The vulnerable populations are at risk of developing health problems because of limited healthcare delivery set to meet their needs. Nurses have historically cared for the growing immigrant women population. Although nurses and doctors have created continuously mechanisms to meet their psychosocial needs, there are modern social, cultural and economic issues affecting the delivery of women healthcare.
The Immigrant Women Population
An immigrant woman is a person who lives in a country different from her original native land for less than ten years. The American constitution does not directly define immigration. However, the section 1 of the 14th amendment addresses the responsibly of the government to every person or naturalized within the U.S borders. The rules of immigration were limited to states until 1875 when the U.S supreme court ruled that regulating immigration is a federal responsibility (Foner, 2018). Immigrant women consist of citizens who are either naturalized or in the U.S. The second category of immigrants is those with Legal Permanent Residents. They are authorized to live and work in the US through a green card on a permanent basis. The final category of immigrant women is those who live illegally in the United States without permission. They are called undocumented citizens and cannot receive public healthcare benefits.
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Immigrant women are an important vulnerable group because of the historical restrictions facing them. In 1996, Congress passed an act that mandatory delayed the lawful American immigrates to get medical cover (Foner, 2018). The Personal Responsibility Act and Work Opportunity Reconciliation Act forced illegal permanent women immigrants in America to wait for five years before they could get medical cover. The Obama care also explicitly left out immigrant women together with their families out of the healthcare access. Undocumented women cannot receive tax credits that help them participate in the health insurance marketplace. The Obamacare, also known as Patient Protection and Affordable Care act of 2009 barred immigrant women from buying plans at full price (Anderson, Hatch, Comacchio, & Howard, 2017). The historical policies make immigrant women a group of interest when addressing the issues of affordable healthcare for vulnerable populations.
The Immigrant Woman’s Health
Immigration has increased around the globe despite the barriers enacted by wealthier nations. Typically, needy and desperate women move to developed countries to search for work and a better life. Although immigrants have delivered social and economic benefits, the native-born are skeptical about their contributions. The 2015 statistics state that 42 million immigrants are living in America, which is 13% of its total population. The immigration has been increasing since 1960 when the country only had 9.7 million immigrants. Approximately 21 million migrants are women, and they make up 13 % of the United States female population. The significant origins of immigrant women are Mexico 25%, Philippines 5%, China 4% and India 4% (Blau, & Kahn, 2015). Immigrant women play multiple roles as professionals, students, spouses and parents in the United States. World Health Organization states that women immigrants lack universal health coverage hence overspend on healthcare become they pay out of their pockets. Among the 31 pregnant women in the vulnerable situations where Doctors of World in Europe collected data, 54% could not have access to antenatal care. The rate of maternal death is also higher among foreign-born mothers than natives.
The rising statistics of immigrant women has increased the vulnerabilities of women to depression and lesser satisfaction with the currently available social support. Research conducted by Blau, & Kahn (2015), obtained that immigrant women have an increased risk of postpartum depression and poor mental health.
Limited access to contraception, delayed access to screening and pregnancy termination is also associated with the immigrant women. The health of an immigrant woman is not considered as significant as that of native Americans. They experience disproportional pregnancy outcomes such as low birth weight, maternal and infant mortality. Migrant women are likely to deliver without professional assistance. Pregnant women and adolescent immigrant girls are unable to access medical care yet they are significantly affected by sexual violence.
Migrant women in detention also face diminished physical and mental health. The American detention systems in America do not have accessible healthcare facilities for immigrants. The limited healthcare for detained women immigrants has been a concern, especially for the lawmakers. Young women face challenges in the detention centers when they are pregnant and need attention.
Psychosocial Needs of Immigrant Women
According to a disillusionment model, there are predictable phases of migrants’ psychological adaptation. The first stage is called euphoria of arrival where their mental health equals to that of the natives. The second phase is named disillusionment and nostalgia because deteriorating past health characterizes it. During the second phase, the immigrant adapts to the native-born mental health. However, the mental health and psychological health has been deteriorating because of socioeconomic, financial, cultural changes. Migrant women are affected by poverty, multiple responsibilities, and discriminatory treatment. The psychosocial factors that influence them are within and outside their control.
Migrant women need social connectedness to keep them safe from mental problems. Being an immigrant woman in the midst of stereotypes, bias and racists societies has been a problem since they arrived in America. They have been discriminated base on their ancestral origin. They are victims of actual systematic racism in a country that make laws to prohibit discrimination against the majority. They, therefore, lack social connection which is part of mental health (Anderson, (Hatch, Comacchio, & Howard,2017). Migrant-American women are unable to go to good schools despite having the best skills because they are not accepted. Although there are huge variations among immigrant women sub-groups, they experience similar problems that may cause a deterioration in mental health.
