Inadequate Prenatal Care for an Undocumented Immigrant
Desired Outcome and Evidence-Based Solution
PRENATAL CARE FOR UNDOCUMENTED IMMIGRANT
Inadequate Prenatal Care for an Undocumented Immigrant
Adequate access to prenatal care remains a major problem amongst undocumented immigrant women in the U.S. This difficulty arises from factors such as lack of health insurance, inability to meet costs relating to prenatal care, inaccessibility to sources of prenatal care, linguistic barriers, distrust in the healthcare system, and unusually rigid work schedules (Fabi, 2014; Lee, 2015). Other challenges include misinformation about the consequences of immigration as well as perceived and actual fear of encountering law enforcement or immigration authorities while seeking health care (Fabi, 2014). Inadequate access to prenatal care often increases the likelihood of poor reproductive, maternal, and neonatal health outcomes amongst undocumented immigrant women and their babies. With reference to an identified undocumented immigrant woman, this paper describes the problem of accessing prenatal care amongst illegal immigrants in the U.S. Relevant literature is particularly quoted to provide evidence of the problem among the population as well as its solution. The paper also critically explores the applicability of Lorraine M. Wright’s and Maureen Leahey’s Calgary Family Assessment Model (CFAM) to the problem.
Problem
Li Ying (not her real name) is a 29-year-old immigrant woman of Chinese origin living in the U.S. with her husband, who is also of Chinese origin. During her first pregnancy, Ying was not able to access prenatal care, due to lack of medical cover. In addition, Ying and her partner have not yet secured stable, well-paying jobs to allow them to subscribe to private or employer-sponsored medical insurance. In the seventh month of the pregnancy, Ying was admitted to emergency care at a local hospital after suffering from hypertension. She was immediately diagnosed with eclampsia, a serious medical condition that often develops in the course of pregnancy. The condition can cause complications such as preterm delivery, seizures, bleeding, and in some instances, death.
Eclampsia is usually detected during the early days of pregnancy, and can often be managed via basic antenatal care. Regrettably, Ying was not in a position to afford prenatal care, primarily due to her immigrant status. Due to the severity of the condition at the time it was diagnosed and the danger it posed to both her and the infant, a premature delivery became necessary. The infant was placed in a nursery for two months while the mother underwent three separate procedures to drain her brain of excess blood. The entire cost of taking care of Ying and her newborn child on the hospital exceeded $200,000. In the end, Ying suffered partial paralysis as a result of the condition, making it quite hard for her to mother the much-in-need infant, her new-born baby.
Literature
The primary aim of prenatal care is to prevent or minimize the likelihood of health complications during pregnancy as well as to promote a healthy lifestyle to the benefit of both the mother and the infant (Lee, 2015). Through frequent checkups in the course of gestation, women are equipped with critical information about maternal physiological changes, nutrition, reproductive health, infant health, and other aspects relating to the health of the mother and the baby (Wolff et al., 2008). This reduces the possibility of miscarriage, birth defects, maternal death, low birth weight, neonatal diseases, infant mortality, and other avoidable health complications (Lee, 2015).
Owing to challenges such as financial constraints, undocumented immigrant women who comprise approximately 47% of the total unauthorized population in the U.S., are often not in a position to access prenatal care, which consequently predisposes them and their babies to potentially serious health complications (American College of Obstetricians and Gynecologists [ACOG], 2015). According to Fabi (2014), undocumented pregnant women are more likely to experience birth complications such as excessive bleeding, precipitous labor, cord prolapsed, and fetal distress compared to the rest of the pregnant women population. Furthermore, childbirth-related hospital admission as well as neonatal morbidities such as respiratory complications and seizures tend to be more widespread amongst unauthorized compared the general population (Reed et al., 2005; ACOG, 2015).
