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Archive for the ‘Research’ Category

According to the UN Convention on the Rights of the Child:

States…should ensure the rights of the female and male adolescents to sexual and reproductive health education…in specially designed programs that respect their right to privacy and confidentiality.

The United States and Somalia are the only countries in the world that have not ratified this treaty. The relevance of this non-ratification may seem unclear, but work by R. Cook and BM Dickens in the International Journal of Gynecology & Obstetrics, highlights problems that youth face when trying to obtain health education and healthcare. Consider the fact that in Texas:

Not even young parents in Texas can get birth control without their own parents’ permission at nearly a third of the family planning clinics on contract with the state health department.

Basically, a teen parent might end up making medical decisions for her child or for her children, but is still unable to obtain birth control for herself. Here’s a really important place for researchers who are interested in getting to the bottom of things to jump in. Instead of asking questions about whether or not teens and young adults have the ‘ability’ to make decisions about their own reproductive healthcare, we might consider asking what barriers are in place that prevent young parents from accessing the healthcare they need.

Research questions are just as important as research answers. Cook and Dickens talk a lot about and explain three things States should do (respect, protect, and fulfill healthcare rights) to ensure that youth have access to reproductive healthcare. The fact remains, however, that from their work we can’t understand why healthcare isn’t working and what could immediately be better about healthcare services. It’s crucial to include youth in these types of discussion since they know what’s not working and have crucial ideas about what might work. Youth and community driven research have their work cut out for them – and apparently, so does Texas!

By Adrienne Wallace, Research Intern

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Nationally, one-third of women self-identify as a member of a racial or ethnic minority group and it is estimated that this will grow to more than half by 2045. As the country becomes more racially and ethnically diverse, there is a growing recognition of the need to understand racial and ethnic disparities in health status and access to care.

A new report by the Kaiser Family Foundation, “Putting Women’s Health Care Disparities on the Map: Examining Racial and Ethnic Disparities at the State Level,” documents the persistence of disparities between white women and women of color across the country and on a broad range of indicators of health and well-being, including rates of diseases, such as diabetes, AIDS and cancer, as well as access to health insurance and preventive screenings.

According to the Kaiser Family Foundation, women of color consistently fared worse than white women across a broad range of measures in almost every state, and in some states, these disparities were quite stark.

For Hispanic women, access and utilization were consistent problems, even though they fared better on some health status indicators, such as smoking and cancer mortality. A greater share of Latinas than other groups lacked insurance coverage, did not have a personal doctor/health care provider, and delayed or went without care because of cost. Latinas were also disproportionately poor and had low educational status, factors that contribute to their overall health and access to care. The large population of Latina immigrants do not qualify for publicly funded insurance programs like Medicaid even if in the U.S. legally, and some have language barriers that make access and health literacy a greater challenge.

This report highlights the need for policy-makers to look beyond national statistics to the state level in order to gain a better understanding of where challenges are the greatest or different, and to determine how to shape policies that can ultimately eliminate racial and ethnic disparities.

For more information, the report can be found here.

by Ivette Sanchez, Policy and Advocacy Intern

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A new Pew Hispanic report concluded that are 8.8 million people who are living in mixed-status households, meaning that people in the same family have different immigration statuses–born and naturalized U.S. citizens, documented immigrants, and undocumented immigrants. They also note that 76% of undocumented immigrants are Latino.

 

This report highlights the tremendous impact that anti-immigrant policies have of the reproductive health of Latinas and their families.

 

  • Immigration raids, meant to brutally intimidate immigrant communities, result in nonsensically separating parents from their children based in immigration status and often place pregnant and breastfeeding women in detention where they cannot access prenatal care or pump milk.
  • Eligibility for public health insurances like Medicaid and CHIP have excluded documented immigrants for their first 5 years in the U.S., and immigrants with no documentation have almost no access to affordable health care except in the most serious emergencies, like childbirth. For Latin@s in mixed-status households, some are afraid that accessing the care they are eligible for may put at risk the safety of a family member who is undocumented. It also means that some family members are arbitrarily left without any access to health care at all. For Latinas who want to plan for or prevent pregnancy, and get the best care possible for the children they are raising,  policies that cut out immigrants from the health care system are undermining their health and well-being.

There is some promising news: this article reports that immigration raids “have slowed to a near halt.” But the reproductive justice community must join others in holding the Obama Administration accountable for ensuring that raids stop completely – not just so the census goes smoothly, but so that health and human rights of Latinas and their families are ensured.

