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Published by the Public Affairs Office at San Francisco State University, Lakeview Center

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Contact: Ted DeAdwyler/Ligeia Polidora
phone:(415) 338-1665

New study shows low-income immigrant pregnant women still afraid to seek health care

Major findings indicate that both illegal and legal female immigrants often avoid CA's health care system due to fear of retribution in terms of immigration status and naturalization process

SAN FRANCISCO, April 18, 2001 ---A sampling of health care providers across California shows that many low-income pregnant immigrant women in the state are still reluctant to seek free medical care despite government assurances their immigration status will not be affected.

"There is almost a climate of fear and suspicion among immigrants," Grace J. Yoo, assistant professor of Asian American Studies at S.F. State. "They don't seek preventative care and pregnant women don't get prenatal care. Many times they seek medical care only when it is an emergency."

Added Yoo: "There seems to be a sense among many immigrants that the political system is decidedly anti-immigrant." Due to the complex nature of immigration laws, many immigrants have long-standing fears that they or family members will be deported if they seek subsidized health care, nutrition or housing, she said.

Yoo, along with Lisa Sun-Hee Park of the University of Colorado, Boulder began their work one year after the Clinton administration issued a clarification to the policy on "public charge," a term immigration officials use to define someone primarily dependent on the government for subsistence and could be denied permanent residency in the U.S. The Clinton administration made it clear that it was safe for immigrants to use programs that do not provide cash income maintenance such as Medicare, Medi-Cal, food stamps or other such programs without affecting immigration status.

SFSU study shows low-income pregnant women afraid to seek medical care.

"This was an important policy action for immigrant and advocacy organizations. But the question we wanted to explore is how well was this is understood by health care providers in working with the women," said Yoo, adding that state and federal initiatives to disseminate information have been minimal or non-existent.

The researchers conducted focus groups and telephone interviews between August and December 2000 with nearly 100 doctors, nurses, outreach workers and other health care providers in San Francisco, Fresno and San Diego who work with low-income pregnant immigrant women.

In their study, commissioned by the California Program on Access to Care at the University of California's California Policy Research Center, the biggest finding, according to Yoo, is that "the concept of 'public charge' and the recent Clinton administration clarification is still too confusing to be widely helpful, even to health care providers themselves. As a result, both illegal and legal immigrants often avoid using the health care system because they fear retribution in terms of their immigratio n status and naturalization process. Other findings include:

Safety-net clinics, faced with few resources and limited staff, find it difficult to adequately explain policy changes to service workers.

Access to prenatal care and other health services increased with the Clinton clarification.

The time completing the Medi-Cal application and lengthy approval process keeps some immigrants from enrolling.

Organizations serving low-income women need more resources to do better outreach.

Health care providers in the San Francisco Bay Area appear most informed about public policies affecting women's health care coverage compared to Fresno and San Diego. The researcher said greater policy awareness comes from a strong regional network of health care/legal advocates as well as the designation of central personnel to decipher and disseminate policy changes within health care facilities.

Yoo and Park heard examples of the dire health implications that arise from the fear many immigrants still feel. Some health care providers talked about patients entering the emergency room for delivery without prenatal care. A health care provider in Fresno said a number of patients who had limbs amputated due to untreated gestational diabetes had been afraid to come to the hospital.

SFSU study shows low-income pregnant women afraid to seek medical care.

"Quite a few women have had a serious illness but wouldn't do anything about it because they were afraid that they would be deported or that their family will be deported or somehow somebody in their family was going to get in trouble for this," said one San Diego clinic director.

To dispel the fears and to encourage low-income immigrant women to seek health care, Yoo and Park recommend stronger outreach efforts to disseminate information. "With Proposition

187 and other federal measures, low-income immigrants are still uncertain whether to use Medi-Cal," said Yoo. "But the message needs to be clear: If they are sick, go to the doctor and don't worry about your immigration status."

The researchers said that not only should service providers be a part of outreach efforts but the media and the public schools should also be involved. Yoo and Park added that the outreach message should be clearly understood by immigrants, outreach should focus on immigrant communities as well as immigrant legal providers, service providers need to be better informed, ethnic media should be better utilized and information needs to be distributed in public places, such as ethnic grocery stores and laun dromats.

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For more information about the study, call San Francisco State University Public Affairs Office at (415) 338-1665, researchers Grace Yoo at 415/338-3891 or Lisa Park at 303/735-0068.



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Last modified April 23, 2001, by Office of Public Affairs