“We’re constantly fighting for that opportunity”: A Qualitative Study of Access Barriers to Sexual and Reproductive Health for Hispanic Immigrant Women in the United States

Immigrant women in the United States face overlapping difficulties when seeking sexual and reproductive healthcare. A large amount of literature has demonstrated the significant barriers undocumented immigrant women have encountered in accessing this type of healthcare, but little research has explored the uses of services and outcomes among different groups of immigrant women. Therefore, to help in part to close the gap in the literature, this study examines how Hispanic immigrant women in Philadelphia, Pennsylvania, with various immigration statuses and conditions, access and utilise sexual and reproductive services and describe the obstacles they face. The city of Philadelphia was chosen as the case study site due to the high foreign-born population, where an estimated number of 390,000 residents were immigrations or natives with immigrant parents. In addition, Philadelphia was estimated to have the largest undocumented immigrant population among the Northeast American cities. An exploratory qualitative study was designed with 18 in-depth ad hoc interviews with Hispanic women with the following immigration statuses: first- and second-generation immigrants, lawful permanent residents, naturalised citizens, and undocumented immigrants. The barriers were understood in terms of discrimination and inequitable access to healthcare under international human rights law. To detect the root causes of healthcare inequalities and lack of human rights fulfilment, we relied on an intersectionality perspective to analyse and understand the multiple sources of discrimination and how they overlap and create multiple levels of social injustices in the lives of the women. Interviews were audio-recorded, transcribed verbatim, and thematically analysed through the software NVivo. The research yielded four key themes: historical cultural beliefs, practises, and languages; fear, stigma, and negative self- perception; the role of community and social services; and influence of socioeconomic status . The results showed that while a woman’s immigration status impacted their access to healthcare, other interconnected barriers were present that were mutually reinforcing sources of marginalisation. Therefore, the need to go beyond the sole focus on an women’s immigration status in their access to sexual and reproductive healthcare confirms the usefulness of intersectionality in analysing the discriminatory processes through a gender lens and in framing equality and social justice, whilst making reference to a human rights paradigm.