Access to Primary and Preventive Care Services Among Immigrant Women in the District of Columbia Justice Armattoe, MHA, MPH Justice Armattoe, MHA, MPH CityMatCH Annual Urban Maternal & Child Health Leadership Conference Portland, OR September 11-14, 2004

Purpose of Study  To identify the health needs and health access problems of immigrant women  To determine the baseline health status of immigrant groups in the District of Columbia I

Introduction and Background  According US 2000 census, immigrant residents of the District of Columbia are as follows:  44,953 Latino/ Hispanic  15,189 Asians  16,010 Sub-Saharan Africans  7,861 West Indians  3,120 Arabs  1,713 American Indian/ Alaska Natives and  348 Pacific Islanders

Methodology  A structured survey of 250 Africans, 250 Asian Pacific Islanders (API), 250 Caribbean and 250 Latino immigrant women conducted in May-September 2003 for a total population of  Response: 109 Africans, 144 Caribbean, 129 API, and 108 Latino for total population of 490 immigrant women  Questionnaires were translated into Mandarin-Chinese, Vietnamese, Korean, Spanish and French

Methodology cont’d  Participants were each paid a $10 honorarium for time and effort.  Survey data analyzed using SPSS

Demographics  85% reported they were heterosexual, 5% were bisexual, while 3% were lesbians  7% chose not to disclose their sexual orientation.  Average age of respondents was 37 years and average income was $25,000 per year

Educational Attainment

Percent of Education Level of Immigrant Women surveyed Percent of Education Level of Immigrant Women surveyed

Percent of Respondents with Insurance

Insurance Coverage

Percent of Respondents with Access to Primary Care Services

Percent of Respondents using Primary Care Services

Percent of Respondents Using Gynecological Services Percent of Respondents Using Gynecological Services

Barriers to Primary Care Services

Self Perception of Risk for HIV Self Perception of Risk for HIV  84% did not perceive to be at risk for HIV.  11% perceived themselves at risk for HIV.  5% did not respond.

HIV Testing HIV Testing  59% of respondents reported having been tested for HIV.  33% of respondents have never been tested for HIV.

Reasons for Not Testing for HIV  26% did not know any HIV test site  17% blamed it on the cost of the test

Perception of DOH Immigrant Outreach as Effective or Non Effective

Effectiveness of DOH Information Outreach

Conclusion Conclusion  Utilization of medical services often is due to cost, language and cultural barriers, and distrust.  Fear of authorities, immigrants underutilize health services, especially preventive services (prenatal care, immunizations and dental care).  Issues of day-to-day survival include insecurity about availability of food, clothing, and shelter often override other concerns such as obtaining essential health screenings and care.

Conclusion  They also often delay seeking care for minor conditions until those conditions become more serious.  Underutilization of Primary Health Services by immigrant women is alarming because they are clearly delaying seeking care for many conditions until these become serious.

Public Health Implications Restrictions on access to services placed on immigrants seriously limit the effectiveness of outreach, case finding, and prevention and treatment programs related to infectious diseases. Restrictions on access to services placed on immigrants seriously limit the effectiveness of outreach, case finding, and prevention and treatment programs related to infectious diseases. Patients needing prenatal care and family planning services lose access to important preventive care, resulting in increased risks for poor pregnancy outcomes and the major long-term disabilities associated with such outcomes and their subsequent costs. Patients needing prenatal care and family planning services lose access to important preventive care, resulting in increased risks for poor pregnancy outcomes and the major long-term disabilities associated with such outcomes and their subsequent costs.

Public Health Implications  Postponement of preventive care services has a potential to impose more costs due to hospitalizations

Contact Information Phone: District of Columbia Department of Health District of Columbia Department of Health Maternal and Family Health Administration Maternal and Family Health Administration 825 North Capitol Street NE 825 North Capitol Street NE Washington, DC Washington, DC 20002