201 - The Challenge of Ensuring Access to Care for Pregnant Migrant Women on the US-Mexican Border

Poster Number: 201
Publication Number: 201.319

Eric A. Russell, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, United States; Karla Fredricks, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, United States; Deliana D. Garcia, Migrant Clinicians Network, Austin, TX, United States; Annie Leone, Holy Family Birth Center, Weslaco, TX, United States; Robert M. Nelson, University of Texas Rio Grande Valley School of Medicine, Harlingen, TX, United States; Candace Kugel, Migrant Clinicians Network - Austin, TX, Clinton, NY, United States; Paul H. Wise, Stanford University, stanford, CA, United States; Lisa J. Chamberlain, Stanford University School of Medicine, Stanford, CA, United States; Marsha R. Griffin, University of Texas Rio Grande Valley School of Medicine, Brownsville, TX, United States

Background: In recent years, restrictive immigration policies have severely limited the ability of immigrants to seek asylum in the United States. Although most were sent to Mexico to await their asylum hearings, late-term pregnant women were often allowed to enter the US. However, initiating care late in pregnancy can be exceedingly difficult, with a failure to obtain care exposing mothers and their children to negative outcomes.

Objective: Describe the results of a nationwide initiative to connect newly arrived pregnant women at the US-Mexico border to prenatal care in the US, including the demographics of the women as well as the obstacles encountered in ensuring appropriate clinical care.

Design/Methods: Case managers for the Migrant Clinicians Network (MCN) were charged with assisting pregnant women by connecting them with obstetric care and supporting them and their newborns through the initial post-partum period. A retrospective review and descriptive analysis of the internal database maintained by MCN was completed. De-identified data was obtained on all women enrolled from January 2020 through August 2021. Only women for whom at least one obstetrics referral was attempted were included in the analysis. Demographics, descriptive pregnancy information, and data describing the access to care process were analyzed.

Results: A total of 405 women were enrolled and received at least one referral to a healthcare facility. The largest percentage were from Honduras (41.7%), followed by Cuba (9.4%) and Guatemala (9.1%). Fifty-eight percent were in their third trimester and only 54.3% were known to have received any prenatal care. Eight percent reported domestic violence and 41% reported preceding traumatic events, either before or during their journey. Despite active case management, an average of three referrals to healthcare facilities were required before care was established (up to 7 were required in some cases). Conclusion(s): Many participants in this initiative, who are likely representative of newly arrived pregnant women at the US-Mexico border, appear to be in their third trimester, have received limited prenatal care, and have experienced trauma. Despite the time-sensitive need to connect them to obstetric care, a variety of challenges exist.  In our experience, these obstacles included fear among recently arrived immigrants, a lack of insurance coverage, and administrative disincentives for enrolling women late in pregnancy.  Policies and programs that remove barriers and expedite care should be encouraged to improve the health of recently arrived mothers and their infants.
Destination States for Recently Arrived Women