Today I was able to attend a meeting of the secretary of Health and Human Services, Kathleen Sebelius, with City University of New York faculty and staff at Hunter College. At first I was disappointed that we were only going to discuss the HHS efforts to provide the H1N1 vaccine to all Americans, but as I learned more I understood that the nation’s response to pandemics like H1N1 is important for Latina reproductive health and wellbeing.
In fact, the H1N1 vaccine is a reproductive justice issue for several reasons. First, pregnant women and possibly women who have recently given birth are at increased risk for severe complications from the H1N1 flu. Latinas are less likely to have health insurance care and are more likely to start prenatal care later in pregnancy, potentially making it more difficult to prevent H1N1 in this important group.
Secondly, immigrant women, especially those in mixed-status household, are less likely to have health insurance and more likely to be low-income , posing serious barriers to getting the vaccine. Third, many Latinas and their family members are migrant and seasonal farmer workers who live in rural communities with little or no public transportation and local health services, which poses barriers to receiving timely care, like the vaccine (and other care like emergency contraception for example).
As one professor noted in the meeting, new health technologies and interventions like the H1N1 vaccine are often accessible to the most advantaged people first, many times exacerbating health disparities – because while one advantaged group experiences improved health from the intervention, lower-resourced groups’ health does not improve. Therefore, just making enough doses of H1N1 vaccine is not enough to ensure that all groups, including Latinas and immigrant women, are able to get this essential preventive care. But effective education, outreach, and affordability are key to eliminating health disparities associated with new interventions.
I was able to ask Secretary Sebelius one question. “Madam Secretary, as you know immigrant workers and their families, especially those who are out of status, are less likely to have health insurance and more likely to be low-income, creating barriers to health care services. What are HHS’s strategies for and challenges in ensuring that immigrants of all statuses have access to the H1N1 vaccine?” I was glad that in her response, Secretary Sebelius clearly noted that in addition to the barriers I mentioned, many immigrants may also fear seeking health care services if they or a family member lack documents, and that HHS had this in mind when they implemented several strategies to ensure that all U.S. residents could get the H1N1 vaccine:
- The vaccine was distributed and made available for free to providers (clinics and community non-profits) by the United States government. Sebelius mentioned that some providers may be charging a $15 fee to cover administrative costs for providing the vaccine, but that many other providers are offering it for free.
- School-based immunization clinics, which had not been used for several decades, were created to distribute the vaccine to children and their parents for free. Sebelius said that at these school clinics and other distribution sites no documentation is asked for or required in order to get the vaccine.
- DHHS’s website and education materials about flu season is also available in Spanish and other languages.
Secretary Sebelius and HHS have appeared to approach the prevention of H1N1 flu infection seriously and thoughtfully, and with all families in mind. I couldn’t help but think, what if our health care system ensured that all reproductive health and family care was delivered in this way: family oriented, where children and their parents may access services, including those of all immigration statuses, affordably, where the cost of care or health coverage was in reach, and in the language that you are most comfortable with? If the U.S. had a public health and health services system that served Latinas and all communities in the way we are providing the H1N1 vaccine, it would greatly improve Latina reproductive health and reduce health disparities.
By Liza Fuentes, MPH
Senior Research Associate, National Latina Institute for Reproductive Health