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Abstract

As has been documented in public health data, infections and deaths from COVID-19 have been inequitably distributed in the United States, producing adverse health outcomes among vulnerable populations including Latina immigrants. Using a critical feminist theoretical perspective, this discussion examines the mechanisms informing these outcomes including lack of access to health insurance and health care and work in low-waged jobs with high potential exposure to the virus. In addition, we examine related risks to this population, including domestic violence during stay-at-home orders. We argue that social workers can join forces with immigrant-led organizations to support advocacy to reverse government policies that limit immigrants’ access to health care as well as ensuring that Latina women workers earn adequate wages for essential jobs.

Keywords

COVID-19 Latina immigrants low-income workers undocumented immigrants

The daily COVID-19 death counts, and the alarming infection rates in the wealthiest nation on Earth, illuminate the reality of health disparities in the United States—offering a seemingly irrefutable argument that the burden of this disease is not equitably distributed. Latino communities have been particularly hard-hit, with some public health officials linking disease rates to the large proportion of Latinos working in essential jobs such as meatpacking, housekeeping, and caregiving (Sing & Koran, 2020). Data from New York City, the pandemic’s initial U.S. epicenter, show infection rates of Latinos at 1.6 times the rate of whites (Bureau of Communicable Disease Surveillance System, 2020). More recent studies found that as of June 8, 2020, Latinos accounted for 33% of all confirmed COVID-19 cases in the United States with known ethnicity/race (Rodriguez-Diaz et al., 2020).

Nationally, COVID-19-related diagnoses and deaths increased with higher numbers of Latino residents in a county; COVID-19 cases were greater in Northeastern and Midwestern Latino counties, and deaths were higher in Midwestern Latino counties. Certain factors such as occupational exposure and less social distancing due to shared, crowded housing put Latinos, particularly monolingual Spanish speakers, at higher risk (Olivieri, 2009; Rodriguez-Diaz et al., 2020). The Centers for Disease Control and Prevention (CDC, 2020) reported on June 25 that in New Jersey, for example, Latinos are 19% of the population but comprise 30% of COVID-19 cases (Calo et al., 2020). The same analysis noted that conspicuous COVID-19 rate disparities for Latinos have been reported in many states including Utah, where only 14% of residents are Latinos but account for 38% of COVID-19 cases. Similarly, Washington’s Latinos are 13% of total population but comprise 34% of confirmed COVID-19 cases (Calo et al., 2020). An October 6 analysis by the CDC (2020) using weighted population distributions found a 32.4% death rate among Latinos, a ratio that dwarfs other ethnic groups; in sorting death rates by race and age, Latinos had the highest death rates except for age 65 and above, in which African Americans died at a slightly higher rate (CDC).

Theoretical Considerations

In this analysis, we build on the scholarship of sociologist Menjivar (2006) and by epidemiologist Krieger (1999) to analyze from a critical feminist framework how undocumented Latina immigrants are uniquely made vulnerable to COVID-19. In this analysis, the term, Latino, is used to respect the Spanish-language term for populations comprising both men and women. The term Latina specifically refers to women. As noted by Menjivar, an immigrant’s lack of legal status informs virtually all aspects of her daily life: from how she fares in the labor market, whether she feels safe to report domestic violence, and her ability and sense of safety when accessing resources such as health care. Given that COVID-19 exposure and potential illness are the focus here, we also draw from Krieger’s seminal epidemiological work on discrimination and health. Krieger (1999) argued for examining the accumulated assaults experienced by vulnerable populations. Research must examine how people come to embody experiences of social inequality including racism and sexism (Krieger, 1999). “Taking literally the notion of ‘embodiment,’ this theory asks how we literally incorporate biologically—from conception to death—our social experiences and express this embodiment in population patterns of health, disease, and well-being” (Krieger, 1999, p. 296). Thus, scholarship must delineate inequity in access to resources as well as individual trajectories of development (Krieger, 1999).