Migrant women need protection from violence and discrimination caused by forces within the government and the society. The healthcare policy is discriminate against immigrant women by limiting the insurance benefits that they need to address health issues. The historical healthcare acts such as Obama care are examples of continuing discrimination against immigrant women. The detention centers and unsafe neighborhood also affect immigrant women health. They need policies that protect them from sexual violence and discrimination at the healthcare centers. Immigrant women also need protection from effective medical procedures. The North American government legalized sterilization of Puerto Rican women to respond to the excess population of Puerto Ricans in the United States. ‘La Operation’ was the term used in Puerto Rico for government promoted sterilization and public health programs aimed at controlling Puerto Rican population. Although local personnel did the job, the US government funded and planned for it.
Immigrant women need social support from family, friends, and peers. They need family members to meet their settlement related need in the US. Support from extended family is powerful, protective and helps to improve the mental health status of immigrant women (Dreby, 2015). They also need fellow immigrant women who face similar challenges to speak to them because they understand each other’s problems. Social support outside family and friends concerning religious instructions and other organized systems also influence a psychological pathway.
Issues Impacting Culturally Competent Care Delivery
Immigrant women are affected by laws and policies that do not respect their values and preferences. They are mystified by legal healthcare limits making it difficult for their children to avoid the lure of gang life (Lin, Lee, & Huang, 2017). The idea of sterilizing the Puerto Rican women was not a culturally competent idea. The policy was against the culture in the immigrant families who support more children. Although there was a significant reduction in population because of mass sterilization of women, Puerto Ricans remained poor, and the situation worsened. The US government assumed that overpopulation was the cause of disastrous economic and social conditions in Puerto Rico. However, the free population control policy did not change the economic and social state of Puerto Ricans. More than 60% of Puerto Ricans still live below poverty levels.
The perception about the women immigrants created by the media has negatively the culturally competent care delivery. Asian American women have been reduced to “one-dimensional caricature” in American representation which causes the social injustice of racial, gender and class impression. The perception has influenced healthcare policies that target specific social class. The misrepresentation disrespects the immigrant women who need equal treatment in the society. The modern Filipino wife is used in vogue by American men as brides to form picture catalogues.
Poverty is a limiting factor affecting a culturally competent care delivery for immigrant women. They have low-income levels and cannot afford the culturally competent care delivered to them. They live in poverty-stricken neighborhoods exposing them to diseases such as diabetes, depression and high blood pressure.
Culturally and Competent Healthcare Methods for Immigrant Women
The best approach used in culturally competent health care is to respect the cultural political and economic backgrounds of immigrant women. Immigrant women traditionally practice midwifery and can be allowed to incorporate their practices in the maternal treatment.
Providing knowledge about the immigrant groups is important when creating ethical and cultural health care. The healthcare providers should demystify the wrong notion that exists to tarnish the image of immigrant women. Training healthcare providers will help to create some trust between the healthcare institutions and immigrant women.
The current healthcare system lacks a culturally competent professional hence nurses and doctors should be tested to know whether they can shift from using their own cultures to that of the immigrants (Betancourt, Corbett, & Bondaryk, 2014). The assessment should ensure that nurses are competent enough to help immigrant women.
In conclusion, the presence of immigrant women continues to increase in the United States calling for a review of their healthcare delivery. The government policies have not favored them but made them feel less important than the natives. The healthcare policies favor natives over immigrants, who spend a lot on healthcare costs. Immigrant women also have psychosocial needs such as social support from family and friends. They need protection from violence and discriminating which affected their mental health. There is a need to create a culturally competitive healthcare method, which can be successfully implemented in the United States of America. The nurses and doctors need to understand the cultures, beliefs, and preferences of the immigrant women to meet their psychosocial needs.
References
Anderson, F. M., Hatch, S. L., Comacchio, C., & Howard, L. M. (2017). Prevalence and risk of mental disorders in the perinatal period among migrant women: a systematic review and meta-analysis. Archives of women's mental health , 20 (3), 449-462.
Betancourt, J. R., Corbett, J., & Bondaryk, M. R. (2014). Addressing disparities and achieving equity: cultural competence, ethics, and health-care transformation. Chest , 145 (1), 143- 148.
Blau, F. D., & Kahn, L. M. (2015). Substitution between individual and source country characteristics: Social capital, culture, and us labor market outcomes among immigrant women. Journal of Human Capital , 9 (4), 439-482.
Dreby, J. (2015). US immigration policy and family separation: The consequences for children's well-being. Social Science & Medicine , 132 , 245-251.
Foner, N. (2018). Benefits and burdens: Immigrant women and work in New York City. In Immigrant women (pp. 1-20). Routledge.
Lin, C. J., Lee, C. K., & Huang, M. C. (2017). Cultural competence of healthcare providers: A systematic review of assessment instruments. journal of nursing research , 25 (3), 174- 186.
