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DiMeo A, Logendran R, Sommers BD, Beecroft A, Herencia YP, Bazan M, Wade C, Sprankle J, Sullivan MM, Molina RL. Navigating the Labyrinth of Pregnancy-Related Coverage for Undocumented Immigrants: An Assessment of Current State and Federal Policies. Am J Public Health 2024; 114:1051-1060. [PMID: 39146520 PMCID: PMC11375342 DOI: 10.2105/ajph.2024.307750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
Insurance coverage for prenatal care, labor and delivery care, and postpartum care for undocumented immigrants consists of a patchwork of state and federal policies, which varies widely by state. According to federal law, states must provide coverage for labor and delivery through Emergency Medicaid. Various states have additional prenatal and postpartum coverage for undocumented immigrants through policy mechanisms such as the Children's Health Insurance Program's "unborn child" option, expansion of Medicaid, and independent state-level mechanisms. Using a search of state Medicaid and federal government websites, we found that 27 states and the District of Columbia provide additional coverage for prenatal care, postpartum care, or both, while 23 states do not. Twelve states include any postpartum coverage; 7 provide coverage for 12 months postpartum. Although information regarding coverage is available publicly online, there exist many barriers to access, such as lack of transparency, lack of availability of information in multiple languages, and incorrect information. More inclusive and easily accessible policies are needed as the first step toward improving maternal health among undocumented immigrants, a population trapped in a complicated web of immigration policy and a maternal health crisis. (Am J Public Health. 2024;114(10):1051-1060. https://doi.org/10.2105/AJPH.2024.307750).
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Affiliation(s)
- Amanda DiMeo
- Amanda DiMeo is with Ariadne Labs at Brigham and Women's Hospital and Harvard T. H. Chan School of Public Health, Boston, MA. Rasheca Logendran is with Harvard Medical School, Boston. Benjamin D. Sommers is with Harvard Medical School and Harvard T. H. Chan School of Public Health. Alexandra Beecroft and Yessamin Pazos Herencia are with Brigham Young University, Provo, UT. Maria Bazan, Jeffrey Sprankle, and Rose L. Molina are with the Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston. Carrie Wade is with Countway Library, Harvard Medical School. Margaret M. Sullivan is with François-Xavier Bagnoud Center for Health and Human Rights, Harvard University, Boston
| | - Rasheca Logendran
- Amanda DiMeo is with Ariadne Labs at Brigham and Women's Hospital and Harvard T. H. Chan School of Public Health, Boston, MA. Rasheca Logendran is with Harvard Medical School, Boston. Benjamin D. Sommers is with Harvard Medical School and Harvard T. H. Chan School of Public Health. Alexandra Beecroft and Yessamin Pazos Herencia are with Brigham Young University, Provo, UT. Maria Bazan, Jeffrey Sprankle, and Rose L. Molina are with the Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston. Carrie Wade is with Countway Library, Harvard Medical School. Margaret M. Sullivan is with François-Xavier Bagnoud Center for Health and Human Rights, Harvard University, Boston
| | - Benjamin D Sommers
- Amanda DiMeo is with Ariadne Labs at Brigham and Women's Hospital and Harvard T. H. Chan School of Public Health, Boston, MA. Rasheca Logendran is with Harvard Medical School, Boston. Benjamin D. Sommers is with Harvard Medical School and Harvard T. H. Chan School of Public Health. Alexandra Beecroft and Yessamin Pazos Herencia are with Brigham Young University, Provo, UT. Maria Bazan, Jeffrey Sprankle, and Rose L. Molina are with the Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston. Carrie Wade is with Countway Library, Harvard Medical School. Margaret M. Sullivan is with François-Xavier Bagnoud Center for Health and Human Rights, Harvard University, Boston
| | - Alexandra Beecroft
- Amanda DiMeo is with Ariadne Labs at Brigham and Women's Hospital and Harvard T. H. Chan School of Public Health, Boston, MA. Rasheca Logendran is with Harvard Medical School, Boston. Benjamin D. Sommers is with Harvard Medical School and Harvard T. H. Chan School of Public Health. Alexandra Beecroft and Yessamin Pazos Herencia are with Brigham Young University, Provo, UT. Maria Bazan, Jeffrey Sprankle, and Rose L. Molina are with the Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston. Carrie Wade is with Countway Library, Harvard Medical School. Margaret M. Sullivan is with François-Xavier Bagnoud Center for Health and Human Rights, Harvard University, Boston
| | - Yessamin Pazos Herencia
