PM3044: Mitigating the Chilling Effect of Immigration Concerns on Prenatal Care: Insights from Immigrant Latine Birthing People

Background: Punitive immigration policies in the US have been associated with decreased use of prenatal care and increased risk of adverse birth outcomes among pregnant immigrants. The phenomenon that describes immigrants’ avoidance of health and social benefits for themselves or family members, despite eligibility, based on policies or other immigration-related concerns, is known as the “chilling effect.” We interviewed Latine birthing people in Philadelphia who were actively or recently pregnant (i.e. in the last two years) about their most recent pregnancy experiences. We asked participants to discuss ways in which healthcare providers or the healthcare system might mitigate fear or confusion related to immigration status or policies during prenatal care.

Methods: Given the sensitive nature of conversations regarding immigration status and pregnancy, we designed a community-informed study with a multidisciplinary team of obstetricians, pediatricians, and community-based organizations (CBO) that regularly interact with Latine pregnant clients. In order to capture birthing people who may or may not have received prenatal care, we recruited from an obstetric clinic serving primarily Latine patients, two pediatric clinics situated in neighborhoods with a high density of Latine people, and the client pool of the CBO team members we hired. The interview guide was collaboratively developed to ensure the use of trauma-informed language and was professionally translated. All semi-structured telephone interviews and demographic surveys were conducted in Spanish by bilingual team members. Interviews were translated and transcribed verbatim, and analysis was facilitated by NVivo 12 software.

Results: We interviewed 21 Latine birthing people about their experiences and their suggestions related to prenatal care. The median age was 31 years and the majority were postpartum (Table 1). Participants described four main themes related to their prenatal care experiences: (1) experiences of racism from the medical community, which lead to distrust, fear of mistreatment and avoiding necessary prenatal care; (2) avoiding care due to cost and lack of understanding about payment and insurance options as an undocumented person; (3) feeling less stress or anxiety about being an immigrant when Spanish was spoken at appointments; and (4) a desire for providers to educate immigrant patients about their rights and inform them that seeking medical care will not affect their immigration status. Sample quotes for each theme are provided in Table 2.

Conclusion: This study provides an in-depth examination of the experiences of immigrant Latine birth parents during a time period in which a chilling effect on healthcare utilization has been documented among immigrant adults across the country. The recommendations that emerged from the interviews could be implemented to improve health equity for immigrant Latine communities in Philadelphia. These findings should also be explored in other contexts, given potential widespread applicability despite national variability in immigrant makeup and policymaking culture.