Philadelphia Latine Immigrant Birthing People’s Perspectives on Mitigating the Chilling Effect on Prenatal Care Utilization

Abstract

Research Design: Community-engaged qualitative study using inductive thematic analysis of semistructured interviews. Objective: To understand Latine immigrants’ recent prenatal care experiences and develop community-informed strategies to mitigate policy-related chilling effects on prenatal care utilization. Background: Decreased health care utilization among immigrants due to punitive immigration policies (ie, the “chilling effect”) has been well-documented among Latine birthing people both pre and postnatally. Patients and Methods: Currently or recently pregnant immigrant Latine people in greater Philadelphia were recruited from an obstetric clinic, 2 pediatric primary care clinics, and 2 community-based organization client pools. Thematic saturation was achieved with 24 people. Participants’ pregnancy narratives and their perspectives on how health care providers and systems could make prenatal care feel safer and more comfortable for immigrants. Results: Participants’ recommendations for mitigating the chilling effect during the prenatal period included training prenatal health care providers to sensitively initiate discussions about immigrants’ rights and reaffirm confidentiality around immigration status. Participants suggested that health care systems should expand sources of information for pregnant immigrants, either by partnering with community organizations to disseminate information or by increasing access to trusted individuals knowledgeable about immigrants’ rights to health care. Participants also suggested training non-medical office staff in the use of interpreters. Conclusion: Immigrant Latine pregnant and birthing people in greater Philadelphia described ongoing fear and confusion regarding the utilization of prenatal care, as well as experiences of discrimination. Participants’ suggestions for mitigating immigration-related chilling effects can be translated into potential policy and programmatic interventions which could be implemented locally and evaluated for broader applicability.