- Amanda DiMeo is with Ariadne Labs at Brigham and Women's Hospital and Harvard T. H. Chan School of Public Health, Boston, MA. Rasheca Logendran is with Harvard Medical School, Boston. Benjamin D. Sommers is with Harvard Medical School and Harvard T. H. Chan School of Public Health. Alexandra Beecroft and Yessamin Pazos Herencia are with Brigham Young University, Provo, UT. Maria Bazan, Jeffrey Sprankle, and Rose L. Molina are with the Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston. Carrie Wade is with Countway Library, Harvard Medical School. Margaret M. Sullivan is with François-Xavier Bagnoud Center for Health and Human Rights, Harvard University, Boston
| | - Maria Bazan
- Amanda DiMeo is with Ariadne Labs at Brigham and Women's Hospital and Harvard T. H. Chan School of Public Health, Boston, MA. Rasheca Logendran is with Harvard Medical School, Boston. Benjamin D. Sommers is with Harvard Medical School and Harvard T. H. Chan School of Public Health. Alexandra Beecroft and Yessamin Pazos Herencia are with Brigham Young University, Provo, UT. Maria Bazan, Jeffrey Sprankle, and Rose L. Molina are with the Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston. Carrie Wade is with Countway Library, Harvard Medical School. Margaret M. Sullivan is with François-Xavier Bagnoud Center for Health and Human Rights, Harvard University, Boston
| | - Carrie Wade
- Amanda DiMeo is with Ariadne Labs at Brigham and Women's Hospital and Harvard T. H. Chan School of Public Health, Boston, MA. Rasheca Logendran is with Harvard Medical School, Boston. Benjamin D. Sommers is with Harvard Medical School and Harvard T. H. Chan School of Public Health. Alexandra Beecroft and Yessamin Pazos Herencia are with Brigham Young University, Provo, UT. Maria Bazan, Jeffrey Sprankle, and Rose L. Molina are with the Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston. Carrie Wade is with Countway Library, Harvard Medical School. Margaret M. Sullivan is with François-Xavier Bagnoud Center for Health and Human Rights, Harvard University, Boston
| | - Jeffrey Sprankle
- Amanda DiMeo is with Ariadne Labs at Brigham and Women's Hospital and Harvard T. H. Chan School of Public Health, Boston, MA. Rasheca Logendran is with Harvard Medical School, Boston. Benjamin D. Sommers is with Harvard Medical School and Harvard T. H. Chan School of Public Health. Alexandra Beecroft and Yessamin Pazos Herencia are with Brigham Young University, Provo, UT. Maria Bazan, Jeffrey Sprankle, and Rose L. Molina are with the Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston. Carrie Wade is with Countway Library, Harvard Medical School. Margaret M. Sullivan is with François-Xavier Bagnoud Center for Health and Human Rights, Harvard University, Boston
| | - Margaret M Sullivan
- Amanda DiMeo is with Ariadne Labs at Brigham and Women's Hospital and Harvard T. H. Chan School of Public Health, Boston, MA. Rasheca Logendran is with Harvard Medical School, Boston. Benjamin D. Sommers is with Harvard Medical School and Harvard T. H. Chan School of Public Health. Alexandra Beecroft and Yessamin Pazos Herencia are with Brigham Young University, Provo, UT. Maria Bazan, Jeffrey Sprankle, and Rose L. Molina are with the Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston. Carrie Wade is with Countway Library, Harvard Medical School. Margaret M. Sullivan is with François-Xavier Bagnoud Center for Health and Human Rights, Harvard University, Boston
| | - Rose L Molina
- Amanda DiMeo is with Ariadne Labs at Brigham and Women's Hospital and Harvard T. H. Chan School of Public Health, Boston, MA. Rasheca Logendran is with Harvard Medical School, Boston. Benjamin D. Sommers is with Harvard Medical School and Harvard T. H. Chan School of Public Health. Alexandra Beecroft and Yessamin Pazos Herencia are with Brigham Young University, Provo, UT. Maria Bazan, Jeffrey Sprankle, and Rose L. Molina are with the Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston. Carrie Wade is with Countway Library, Harvard Medical School. Margaret M. Sullivan is with François-Xavier Bagnoud Center for Health and Human Rights, Harvard University, Boston
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Azugbene EA, Cornelius LJ, Johnson-Agbakwu CE. African Immigrant Women's Maternal Health Experiences in Clarkston, Georgia: A Qualitative Study. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2023; 4:603-616. [PMID: 38155870 PMCID: PMC10754423 DOI: 10.1089/whr.2023.0062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/10/2023] [Indexed: 12/30/2023]
Abstract
