Exploring the Differences in Maternal Risk Factors and Prenatal Care Among Unauthorized Mexican and Guatemalan Immigrants

Background and Purpose:

Unauthorized Latina immigrants encounter multiple risks during pregnancy, which often stem from poor prenatal care. Even in states, such as Nebraska, in which Medicaid covers prenatal care for unauthorized immigrants, linguistic, transportation, and fear-related barriers persist. Though prior research suggests the importance of studying Latina immigrant health by country of origin, we lack data on maternal risks and prenatal care utilization specific to Latina subgroups. The current study examines maternal risk factors and prenatal care utilization for unauthorized Mexican and Guatemalan immigrants, whom constitute the largest unauthorized immigrant populations, in Nebraska.

Methods:

Data were drawn from 2007-2011 Nebraska birth certificate records of unauthorized Guatemalan and Mexican women ages 18 years and older (N = 4,188). The two dependent variables were maternal risk and prenatal care. Maternal risk factors included age risk, pre-existing health risks, pregnancy health risks, and prior pregnancy risks. Chi-square analyses and Student t-tests were utilized to examine maternal risk factors by origin.

Prenatal care adequacy included a dichotomous (adequate/inadequate) variable assessed by a standardized measure (The Kotelchuck Index) and number of prenatal visit. Logistic regression analysis was used to examine the relationship between country of origin and prenatal care adequacy, with negative binomial regression being employed to examine the relationship between country of origin and number of prenatal care visits.

Results:

Descriptive analyses found that unauthorized Mexican women were slightly older, more likely to attain high school and college education, and more likely to have private health insurance than their Guatemalan counterparts.

Maternal risk factors varied by origin. Mexican women had significantly greater risks in regard to age, obesity, pre-pregnancy smoking, and excessive weight gain. In regard to adequacy of prenatal care utilization, Guatemalan women were significantly more likely to have inadequate prenatal care and were found to have half the number of prenatal visits when compared to Mexican participants.

Conclusions and Implications:

Findings are relevant for both policy and practice. Current federal policies criminalize unauthorized immigrants, which instills a pervasive fear of health care service utilization. Promoting safe access to health services is essential for promoting health of pregnant unauthorized women and increasing the likelihood of a safe birth and healthy newborn. These goals also align closely with two Social Work Grand Challenges impacting unauthorized immigrants and their newborns: close the health gap and ensure healthy development of all youth. 

In regard to practice, this study highlights the importance of designing engagement strategies specific to the needs of Latina subgroups. Social workers on multidisciplinary medical teams can foster psychoeducation and service provision to encourage unauthorized pregnant Mexican women to treatment adherence through behavior modification and psychosocial support, while using community-based strategies to encourage prenatal care utilization among unauthorized Guatemalan women. Social workers are well positioned to evaluate barriers to service utilization and treatment adherence, in addition to helping address both factors at a micro-level (e.g., addressing transportation barriers, linguistic challenges, and cultural barriers) and macro-level (e.g., ensuring a safe, culturally competent service setting).