1. Jessica Gonzalez-Rojas
Will it Really be Health Care for All? Mobilizing Reproductive Health Advocates for Quality Health Care for All: Challenges and Opportunities
APHA 135th Annual Meeting November 6, 2007
Jessica Gonzalez-Rojas
Director of Policy and Advocacy
National Latina Institute for Reproductive Health

2. Overview
Reproductive Justice: Why talk about immigration when discussing universal health care?
Will offer the perspective of Latinas (immigrants and U.S.-born)
Barriers to Reproductive Health Care for Latinas
Uninsured rates for Latinas
Latina’s Health Disparities
Advocating for Quality Health Care for ALL

3. Reproductive Justice
Everyone, regardless of race, age, ability, national origin, income, sexual orientation or gender expression, has equal rights and access to reproductive health services, as well as the right to make informed decisions about whether or when to have children.

4. INTERSECTIONALITY
Women of color are influenced by multiple factors (their socio-economic, cultural, spiritual, political, educational and immigration status as well as their sexual orientation, gender expression and physical ability) and the interaction of these factors must be taken into account.

5. National Latina Institute
The mission of the National Latina Institute for Reproductive Health is to ensure the fundamental human right to reproductive health and justice for Latinas, their families and their communities through public education, policy advocacy, and community mobilization.

6. Who are Latinos? 40% of Latinos are Foreign-Born
43% of entered the US in the 1990’s
In March 2002, Latinos were 17 million of foreign-born population
Only 6.7% have US citizenship
Primary language among immigrants is Spanish
72% of immigrant Latinos speak only Spanish
24% are bilingual
Latinas: In 2000, Latina women are 12.5% of U.S. female population (over 17 million of 143 million women in U.S.)

7. Undocumented vs. Documented Immigrants in the U.S.
A Pew Hispanic Center analysis of the March 2005 Current Population Survey shows that of an estimated 11.1 million unauthorized migrants, 58% of the adults were male while 42% were female (Passel 2006). In contrast, females accounted for 52% of the adult legal migrant population in 2005.
According to Pew, Of the estimated 11.1 million undocumented immigrants: Mexico, Central and South America account for more than ¾ (75%) of the undocumented population
Mexico alone accounts for 56% of the unauthorized (undocumented) population
Source: Pew Hispanic Center Analysis of March 2005 Current Population Study

8. What are the barriers to reproductive health care for Latinas?
Lack of health insurance/ access to providers
Anti-immigrant policies
Cultural/Language Barriers
Unequal Treatment
Lack of information
…. Lead to Health Disparities

9. Lack of Access to Basic Health Care
Latinas have the highest uninsured rate (41%) among racial/ethnic groups
Almost 60% of low-income Latina immigrants of reproductive age are uninsured
Almost half of all Latinas lack health insurance for part of the year
Almost 25% of Latinas have not visited a physician in the last year
Almost one-third of Latinas do not have a regular health care provider
Lack of transportation and geographic isolation affect access
* Over 45 Million Uninsured
Even for Latinas who have a job it is still unaffordable—
Many Latinas work in jobs where there is no employer-based coverage and in some cases the employer may not provide health insurance any more
Public benefits: fear of INS and deportation

10. Racial and Ethnic Disparities in Women’s Access to Health Care
Findings from the 2001 Kaiser Women’s Health Survey.

11. Immigration Status
Under the 1996 Welfare Law, legal immigrants who arrived after August 22, 1996 do not have access to federal Medicaid and SCHIP funding for their first five years in the US
18 states use state funds to cover pregnant immigrants
Most immigrants are not able to obtain employer-based coverage, leaving a large number uninsured:
55% of non-citizen Latinos who speak English lack coverage
72% of non-citizen Spanish-speaking Latinos are uninsured
51% of low-income non-citizen children are uninsured compared to 26% of low-income citizen children

12. Health Insurance Status of Latino Immigrants

13. Limited Access to Reproductive Health Services
Cuts to Medicaid and Title X clinics affect access to Family Planning/ STI & HIV testing and treatment
33% of Latinas did not receive a pap smear in one given year
Immigrant Latinas are least likely to get pap test and mammogram
Undocumented immigrants may be excluded from public health programs
17-20% of women having abortions are Latinas, although Latinas represent 13% of women
The Hyde Amendment restricts federal Medicaid funding for abortion to cases of rape/incest/life endangerment
Misoprostol use among immigrants to self-induce abortions
17 states do not cover abortions beyond Hyde exceptions
High rate of poverty and limited public funding sources for abortion make it difficult for many Latinas to access abortion
Studies show that qualified immigrant women are wrongly denied because of status; undocumented women do not always apply because they do not know they are eligible or they fear deportation
Abortion is not considered an emergency service under Medicaid for which undocumented would be eligible.
CA and NY Medicaid programs cover abortion for undocumented women
Misoprostol use among immigrants:
Obtaining drug from Central/South America, at low cost
Self-administered at home, not always knowing how to use it
Lack of knowledge that abortion is legal and possibly covered
South Carolina and recent Massachusetts example

14. Latina Reproductive Health Disparities
High teen pregnancy rates
High unintended pregnancy rates
High breast/cervical cancer rates
High STI & HIV/AIDS rates
High rates of Chronic Diseases

15. Universal Health Care as a Human Right
Human Rights Standards for Health Care Policy Assessment: (adapted from the US Human Rights Network Health Caucus)
Recognizes a right to health care
Equitable
Protects from discrimination
Is accessible to everyone
Affordable for all
Ensures acceptable quality of services
Includes private sector accountability
Has process for evaluation, monitoring and public participation
A push towards a universal health care system is supported in international law by various international human rights instruments that ensure the right to health care:
Universal Declaration on Human Rights- Article 25
International Covenant on Economic, Social and Cultural Rights- Articles 7,11,12
Convention on the Elimination of All Forms of Discrimination Against Women- Articles 10,12,14
Convention on the Rights of the Child- Article 24

16. Advocates for Universal Health Care: Challenges & Opportunities
Political environment
SCHIP example: ICHIA removed through ‘compromise’
Elections! Polarizing debate
Opportunities
Elections! Presentation of candidate’s health plans
Attention to 45 million uninsured in U.S.
Will of the people: want to see comprehensive immigration reform and universal health care
Polictical environment:
Polarized Congress (although Dems lead House, are slim majority in Senate)
Anti-women
Anti-choice
Homophobic
Anti-immigrant
SCHIP compromises: Legal Immigrant Children’s Health Improvement Act removed during negotiations; compromising chip

17. Advocates for Universal Health Care: Recommendations
Must be principled!
Ensure that those who need insurance the most are included; advocate for inclusion of immigrants; documented and undocumented alike
Join coalitions that embrace human rights model for universal health care
Ensure linguistically and culturally appropriate care
Ensure comprehensive care: repro health and abortion services
Ensure affordable care (beware of high deductibles and out-of-pocket costs)
California example: Senator Sheila Kuehl’s proposal (Senate Bill 840) includes all Californians via single-payer system, regardless of immigration status

18. References Visit us online! www.latinainstitute.org
Kaiser Family Foundation
The National Women’s Law Center
The Alan Guttmacher Institute
The National Health Law Program
The Institute for Reproductive Health
US Human Rights Network Health Caucus
Having our Say Coalition (California)
Pew Hispanic Center
Visit us online!