Although Krieger’s work originated in public health, it clearly aligns with recent critical feminist scholarship focused on the structural oppression experienced by women according to their race, class, and ethnic position. It includes understanding how the intersections of one’s class, race, or ethnic position influence lived experiences of poverty, discrimination, and poor health outcomes in comparison to other groups (Belliveau, 2011; Mattsson, 2014). Menjivar’s (2006) work is relevant here, as she explored the uncertainty, legal limbo, and essential statelessness for some migrants from Central America, a condition she identified as “liminal legality” (p. 1004). In her conceptualization, immigrants continually negotiate spaces of social exclusion as well as gray areas in which, still facing great uncertainty, they may apply for asylum while contributing to U.S. society by working and paying taxes. Although the paths to legality are uncertain, Menjivar notes that many have organized to advocate for their rights as workers as well as fighting via the legal system to obtain justice or at least protection from deportation.

Looking back to Krieger (1999), we note the tension between the work of immigrants to contest their marginalization as described by Menjivar (2006), while still facing notable disadvantages during the COVID-19 pandemic. Even prior to the outbreak of this disease, vulnerable populations such as the immigrants we discuss here have faced the accumulated assault to their physical well-being by multiple factors including poverty and discrimination (Krieger, 1999). Now, with COVID-19, Latinas face inadequate or no access to health care/health insurance, ineligibility for the economic stimulus, work in essential services such as cleaning and caregiving, and discrimination. In what follows, we use these perspectives as a means to inform social work advocacy to ensure not only access to resources but also to mobilize support for structural change that could protect undocumented Latina immigrants from disproportionate disease exposure. Although this discussion focuses on U.S. immigrants, we note that the issues of discrimination and vulnerability discussed here are not unique to this country. As noted by Sassen (2014) and Massey (2005), the global economic conditions discussed in the next section have displaced migrants at an accelerated pace over the past 30 years. According to the United Nations’ International Organization for Migration (IOM)’s 2019 report, there were 272 million international migrants or 3.5% of the world’s population. This compares to 174 million international migrants or 2.8% of the world’s population in the 2000 report (p. 21, Table 1). This total includes approximately 164 million migrant workers who account for 64% of all international migrants. Although much migration is from poor countries to richer countries, the hope of higher paying work or the need to flee violence means that many people flee from one developing country to another (Levitt & Jaworski, 2007). For example, as of 2017, more than two thirds of migrant workers (68%) resided in high-income-level countries while 29% had moved to middle-income countries and 3.4% were in low-income countries (IOM, 2019, p. 33).

Health Disparities as an Accumulation of Assaults

Public health researchers have explored mechanisms that cause disparate health outcomes, compiling evidence of disadvantage for certain groups due to inequitable access to resources such as health insurance (D’Anna et al., 2010), effects of racism and deprivation over the life span (Gee et al., 2019; Morello-Frosch et al., 2011), and exposure to environmental hazards (Boylan et al., 2003). This list is not exhaustive but illustrates that health disparities for undocumented Latinas are the result of a combination of multiple mechanisms, and the impact of the totality of these factors must be understood in order to truly address poor health outcomes in this population.

