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Archive for the ‘Cultural Competency’ Category

The National Latina Institute for Reproductive Health recognizes the critical role community health centers (CHCs) play in delivering health care to Latin@ communities across the country.

And so does the Patient Protection and Affordable Care Act (ACA): the health care reform law will provide $11 billion between 2011 and 2015 to support and expand operations of community health centers.

What exactly are Community Health Centers and how do they help our communities stay healthy?

Community health centers (CHCs) provide affordable, culturally-competent comprehensive primary and preventive health care services to low-income individuals living in medically underserved areas. In practice, this means that a community health center may be the only health care provider accessible to those in our community who most need care.

Community health centers receive specific federal funding to provide free or low-cost services, including reproductive health services like cancer screenings and contraception. Studies show that CHCs play a pivotal role in providing essential reproductive health care for low-income women, including prenatal care, mammograms and Pap tests. Community health centers provide care regardless of one’s ability to pay, immigration status, or primary language. They are often governed by a community board, whose membership is at least half composed of health center patients themselves and understand the community’s needs.

In 2010, approximately 1,100 federally-funded community health centers provided care to 19.5 million Americans. Latinos represent over one-third of all CHC patients and in 2009, 865,000 patients at these centers were migrant and seasonal farmworkers, many of them Latinas. In the new health reform law, $9.5 billion will go to create new CHCs in medically underserved areas as well as expand the types of health services provided at these centers. $1.5 billion will go to enhance infrastructure at existing community health centers.

Why is this funding so important for our community?

With millions of Americans living without health care insurance, there is a dire need for more community health centers to provide essential primary and preventive health care services. Among all racial and ethnic groups, Latinos have the highest health care uninsurance rates. We also know that Latinas disproportionately suffer from conditions and diseases such as cervical cancer and HIV/AIDS among others, so increasing the reach of CHCs will improve access to preventive health services and may begin to reduce health disparities. And finally, as undocumented immigrants and permanent residents who have had that status for five years or less will continue to be ineligible for Medicaid, community health centers will continue to play a unique role on providing quality care regardless of immigration status.

For more information about Community Health Centers,please check out NLIRH’s fact sheet, Medicaid and Community Health Centers Threatened with Funding Cuts: What is really at stake for Latinas and Immigrant Communities?


Photo Credit: Health Center Data: U.S. Department of Health and Human Services, Health Resources and Services Administration, Uniform Data System, 2009. National Data: U.S. Census Bureau, 2008 Current Population Reports. http://www.healthcare.gov/news/factsheets/2010/08/increasing-access.html

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This month, the National Latina Institute for Reproductive Health is serving up 20 DAYS OF ACA, a media, public education, and organizing effort aimed at sharing personal stories, information, and resources on how Latinas have benefited from the Patient Protection and Affordable Care Act (ACA) and how they will continue to benefit as the law is funded and implemented.

As part of our ¡Soy Poderosa! campaign, we will mobilize Latinas to commemorate this important law on its 2-year anniversary and declare their own power as health care advocates, consumers, and providers.

Starting today, we will celebrate the second anniversary of the enactment of the ACA (March 23rd), and we will watch closely as the Supreme Court of the United States (SCOTUS), the highest court of the land, holds three days of oral arguments (March 26-28) in order to review the law.

Latinas have much to gain from this important law, and even more to lose if it is undermined, reversed, or not implemented appropriately:

  • Latin@s have the highest rates of health care uninsurance among all racial and ethnic groups. Barriers to both private health insurance as well as public health programs contribute to Latin@s’  disproportionately high rates of uninsurance.
  • Those Latinas who do have access to medical care are often met with a health care workforce that is not adequately competent and sensitive to their culture and language preferences. Co-pays for even basic preventive services, including contraception, create situations where Latinas have to choose between groceries and health care.
  • Fear of bias and discrimination from health professionals due to one’s immigration status, sexual orientation, and gender identity among others also create barriers to meaningful health care.
  • The lack of a diverse health care workforce serving in communities where Latinas live puts health care out of reach for many.
  • Those without employer-sponsored coverage face prohibitively high cost and ever-increasing premiums on the individual health insurance market.
  • Eligibility rules for Medicaid, Medicare and the Children’s Health Insurance Program often deny coverage to populations of Latinas: for example by excluding those without documentation and permanent residents who have had that status for five years or less.
  • The result is that Latinas disproportionately suffer from a number of diseases and conditions, such as cervical cancer, HIV/AIDS and other sexually transmitted infections (STIs).

