Thursday, December 18, 2014

A program that allowed states and localities to enforce federal immigration laws adversely impacted the use of pregnancy and childcare-related health services by Hispanics, according to a new study published on December 18, 2014 in the American Journal of Public Health.

The study, conducted in North Carolina, examined vital records data to understand the use of prenatal care by Hispanic/Latina women shortly before and after implementation of Section 287(g) of the Immigration and Nationality Act in seven counties that signed on to participate in the program and seven counties that did not.

Section 287(g) authorizes the US Immigration and Custom Enforcement to enter into agreements with state and local law enforcement agencies to enforce federal immigration law during their regular, daily law-enforcement activities. The federal government has started phasing out the program, but it does still exist in five North Carolina counties (Cabarrus, Gaston, Henderson, Mecklenburg and Wake), all of which were examined by this study.

“Our findings suggest that local enforcement of immigration policies affected the health of Hispanics/Latina women, particularly expectant mothers and their children, because the laws created barriers to care and distrust of services,” said Scott D. Rhodes, PhD, MPH, professor of public health sciences at Wake Forest Baptist and lead author of the study.

The vital records data did not identify immigration status, but the researchers found that Hispanic/Latina mothers were more likely to have late and inadequate prenatal care both before and after 287(g) was implemented when compared to non-Hispanic/Latina mothers. Further, the difference between Hispanic/Latina mothers and non-Hispanic/Latina mothers who received late prenatal care was significantly greater following the implementation of 287(g).

To better understand the extent local immigration enforcement policies were related to access to and the use of public health services among Hispanic/Latinas, the research team also conducted focus groups and individual interviews with 83 Hispanic/Latino residents of three counties that had and three counties that had not implemented the 287(g) program. None were asked to reveal their immigration status, but on average, the participants had lived in North Carolina for more than a decade.

“Overall, participants reported fearing immigration enforcement policies and avoiding or delaying utilization of health services, thus endangering their own health and that of their families,” Rhodes said.

The participants were unclear about their rights and the details of immigration enforcement under 287(g) in North Carolina, and they reported during the interview and focus group sessions that they perceived the policies as condoning racism and hostility toward immigrants.

They also reported that they did not trust staff at agencies providing health services, and that they feared presenting identification or being discovered as undocumented even when seeking services for sick children or filling prescriptions for medications at pharmacies. The law does not empower clinics or health care providers to enforce immigration laws.

Beyond those concerns, ineligibility for state-issued driver’s licenses and the threat of police enforcement while driving were also identified as two key issues that created barriers to care and services. Participants indicated that some Hispanics/Latinos in North Carolina avoided driving even during medical emergencies.

Many reported that they and others they knew often did not seek care when needed, delaying important preventative services, remaining sicker for longer periods of time, or relying on recycled medications and other non-standard or unsafe sources of care.

The Affordable Care Act bars undocumented or recent legal immigrants from receiving financial assistance for health insurance, so many will continue to remain uninsured and dependent on public health services and free clinics for a significant portion of their care, the authors explain. Because these services are associated with government authority, there is the potential that increasing immigration enforcement policies will deter non-citizens from seeking needed care, not only to their detriment but also to the detriment of public health.

The researchers suggest education programs that de-mystify the process for accessing health services, and provide guidance to immigrants about their rights, what they are obligated to say when approached by law enforcement officials, and the types of documentation they need to access health services. Efforts to address transportation barriers would also help to increase use of health care service.

The researchers note that original intent of Section 287(g) was to target and remove undocumented immigrants convicted of violent crimes, human smuggling, gang/organized crime activity, sexual-related offenses, narcotics smuggling and money laundering.

The study was funded by a grant from the Public Health Law Research program. It was conducted by Lilli Mann, MPH, Eunyoung Song, PhD, Mary Claire O’Brien, MD, Beth A. Reboussin, PhD, Jorge Alonzo, JD, Christina J. Sun, PhD, and Mario Downs at Wake Forest Baptist; Mark A. Hall, JD, at Wake Forest University School of Law; Omar Martinez, JD, MPH, at Columbia University; Florence M. Simán, MPH, El Pueblo Inc.; and Emma Lawlor, BA, at the University of Arizona.         

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