High Costs and Fear of Deportation: Obstacles in Prenatal Care in Philadelphia

The high cost and potential deportation are causing some Latino immigrants in Philadelphia to delay or forgo prenatal care, according to a study conducted by the Children’s Hospital of Philadelphia (CHOP) and the University of Pennsylvania.

Diana Montoya-Williams, an assistant neonatologist at CHOP and the study’s lead author, detailed that the seeds of the study date back to around 2016, when anti-immigrant policies began to be enacted, which researchers later found were having a chilling effect on healthcare utilization.

Montoya-Williams emphasized that concerns about a portion of the population not receiving healthcare led her to design a study that not only provided information on the specific reasons why immigrants might be less likely to access prenatal care but also on what the medical system could do about it.

“I was interested in finding community-oriented ways to mitigate fears and serve immigrant communities,” Montoya-Williams said. Along with her co-authors, she interviewed about two dozen pregnant or recently pregnant Latina immigrants about their experiences in accessing or not accessing prenatal care.

Montoya-Williams indicated that with the study, they determined that in Philadelphia, a city known for embracing immigrants, people are scared and report significant discrimination in their perinatal experiences.

“This demonstrated that even here, we have many areas where we can work within the healthcare sector to provide culturally humble and trauma-informed care to a population that is becoming vulnerable due to large-scale events happening at the federal and national levels.”

The researchers recruited Spanish-speaking interviewers from local community health groups, Nursing Care Coalition and Puentes de Salud, to make participants feel comfortable. They also refrained from asking about each person’s immigration status.

Among the reasons for Latinos to forgo or delay prenatal care, confusion about the healthcare system and insurance coverage predominated, as well as concerns about the high cost of medical care, particularly childbirth, and fears that their immigration status might be reported to authorities.

¿How Can Barriers Be Overcome?

The researchers provided several recommendations to help healthcare workers and systems in Philadelphia overcome these care barriers.

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Some of the measures suggested in the study are relatively easy to implement, such as posting signs in Spanish that reflect that immigrants are welcome, having doctors directly address their fears, and securing funds to hire Spanish-speaking guides to help patients navigate the healthcare system.

Studies have shown that the lack of prenatal care makes babies three times more likely to have low birth weight and five times more likely to die in infancy, in addition to contributing to longer-term complications.

Mothers who do not receive prenatal care are also three to four times more likely to die from pregnancy-related complications.