What’s stopping some immigrants from accessing prenatal care — and what Philly’s health system can do about it

Years later, the Trump administration’s anti-immigrant policies have continued to sow fear and confusion among immigrants in need of health care.

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A doctor uses a hand-held Doppler probe on a pregnant woman

FILE - A doctor uses a hand-held Doppler probe on a pregnant woman to measure the heartbeat of the fetus, Dec. 17, 2021, in Jackson, Miss. (AP Photo/Rogelio V. Solis, File)

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Fears of discrimination, the high cost of health care and possible deportation are causing some Latino immigrants in Philadelphia to delay or forego prenatal care, according to a new study by researchers at the Children’s Hospital of Philadelphia (CHOP) and the University of Pennsylvania.

Lead author Diana Montoya-Williams, an attending neonatologist at CHOP, says the seeds of the study date back to around 2016, when the Trump administration began enacting anti-immigrant policies that researchers later found were having a “chilling effect” on immigrants’ use of health care.

“And so, as a neonatologist who takes care of children, who takes care of families in the perinatal period,” Montoya-Williams said, “I was really worried that we were starting to see some things happen at a federal level that were going to play out on a big population level [leading to] more families needing services like mine and the NICU because of this chilling effect.”

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Studies have shown that a lack of prenatal care makes babies three times more likely to have a low birth weight and five times more likely to die in infancy, and can also contribute to longer-term complications. Mothers who don’t receive prenatal care are also three-to-four times more likely to die from pregnancy-related complications.

Montoya-Williams said concerns over this chilling effect prompted her to design a study that would not only provide insight into the specific reasons why immigrants might be less likely to access prenatal care, but what the medical system could do about it.

“How are we going to be proactive about what many of us were concerned were going to be long-lasting repercussions that were not going to just vanish with the turn of an election,” she said. She was interested in finding community-oriented ways to mitigate fears and serve immigrant communities.

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.”

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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.”

Other measures would require structural change — like finding funds to hire Spanish-speaking guides to help patients navigate the health care system.

“You know, we called our study the ‘Promoting Resilience in Immigrant Mothers’ study or PRIMAS, and prima translates to cousin in Spanish,” Montoya-Williams said. “If someone had a prima, if someone had someone like a cousin who could help them navigate, the experience was completely different — they were in prenatal care earlier, they were recording more comfort, they were reporting less discrimination, they were reporting more language-concordant care.”

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