Introduction The maternal health experiences of African immigrant women, their utilization of health care services, and the effects on maternal health have received limited attention in research. This research explored the maternal health experiences of African immigrant women residing in Clarkston, Georgia, and their use of health services. Methods Fourteen African immigrant women responded to semistructured interviews. An adapted version of the Andersen health care utilization model explained the predisposing factors, enabling factors, and need factors, which influence the use of maternal health care for African immigrant women. Results Findings were presented according to the Andersen health care utilization model. Analysis of the interviews resulted in 11 themes. The themes were as follows: (1) Community social structure, (2) community health beliefs, (3) health organization concerning the use of women, infants, and children, (4) social support at the individual level, (5) limited English proficiency, (6) need for better health education, (7) perception of care, (8) health financing, (9) long wait times and lack of transportation, (10) fear of medication and obstetrical interventions, and (11) impact of Female Genital Mutilation/Cutting. Discussion Maternal health practices of African immigrant women are impacted by environmental and cultural factors. Public health interventions should be implemented to advance African immigrant women's health care utilization practices through required health education and tailored care, which will translate to positive maternal health experiences.
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Affiliation(s)
- Ehiremen Adesua Azugbene
- Maternal and Child Health Translational Research Team (MCHTRT), College of Public Health Solutions, Arizona State University, Phoenix, Arizona, USA
| | | | - Crista E. Johnson-Agbakwu
- Division of Preventive and Behavioral Medicine, UMass Chan Medical School, UMass Memorial Health, Worcester, Massachusetts, USA
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Truong S, Foley OW, Fallah P, Lalla AT, Osterbur Badhey M, Boatin AA, Mitchell CM, Bryant AS, Molina RL. Transcending Language Barriers in Obstetrics and Gynecology: A Critical Dimension for Health Equity. Obstet Gynecol 2023; 142:809-817. [PMID: 37678884 PMCID: PMC10510840 DOI: 10.1097/aog.0000000000005334] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/26/2023] [Accepted: 05/04/2023] [Indexed: 09/09/2023]
Abstract
There is growing evidence that language discordance between patients and their health care teams negatively affects quality of care, experience of care, and health outcomes, yet there is limited guidance on best practices for advancing equitable care for patients who have language barriers within obstetrics and gynecology. In this commentary, we present two cases of language-discordant care and a framework for addressing language as a critical lens for health inequities in obstetrics and gynecology, which includes a variety of clinical settings such as labor and delivery, perioperative care, outpatient clinics, and inpatient services, as well as sensitivity around reproductive health topics. The proposed framework explores drivers of language-related inequities at the clinician, health system, and societal level. We end with actionable recommendations for enhancing equitable care for patients experiencing language barriers. Because language and communication barriers undergird other structural drivers of inequities in reproductive health outcomes, we urge obstetrician-gynecologists to prioritize improving care for patients experiencing language barriers.
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Affiliation(s)
- Samantha Truong
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, the Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, and the Division of Global and Community Health, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; and the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Northwestern Memorial Hospital, Chicago, Illinois
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Khan R, Rayburn W. Health Advocacy for Undocumented Immigrant Pregnant Patients. Obstet Gynecol Clin North Am 2023; 50:639-652. [PMID: 37500222 DOI: 10.1016/j.ogc.2023.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
The challenges of providing prenatal care for undocumented immigrants require patience. Pregnant undocumented immigrant women should receive routine prenatal care tailored to their specific needs, with an emphasis on basic needs (eg, housing, safety, food, transportation to appointment). Financial, cultural, and language barriers can impede undocumented immigrants from receiving adequate or optimal prenatal care. Adverse maternal and fetal outcomes may be more common but have not been well-quantified and cannot be compared with outcomes if care had been provided in their country of origin. An example of a community-funded clinic is described in minimizing cost and optimizing outcomes.
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Affiliation(s)
- Reshma Khan
- Shifa Free Clinic, 668 Marina Drive, Unit 4A, Charleston, SC 29492, USA.
| | - William Rayburn
- Department of Obstetrics and Gynecology, Medical University of South Carolina, 1721 Atlantic Avenue, Sullivan's Island, SC 294482, USA
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