However, many provisions of the ACA hold the promise of expanding meaningful access to quality and affordable health care and public health services for Latinas, their families and their communities.

So for the next 20 days, we will be unpacking the ACA, highlighting personal stories of Latinas who have already benefited from the reforms, and previewing what Latinas can look forward to as the law is further implemented. Stay tuned for new fact sheets, information on calls and webinars, and opportunities to ask YOUR questions about the ACA and what it means for you.

Hope you will stay tuned! If you have a personal story of how the ACA has positively impacted your access to health care, or you’d like to get involved in our efforts, please contact Kimberly Inez McGuire at Kimberly@latinainstitute.org.

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“Statistically significant”

“Accurate denominator”

“Barrier vs. non-barrier population”

This is what I heard as I sat in a gloomy conference room today during an agency committee meeting about who classifies as a medically underserved population and where health professional shortages exist.

The committee’s job is to build a model that the federal Department of Health and Human Services’ (HHS) will use to allocate money to populations that lack medical services.

I was at these same meetings in November and realized that the deliberations lacked the human stories needed to make an accurate model. We know that certain elements have the biggest impacts on underservice such as race, ethnicity, culture, language, sexual orientation, and gender identity. So we joined forces with other organizations including the National Asian Pacific American Women’s Forum (NAPAWF) and the National Immigration Law Center to express our concerns.

With these organizations, we submitted written comments to the committee and then I gave public testimony today about these issues. I know that by opening up this conversation, giving strong examples of the problems, and offering solutions we have made an impact in that committee’s focus. They asked us to remain a resource for their future efforts and several committee members thanked me for our participation and expressed that they have tried to elevate these concerns but that it has been difficult. These issues are not easy to raise. They make finding a clean model very difficult. But they are critical in designing a model that is effective at figuring out who really is underserved. I hope, and believe, that our work on this issue has elevated underserved voices and will make a difference in the committee’s deliberations.

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I was fortunate to live in a home where I was raised by both parents. I wasn’t disciplined often, que mal hubiera sido eso. Bueno, tal vez, only a handful of times. But mom really preferred to give me la mirada, the evil eye, which almost twitched in formation as she squinted, or she would gesture her hand in a way that meant trouble. And I mean real trouble, like chanclas flying across the room and munuecas falling off the bed.

My mom knew I was a softie, too. And probably like your mom, mi mama wanted me to strike a perfect a balance between two extremes – queria que fuera fearless, borderline aggressive, yet loving and understanding, and compassionate. Latina moms, they’re quite the character. But I know what she meant. Queria que mis hermanas y yo tuvieramos a fearless approach toward life, a quench thirst to attain the things that we wanted to attain the most. I guess that’s why there is always something comforting, but frightening about hearing mom or abuelita say, donde hay gana, hay maña – “where there’s a will, there’s a way.” Te acuerdas de este dicho? Dichos are part of our language, our ideology as Latinas, and we’ve come to understand and appreciate their meaning! Our stories and the ones of our family are the kind of stories that are told through dichos – including our accomplishments, our defeats, and our good fights, tu sabes.

This year Latinas are fighting the good fight. We are fighting the good fight in the new health care reform law to include birth control in the list of preventive services that the Department of Health and Human Services and The Institute of Medicine (IOM) is putting together. And our allies? One another, si senor! Y cuando quieremos algo, I don’t know how we do it, but we get things done. que no? Mujeres, we have until August to tell our government that women deserve to access birth control at no cost. Actualmente, birth control is not included in the list of preventive services, which means that women would have to pay for birth control under the new health law. Mujeres, we have until August to tell our government that women deserve to access birth control at no cost. Women should not have to pay for health services that are justifiably theirs. Porque?

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NLIRH is excited to announce the Spanish-language versions of our latest reports – Advancing Reproductive Justice in Immigrant Communities: Promotoras/es de Salud as a Model,  and Removing Stigma: Towards a Complete Understanding of Young Latinas’ Sexual Health

Advancing Reproductive Justice in Immigrant Communities: Promotoras/es de Salud as a Model highlights NLIRH’s work with promotoras/es de salud (community health workers) and the connection between promotoras/es and reproductive justice as an opportunity for movement building and social change.

