Leon Yadira Bribiesca, Soun Brenda, Sudhinaraset May
Department of Obstetrics and Gynecology at the Los Angeles General Medical Center, University of Southern California (USC), Los Angeles, CA, USA.
Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, CA, USA.
Soc Sci Med. 2025 Jul 3;382:118374. doi: 10.1016/j.socscimed.2025.118374.
Structural racism in sexual and reproductive healthcare (SRH) has been linked to poor quality of maternal care among Black and Latina groups. Few studies have captured this from the perspective of undocumented female-identifying individuals, who experience compounding barriers from their intersecting minoritized identities including immigration status, race, and gender. This study aims to: 1) reframe Hardeman and colleagues' Racism and Maternal Healthcare framework to center the voices of undocumented Asian and Latina female-identifying individuals; 2) identify historical and contemporary examples of the impact of structural racism on their SRH access; and 3) describe manifestations of structural racism that lead to poor quality of SRH care for this group. Between February and July 2022, 30 semi-structured interviews were conducted with undocumented female-identifying Asian (n = 14) and Latina (n = 16) individuals. Both deductive and inductive thematic analysis of transcripts were conducted in Dedoose. Lack of health insurance, fear of seeking care instilled by immigration enforcement, and mistrust in the healthcare system due to historical and present-day experiences of racism in obstetrics and gynecology emerged as factors impeding access to SRH. Manifestations of structural racism in the health care setting included disrespectful care, ignored pain, dismissed concerns, lack of informed consent, bodily violations, and lack of person-centered SRH education and resources. This study provides valuable insights into how structural racism shapes SRH seeking behaviors and experiences of Latina and Asian undocumented female-identifying individuals. Findings will help guide healthcare providers' and policymakers' decision-making in addressing current barriers that stem from structural racism.
性与生殖健康护理（SRH）中的结构性种族主义与黑人和拉丁裔群体孕产妇护理质量低下有关。很少有研究从无证女性身份认同者的角度来探讨这一问题，她们因移民身份、种族和性别等多重边缘化身份而面临诸多障碍。本研究旨在：1）重新构建哈德曼及其同事的种族主义与孕产妇保健框架，以无证亚洲和拉丁裔女性身份认同者的声音为核心；2）确定结构性种族主义对她们获得性与生殖健康护理机会产生影响的历史和当代实例；3）描述导致该群体性与生殖健康护理质量低下的结构性种族主义表现形式。2022年2月至7月期间，对30名无证女性身份认同的亚洲人（n = 14）和拉丁裔（n = 16）进行了半结构化访谈。在Dedoose软件中对访谈记录进行了演绎和归纳主题分析。缺乏医疗保险、移民执法导致的就医恐惧，以及由于妇产科领域历史和当下的种族主义经历而对医疗系统缺乏信任，都成为阻碍获得性与生殖健康护理的因素。医疗环境中结构性种族主义的表现包括护理不尊重、疼痛被忽视、担忧被驳回、缺乏知情同意、身体侵犯，以及缺乏以患者为中心的性与生殖健康护理教育和资源。本研究为结构性种族主义如何塑造拉丁裔和亚洲无证女性身份认同者的性与生殖健康护理寻求行为和经历提供了宝贵见解。研究结果将有助于指导医疗服务提供者和政策制定者在解决当前由结构性种族主义造成的障碍方面的决策。
