close to two dozen pregnant or recently pregnant Latino immigrants about their experiences accessing — or not accessing — prenatal care.
The researchers recruited Spanish-speaking interviewers from local community health groups Maternity Care Coalition and Puentes de Salud to make participants feel comfortable. They also refrained from asking directly about people’s immigration status (although Montoya-Williams said most participants revealed in the course of their interviews that they were undocumented).
The researchers identified several common themes when it came to reasons for delaying or foregoing prenatal care.
“We learned that even in our city, people are incredibly scared and still are reporting significant discrimination in their perinatal experiences,” Montoya-Williams said, “which shows that even here we have so many places that we can work on within the health care system in terms of how to really provide trauma-informed and culturally humble health care to a population that is being made vulnerable by everything that’s happening on a grand scheme in the federal, national level.”
Participants also cited confusion about the health system and their insurance coverage, concerns about the high cost of health care, and especially giving birth, and fears that their immigration status might be reported to authorities.
“Like, they’re going to ask for my passport, and as soon as they realize I don’t have it, then they’re going to call ICE and I’m going to be separated from my existing child, who’s here in this country and a citizen,” Montoya-Williams said. “And so people had heard these stories and were debating whether or not to seek prenatal care, despite hearing these stories, despite the risk, what they felt was this real risk of deportation or never achieving a green card.”
Montoya-Williams also asked about ways Philadelphia’s health workers and health systems could do better to overcome those barriers.
Some of the measures the study suggests are relatively easy to enact — like posting Spanish-language signs saying that immigrants are welcome, or having doctors directly address their fears.
“Some of our participants talked about how there would be one doctor, for instance, that would mention that it didn’t matter what their documentation status or immigration status was to them,” she said. “Saying those words out loud to them changed the tenor of their fear through the rest of their pregnancy. And so to me that is a very actionable thing that we can incorporate into medical education.”