Understanding the Mental and Physical Health Consequences of the U.S. Citizenship Exam on Refugees: Implications for Practitioners and Policymakers

Background and Purpose: The United States has one of the largest refugee resettlement programs in the world. Yet very little is known about a key aspect of the resettlement process: the experience of preparing for the U.S. citizenship exam. For stateless refugees, in particular those who have never held the citizenship of any country, the hope of naturalization is particularly profound. U.S. citizenship is also critical for reducing precarity, securing access to certain rights and benefits, and obtaining a U.S. passport (which enables travel to see family and friends from whom resettled refugees have been separated). However, preparation for the exam is often difficult due to experiences predating refugee arrival in the United States. This presentation will highlight findings from a community-engaged, critical ethnographic study examining the impact of the U.S. citizenship exam on the mental and physical health of Rohingya refugees from Myanmar.

Our presentation answers the following questions: 1) In what ways do the requirements for the U.S. citizenship exam impact refugee mental and physical health? 2) What is the role of community and health care providers in mitigating the physical, mental, and emotional stressors connected to the process of preparing for the citizenship exam?

Methods: A purposive sampling strategy was employed to ensure participants representing diverse and intersectional experiences were included. Participant recruitment occurred in a Rohingya-led community center situated in a Midwestern city in the U.S. Thirty-one in-depth interviews ranging from 45 minutes to two hours were conducted with participants holding diverse immigration statuses. Qualitative interviews were conducted in English or Rohingya, according to participant preference. In-depth interviews were coupled with participant observations at the community center, as well as in participants’ homes and neighborhoods. All interviews were transcribed and transferred into NVivo, where authors employed thematic analysis with both inductive and deductive approaches.

Results: Participants suffer multiple stressors in preparation for the U.S. citizenship exam, which impact their mental and physical health. These stressors are connected to their identities as stateless refugees with a longstanding history of trauma and denial of the right to seek formal schooling in their country of origin. Our findings also uncover the role of healthcare providers, who at times determine whether participants qualify for medical exemption to the U.S. citizenship exam. Our findings also show the integral role that community-led initiatives play in mitigating some of these challenges through providing citizenship classes and a space for communal gathering with those who are also preparing for the citizenship exam.

Conclusion/implications: Refugees resettled in the United States arrive already on the path to citizenship, but this is not as reassuring as one may think. Rather it makes the passing of the citizenship exam a focal point of stress for individuals, families, and the entire community. Our findings raise critical questions and highlight the importance of considering the ethical and health implications of requiring refugees resettled by the United States due to their persecution and exposure to trauma to pass a difficult exam in order to become U.S. citizens.