Giving Birth in America: California – A Story of Pregnancy and Immigration

By: Melissa Gradilla

In the midst of the migrant caravan, upcoming mid-term elections, and the rights of immigrants in the U.S. being threatened, Every Mother Counts launched Giving Birth in America: California, the fifth installment of the Giving Birth in America series, which focuses on pregnant immigrant women. A population often living in the shadows who face added challenges due to their legal status and discrimination, pregnant immigrant women are among the populations our health care system is failing, a factor contributing to our nation’s maternal health crisis. Our goal with this film was to further examine the drivers that influence this population’s health status and outcomes.

Giving Birth in America: California tells the story of an immigrant farmworker in Watsonville, CA, pregnant with her third child, as she progresses through pregnancy and childbirth. Living in California, she is eligible for pregnancy-related Medi-Cal (Medicaid) and receives high-quality, comprehensive, and culturally-appropriate care from her team of providers at a community health center, Salud Para La Gente. Her providers understand the social, economic, and legal barriers immigrant farmworker populations face and strive to provide quality care in spite of these challenges. But as this film shows, the health issues immigrant women experience often extend beyond the brief window of time around pregnancy when they have reliable access to health care, and can define women’s experience of pregnancy and childbirth.

Maternity care options for immigrant women are less predictable than for most women in the U.S., varying significantly by state. Unlike California, not all states offer pregnancy-related Medicaid regardless of legal status. Additional care options for immigrant women include federally qualified health centers which provide care for uninsured people on a sliding scale and state and city-wide funded health initiatives, options that are not available in many parts of the country. Even where these options for care independent of legal status exist, this care tends to be limited in length and scope.

Many immigrant women enter pregnancy with a window of health coverage for the first time in their lives. This is problematic given that uninsured women are more likely to have unintended pregnancies, obtain late or no prenatal care, and enter pregnancy with untreated pre-existing conditions. Lack of access to prenatal care is particularly stark among immigrant communities in the U.S. and is associated with low infant birth-weight and poor pregnancy outcomes. Immigrant communities are also disproportionately affected by cardiovascular disease risk factors, including hypertension, overweight/obesity, and diabetes, placing pregnant women at an increased risk for complications during pregnancy and childbirth.

Upon seeking care, pregnant immigrant women often have little support and are met with a health system that is challenging to navigate. Language barriers and poor health literacy prevent them from learning more about their health, which is often delivered by multiple providers that do not understand their background, language, or concerns. Unable to advocate for themselves, many times immigrants experience inadequate care, receiving the bare minimum when it comes to services and with little say over decisions about their care.

After childbirth, pregnancy-related Medicaid coverage only extends to 60 days. For women who were uninsured before getting pregnant, this places them behind where they started. The postpartum period is a particularly vulnerable period of time when women are at higher risk for pregnancy related complications, post-partum depression and other health issues. Many women experience complications or develop conditions that require continuing (or ongoing) care. Unfortunately for immigrant women, after 60 days, their window of health coverage has closed.

Giving Birth in America: California reflects just one individual’s story of what it means to be a pregnant immigrant woman in the U.S. Every woman’s story is, without a question, different and encounters distinct challenges before, during, and after pregnancy and childbirth. But what many of their stories have in common is the little support provided by our health care system in a time of increased vulnerability. The care the woman in our film receives is exemplary and a model of care designed to meet the needs of underserved immigrant communities, but this is not the case for most pregnant immigrant women. This film doesn’t just show us what health care for pregnant immigrant women can look like at its best, but it serves as a reminder that we can and must do better.

As complex issues related to immigration continue to take the spotlight in the weeks to come, we emphasize that access to quality, comprehensive maternity care is not a privilege, it’s a human right. And immigrant communities, contributing members to our society, are no less deserving.