Pablo Troop ’26 is A pre-med kinesiology major with a minor in chem. He is a member of Sigma Pi fraternity. Contact him at ptroop@wm.edu
Julius Nyerere Odhiambo is a kinesiology professor at the College of William and Mary. Contact him at jnodhiambo@wm.edu.
The views expressed in this article are the authors’ own.
Elections provide a vital opportunity for marginalized voices to be heard. While common issues such as border security, inflation and taxes dominate this election cycle, a critical crisis affecting millions of women is being severely overlooked: immigrant maternal health. Despite high healthcare spending, the United States continues to lag behind other developed nations, with higher rates of maternal mortality and health complications being reported. Concerningly, women in the United States are three times more likely to die during childbirth than those in countries like France, Canada and the United Kingdom, even though the U.S.’s per capita healthcare spending surpasses these nations. A new report reveals that one in three U.S. counties lacks a single obstetric clinician, severely limiting access to care for many women. This gap in care is particularly concerning for vulnerable populations like immigrants who have the lowest rates of pre and postnatal care, highlighted by the fact that 43% of immigrant women do not visit a healthcare worker in the year leading up to pregnancy. These trends are important because immigrant women comprise 16% of the United States labor force, and negative health outcomes affecting a significant portion of the labor force must be addressed to prevent economic problems. These problems are not speculative either, as an analysis by the Commonwealth Fund calculated in 2019 that through a child’s fifth birthday, the cost of maternal and child morbidity for U.S. births was 32.3 billion. If the health of these women improves, we will likely improve not only their lives but the production rates of the United States, making it an important, yet seemingly neglected, economic issue.
The reasons for these frightening trends are multifaceted. First, migrant women in the United States face significant barriers to healthcare, largely due to unmet social and economic needs that disproportionately affect them and predispose them to lower-quality care. They are more likely to live in poverty compared to U.S.-born women, which places them at a distinct disadvantage. They lack reliable transportation, leading to fewer prenatal and postnatal medical visits, putting them at higher risk for maternal complications. The absence of regular care during these critical stages can have serious long-term effects on their health. Additionally, many migrant women, particularly those who are undocumented, are more likely to be uninsured, further limiting their ability to access necessary medical services. This is particularly problematic due to the severe debt certain medical treatments can cause for people if they are uninsured. The fear of debt further deters immigrant women from seeking care, because it could make their poor economic situation even worse. This lower quality of care, and likelihood for seeking care, not only results in poorer health outcomes but also affects their ability to work and diminishes their overall quality of life, perpetuating a cycle of disadvantage.
The cultural situation of immigrant women is uniquely shaped because they are a melting pot of different cultures and beliefs. Immigrant women in the United States come from everywhere, including Mexico, Haiti and even European countries like Portugal. Despite the various cultural backgrounds of these women, they all share a common thread: the profound impact that institutional changes can have on their lives. Due to cultural factors, such as mistrust in the healthcare system and inability to properly communicate with healthcare workers, immigrants are at an increased risk of maternal health complications. This leads to a neglect of prenatal and postnatal care as they are unlikely to trust healthcare workers and therefore follow their advice or visit regularly. Language barriers can also arise between immigrant women and U.S. healthcare providers. These language barriers significantly impact access to quality healthcare, as it is challenging to receive comparable care when unable to communicate efficiently. In one specific study, Portuguese immigrants were asked about the language barrier in healthcare and were quoted as saying “It’s not the same as communicating in your language. So, sometimes you are not sure you understood everything.” These problems can be in part solved by institutional changes that provide funding for translators in medical settings. Funding for translators would not only mitigate the language barrier, but it would also increase trust in the healthcare system because patients are more likely to trust healthcare workers when a professional translator is present.
These alarming disparities in maternal health care, detailed through socio-economic hardships, cultural barriers and alarming neglect at border camps, make the upcoming election a critical juncture for lawmakers. This is because, with an upcoming election, legislation can be enacted to help decrease the severity of this problem by expanding pre and postnatal care. For example, new legislation which modifies the 2002 Children’s Health Insurance Policy unborn child ruling and allows for an expansion of care could provide crucial aid to immigrant populations. Legislation at the state level could also have meaningful impacts on maternal health, such as legislation in the state of Texas. Texas is a poor performer in maternal health metrics, and therefore legislation expanding child care, like the Texas House Bill 12(H.B), which relates to the duration of services provided under Medicaid, could have very positive effects on maternal health outcomes. Along with this legislation that addresses the healthcare barrier, having trained translators would help decrease cultural distrust, as proper communication would increase satisfaction rates, leading to more visitations, and aid the rates of women attaining pre and postnatal care. If proper legislation is enacted, the entire country could benefit due to the economic ripple effects, such as increased workforces and decreased healthcare costs. This makes the upcoming election even more crucial, because the right candidate will recognize these issues and address them when elected. All of this culminates in a very important upcoming period of legislation, which if treated seriously, these women can get the help they deserve and relief from the socioeconomic and cultural barriers that currently exist in healthcare.
Pablo Troop is a research assistant at Ignite, a multidisciplinary research lab focusing on effective, efficient and equitable distribution of global health resources at the William & Mary Global Research Institute. Julius Nyerere Odhiambo is an assistant professor of public health at the College of William & Mary.