These complications may increase the risk of neonatal and maternal death. In fact, lack of access to prenatal care increases the risk of neonatal death by 40%, particularly for women who deliver at or after the 36th week of gestation (Rosenberg, 2002). Lack of access to prenatal care also increases the risk of maternal mortality, with undocumented immigrant women being the most affected (Molina, 2015). This challenge is further compounded by greater vulnerability to sexual assault and sexually transmitted diseases as well as language barriers, lack of social support, poverty, and occupational health hazards (Molina, 2015).
Essentially, the risks and outcomes associated with insufficient prenatal care can affect not only the health and life of mothers, but also their newborns; ultimately imposing a significant economic burden on individuals and families due to the costs involved in treating conditions that could have been avoided or managed prior to birth.
Desired Outcome and Evidence-Based Solution
The case of Ying is not isolated — it is a representation of the difficulties experienced by undocumented immigrant women to access prenatal care. Statistics indicate that approximately 60% of illegal immigrants in the U.S. do not have medical insurance (Lee, 2015). Additionally, whereas more than 90% of unauthorized immigrant households have one or more individuals working, they often have low-paying jobs with no medical benefits (Lee, 2015). This challenge is further compounded by their immigrant status, which excludes them from state and federally funded health insurance programs such as Medicaid and Children’s Health Insurance Program (CHIP) (Fabi, 2014). There is, therefore, need to improve access to prenatal care in undocumented immigrant women given their increasingly crucial contribution to the economy of the country.
There is considerable consensus amongst scholars and commentators that access to prenatal care on the part of undocumented immigrant women like Ying can effectively be mitigated through compassionate legislation (Wallace et al., 2012; Fabi, 2014; Lee, 2015; ACOG, 2015; Belasco, 2016)). Though the extent to which unauthorized immigrants access health insurance varies from state to state, most states in the U.S. generally exclude this population from health insurance programs (Fabi, 2014). As such, it is pertinent to initiate policy reforms to enable undocumented immigrants accrue benefits of Medicaid and CHIP programs. As of 2014, 16 states across the country had made amendments to CHIP with the aim of extending coverage to unborn children of immigrant women (Fabi, 2014). Other states have also revised Medicaid to enable expectant women obtain short-term Medicaid coverage (Fabi, 2014). It is advisable for other states to follow suit to solve the problem of difficulty in accessing prenatal care in the target population.
However, though policy reforms may expand access to prenatal care by undocumented immigrant women, it is imperative to note that it may take a while before the reforms take concrete shape and become effective, due to the politics usually involved in public policy making. In this regard, public health hospitals and clinics should play a lead role in providing free or significantly subsidized prenatal care to undocumented immigrants voluntarily (Fabi, 2014). Molina (2015) adds that it is important for health care providers to deliver care that considers the social needs of undocumented immigrants. This particularly entails reducing wait times during prenatal appointments, offering culture-sensitive care, being sensitive to their linguistic needs, and guaranteeing them protection from immigration authorities (Belasco, 2016)
With increased access to prenatal care, it is envisaged that the health status of unauthorized pregnant women and their babies will improve significantly (Wallace et al., 2012). There will be lesser cases of maternal and neonatal morbidity and mortality amongst this vulnerable population. For Ying, her first pregnancy was problematic largely due to lack of prenatal care. However, with the inclusion of women like her in public health insurance programs, it is hoped that she will not have to undergo a similar experience in her subsequent pregnancies, if any.
Application of Family Theory
Amongst the many family practice theories, the Calgary Family Assessment Model (CFAM) seems to be the best to apply to the presented case. The model specifically argues for the consideration of family characteristics when designing and delivering health interventions to family members (Boyd, 2005). These characteristics include the structure of the family (in terms of gender, sexual orientation and gender), emotional relationships, as well as the underlying racial background, ethnicity, social class, spirituality, and religious inclination (Oliveira et al., 2015). Other characteristics include developmental history and family functioning (Boyd, 2005). As per the model, considering these aspects enables more effective implementation of health interventions given that individuals tend to rely on social and emotional relationships and other characteristics within their family during times of need and happiness (Oliveira et al., 2015).