 

Additionally, the new CHIPRA law has removed the 5 year bar on Medicaid and CHIP eligibility for documented immigrants who are children and pregnant women. Again this is only promising news- it is up to the states to take up this policy and extend health care coverage to more immigrant women and children under this law. Reproductive justice activists must take this opportunity to mobilize to hold their state governments accountable for doing so.

 

–Liza Fuentes, Senior Research Associate

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A recent study in the Annals of Family Medicine explored factors that influence what Latinas tell and don’t tell their doctors. It was reported that  a warm and compassionate patient-doctor relationship will help create trust is key to fostering good communication between Latinas and their doctors.

 

While this study didn’t interview white women or women from other ethnic groups, the authors mention another study that found that “found that almost double the number of patients (including Latinos) reported satisfaction with care when they were treated with dignity.” Makes sense, but the question is, what are the barriers for Latinas in trusting their doctors with important personal health information?

 

As a qualitative, exploratory study, this may not be able to point to concrete policy approaches to improving the doctor patient encounter, but it does support a diverse and growing body of literature that supports the need to address several important aspects of healthcare for Latinas.

 

1) The need for quality, professional interpreters. It is not only that family members or friends should not have to interpret, but also that interpreters need to make clear their commitment to professional, confidential, non-judgmental and compassionate services. This is especially important for patients seeking sexual and reproductive health care, which can be a sensitive and private topic. Unfortunately, few healthcare facilities made full-time professional interpreters services a funding priority.

 

2) Patients felt that their doctors were not always interested in hearing about their concerns. Appointments are short and often rushed, making women feel dismissed and not giving them a chance to feel comfortable enough to talk about health concerns. The dominant health insurance system in the United States does not reimburse physicians to have discussions with women- just to diagnose disease and perform procedures- so information and advice that helps women address their health concerns might take a back seat. 

 

3) Latinas in the study considered sexual and reproductive health topics sensitive and very personal. Therefore, trust and respect are essential in order for Latinas to feel they can discuss and address issues of sexuality, sexual health, and family planning. The authors noted that a lack of continuity of care could be a barrier to building this trust, and it true. Women of color and low-income women are more likely to get their sexual and reproductive health care needs covered by different funding streams and programs and services, making it difficult to get to know a provider. What if women could get family planning, abortion care, prenatal care, and well-child check-ups, as well as their other primary care needs under the same plan and in the same place? Currently, the superficial separation of sexual and reproductive health care from other services places an undue burden on women, especially Latinas.

 

4) One reason that Latina’s don’t disclose certain health information to their doctors is because the doctors don’t ask! Physicians and other providers need better training in proactively addressing women’s health needs by recognizing how our jobs, families, and other social contexts contribute to our sexual and reproductive health.

 

Contributed by Liza Fuentes, Senior Research Associate

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The National Center of Health Statistics found that the U.S. infant mortality rate declined 2% in 2006, after 5 years of remaining unchanged. This is great new for women and their families. The infant mortality rate is one the key indicators of the overall health of a country and lowering it is one the of Healthy People 2010 goals. But we still have a long way to go to reach that goal: At 6.71 death per 1,000 births, the rate would have to fall 50% to reach the 2010 goal of 4.5.

 

Underlying this good news is the stark reality that major reproductive health inequities still exist between white women and women of color. In 2005, Puerto Rican women had an infant mortality rate almost 1.5 times higher than white women. For black women the rate was 2.4 times higher than white women and for Native American and Alaskan Native women, it was 1.4 times higher.

 

The NCHS doesn’t report infant mortality differences by income or neighborhood, but other data indicate that the poorest neighborhoods, where Latinas are more likely to live, also have higher rates. In 2005 my south Bronx neighborhood, which is 73% Latino, had an infant mortality rate more than 3 times that of the Upper East Side of Manhattan, which is only 6% Latino and 83% white.

 

These data show that there is much work to do to eliminate the reproductive health inequities that Latinas and their families face. We can start by ensuring that all Latinas are able to get early and high quality prenatal and post natal care. This will require a better integration of all reproductive health services into regular primary care, a national health care plans that covers the entire range of reproductive health care services, and Latinas’ equitable access to the services, resources, and facilities that promote the healthiest pregnancies.

Contributed by Liza Fuentes, Senior Research Associate

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