Removing Stigma: Towards a Complete Understanding of Young Latinas’ Sexual Health reviews recent research on adolescent sexuality and reproductive health, sets forth a reproductive justice framework for advancing the sexual health of Latina adolescents, and lays out policy approaches to ensure that communities in which healthy decisions about sexuality and reproduction are supported and available to adolescents.

Take a look at the Spanish-language versions below!

Promoviendo la justicia reproductiva en las comunidades inmigrantes: El modelo de las(os) Promotoras(es) de Salud

Deshaciendo estigma: Hacia una comprensión completa de la salud sexual de las jóvenes latinas

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By Zarah Iqbal, Policy Intern

A recent article in the Times of India described how some religious leaders in Afghanistan (called mullahs) have been encouraging their communities to use contraception, using quotes from the Quran to support their claims.

The most recent edition of the Bulletin of the World Health Organization (WHO) describes the actual study on which the article was based. In 2005, Afghanistan was tied for the second highest maternal mortality rate in the world, at 1800 maternal deaths per 100,000 live births.

It also has an incredibly high fertility rate, especially considering it has been in a state of war and conflict. According to WHO Statistical Information System, in 2006, each woman gave birth to 7.2 children on average. In 2003, contraceptive prevalence in Afghanistan was incredibly low, at 10.3%, as compared to the US, which was 73.8% in 2002.

In this study, government workers and NGOs embarked on a plan in three specific regions of Afghanistan to strengthen family planning services, and create a model for the rest of the country. They hypothesized, and studies have shown, that access to adequate family planning services reduces maternal mortality. The contraception provided was largely free to community members, and the workers were encouraged to use innovative methods of promoting family planning.

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A recent study led by researchers at UC Davis explores the association between intimate partner violence and unintended pregnancy. The study shows that young women often face efforts by their partners to coerce pregnancy or destroy contraception, and that these attempts at reproductive control are associated with other forms of intimate partner violence, increasing the risk of unintended pregnancy.

In this study, “Pregnancy coercion, intimate partner violence and unintended pregnancy,” published in the January issue of Contraception, researchers surveyed over 1300 English and Spanish-speaking women ages 16-29 who were seeking care at five family planning clinics in California. Researchers divided “reproductive control” into two broad areas: pregnancy coercion and birth control sabotage. The results showed that an astounding number of surveyed women had experienced either pregnancy coercion or birth control sabotage.

Approximately a third (35%, 237/683) of women reporting partner violence also reported either pregnancy coercion or birth control sabotage, in contrast to only 15% (91/595) of those who never reported violence reporting reproductive control of either form….The combined effect of both partner violence and reproductive control increased the odds of unintended pregnancy almost two-fold.

While many pregnancy prevention efforts place the responsibility for unintended pregnancy on women, especially among teenagers, this study shows that these efforts are not only wrong, but dangerous. They ignore the possible role of of abusive partners in pregnancy.

It also contradicts the popular notion that men are the sole victims of contraceptive sabotage. We often hear stories of women deliberately missing their pill or lying about using contraception entirely to coerce their partner into a more serious relationship due to pregnancy. Less commonly known or discussed is the fact that men also participate in birth control sabotage to manipulate their partners.

The authors suggest a possible step forward: intervention programs provided by family planning clinics and harm reduction services for women affected by partner violence. Family planning clinics could be a great resource for women suffering domestic abuse if programs such as counseling services are offered.

This study shows how important it is for all women to have access to emergency contraception, and a choice of contraceptive methods. Some women need injectable or intrauterine methods so that their partners cannot see or tamper with their contraception. The study also stresses the importance of confidentiality in reproductive health care, so that women can exercise their right to reproductive health without fearing coercion from their partners.

By Zarah Iqbal, Policy Intern

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While “Nuestra Vida, Nuestra Voz” primarily focuses on reproductive health and justice issues, it’s important to occasionally highlight other issues that impacts the Latin@ community as a whole. Latinos encounter many stereotypes and different forms of discrimination. Even though language is the principle connection, there has to be a recognition of the diverse cultures, ethnicities and vocabulary that exists among Latin@s.

Case in point, there is a new series of Anheuser-Busch’s Bud Light ads being advertised in the New York City subway system that completely butchers the Spanish language (see pictures below): (more…)

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