In the case of Ying, her entire nuclear and extended family lives in China. The only relative she has in the U.S. is her partner, who is depressed by the experiences of his wife and the newborn baby. The depression Ying’s partner has been experiencing is not unusual — family members are often not ready to deal with the pain and suffering of one of its members owing to the fear of treatment-related side effects, material impact, and even death (Oliveira et al., 2015). All the same, the family unit plays an instrumental role in helping one of its members face a life threatening condition (Boyd, 2005). In this case, for instance, Ying’s partner would be valuable in providing emotional support to Ying, who has been more depressed by her condition and that of their child. Considering this aspect during care provision would be important for Ying’s recovery.
Limitations
Whereas the CFAM framework may be useful in certain percepts, a number of limitations become apparent. For instance, the model appears to place emphasis on the strengths of the family unit as opposed to its dysfunctions. As an explanation, the model seems to assume that all families have in-built characteristics that may be useful in the healing process of one of its members. Such presumption may not always true, as healthy social relations and emotional connections, for instance, may sometimes lack in a family unit. In addition, the model appears to advocate or demand for a change in the way a family functions. This somehow results in deviation from the primary role of healthcare professionals, which is to offer medical interventions as opposed to dictating how families should function. As such, engendering such changes is usually beyond the capacity of healthcare professionals.
References
American College of Obstetricians and Gynecologists (ACOG) (2015). Health care for unauthorized immigrants. Retrieved from: http://www.acog.org/Resources-And- Publications/Committee-Opinions/Committee-on-Health-Care-for-Underserved- Women/Health-Care-for-Unauthorized-Immigrants
Boyd, M. (2005). Psychiatric nursing: contemporary practice. 3rd ed. Philadelphia: Lippincott Williams & Wilkins.
Belasco, J. (2016). Behind from the start: why women aren’t receiving early prenatal care
part 2. Retrieved 2 October 2016 from:
http://www.centerforhealthjournalism.org/fellowships/projects/behind-start-why
some-women-arent-receiving-early-prenatal-care
Fabi, R. (2014). Undocumented immigrants in the United States: access to prenatal care. Retrieved from: http://www.undocumentedpatients.org/issuebrief/undocumented- immigrants-in-the-united-states-access-to-prenatal-care/
Lee, C. (2015). Unjust barriers: prenatal care and undocumented immigrants. Journal of Contemporary Health Law & Policy, 31(1), 96-119.
Molina, R. (2015). Inequities in maternal mortality: a focus on undocumented immigrants.
Retrieved 2 October 2016 from: https://www.mhtf.org/2015/11/04/inequities-in
maternal-mortality-a-focus-on-undocumented-immigrants/
Oliveira, P., Maia, L., Rosende, M., Macedo, R., Rodrigues, A., & Aguiar, M. (2015). Use of the Calgary Family Assessment Model in structural, developmental and functional assessment of the family of mastectomized women with breast cancer. Cogitare Enferm., 20(4), 661-6669.
Reed, M., Westfall, J., Bublitz, C., Battaglia, C., & Fickenscher, A. (2005). Birth outcomes in Colorado’s undocumented immigrant population. BMC Public Health, 5, 100.
Rosenberg, J. (2002). Neonatal death risk: effect of prenatal care is most evident after term
birth. Perspectives on Sexual and Reproductive Health, 34(5). Retrieved 2 October
2016 from: https://www.guttmacher.org/about/journals/psrh/2002/09/neonatal-death
risk-effect-prenatal-care-most-evident-after-term-birth
Wallace, S., Torres, J., Sadegh-Nobari, T., Pourat, N., & Brown, E. (2012). Undocumented immigrants and health care reform. Retrieved from: http://healthpolicy.ucla.edu/publications/Documents/PDF/undocumentedreport- aug2013.pdf
Wolff, H., Epiney, M., Lourenco, A. et al. (2008). Undocumented immigrants lack access to pregnancy care and prevention. BMC Public Health, 8, 93.
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