Critical feminism understands oppression as the product of neoliberalism, defined as economic and social policies designed to promote the growth of financial markets and capital through the deregulation of banking, businesses, and trade as well as privatization of health care and the diminution of the social welfare state (Harvey, 2007; Mattsson, 2014; Piven, 2001). Although proponents of neoliberal economic policies argue that women are free to advance themselves in an unfettered market economy, labor statistics show that women are largely disadvantaged in this system: As noted in a recent analysis by Ross and Bateman (2019), 49% of women earn low wages compared to 39% of men. Related to critical feminism is the idea of intersectionality. Intersectionality can be understood as an exploration of how gender, race, and class become intertwined and reinforce oppression because of disadvantaged positions within the processes of neoliberalism (Davis, 2008; de los Reyes & Mulinari, 2020). The concept of intersectionality examines how the interaction of multiple identities within the context of the economy, social policies and systems such as health care, intersect and inform experiences of exclusion and subordination (Davis, 2008). For example, global retailers and transnational corporations have increasingly relied on the work of women in such industries as textile mills in countries where extreme poverty-level wages are common. Such working conditions compel migration although undocumented Latinas routinely find themselves working for penury wages once they reach the United States. A recent analysis by the Economic Policy Institute found that Latinas must work 11 months longer to earn pay equivalent to their male counterparts (Gould, 2019). “Unfortunately, Hispanic women are subject to a double pay gap—an ethnic pay gap and a gender pay gap” (Gould, 2019, para. 1).

Thus, undocumented Latina immigrants experience a unique social position characterized by discrimination because of immigration status, poverty, and language barriers (Fuchsel et al., 2016; Messing et al., 2015; Reina et al., 2014). Further, critical feminism acknowledges that the population in question here—undocumented Latina immigrants—finds itself in a unique and compromised position by virtue of globalization and the market economy (Mattsson, 2014). Many have been forced to migrate from their countries of origins without legal status by virtue of shifts in the market economy that have caused economic displacement and compelled global migration. The shifts in the economy that necessitated migration without authorization placed undocumented Latinas in a web of psychosocial stressors that include familial obligations, low-waged work in the service economy, and inadequate access to health care (Eggerth et al., 2012).

This article delineates the multiple factors and stressors that have accumulated in 2020 to impact the health of Latina immigrants in the United States as they cope with uncertainty with respect to immigration status (Menjivar, 2006) as well as accumulated assaults to health that disproportionately effect certain vulnerable populations (Krieger, 1999). In what follows, we examine the unique stressors faced by this population, including lack of access to health care during the pandemic, low-waged work often in industries deemed essential, and risk for domestic violence followed by recommendations for social work.

Health Care Stressors

The COVID-19 pandemic has highlighted the health care disparities that exist in the United States, including those that impact Latinos (Capps & Gelatt, 2020; Kaiser Family Foundation (KFF), 2020; Rodriguez-Diaz et al., 2020). At a time when access to COVID-19 testing and treatment has proven necessary, many immigrants do not have health insurance and are not eligible for Medicaid, the primary public health insurance program. Furthermore, as millions of workers lose their jobs, they often lose their employer-provided health insurance plans. According to an analysis by the KFF (2020), 23% of legally present immigrants and 45% of undocumented immigrants were uninsured. That compares to only 9% of American citizens (KFF, 2020). Capps and Gelatt (2020) estimated that pre-COVID-19, under 4% unemployment, 7.7 million noncitizens did not have public or private health insurance, representing 27% of the total U.S. uninsured population. In a worst-case scenario where unemployment hits 25%, as many as 10.8 million noncitizens would be uninsured.

While undocumented immigrants are categorically not eligible for federally funded Medicaid and Children’s Health Insurance Program (CHIP), even lawfully present immigrants are subject to eligibility restrictions. “Green card holders” must wait 5 years to enroll in Medicaid. Although refugees and asylees do not have a 5-year wait, immigrants with temporary protected status are ineligible for Medicaid or CHIP regardless of their time in the United States (Capps & Gelatt, 2020; Kaiser, 2020). These analyses did not disaggregate females or immigrants by ethnicity or country of origin, but the statistics do illustrate the vulnerability of undocumented Latinas. Without legal status and working in low-waged jobs, undocumented Latinas are unlikely to have access to health coverage and care. Krieger (1999) notes that health adverse outcomes are also informed by cumulative exposure to discrimination. For Latina immigrants, the threat of deportation as well as microaggressions such as experiencing racist behavior are examples of such exposures.

New government policies targeting immigrants create additional complications for undocumented Latinas and others seeking medical care during a global pandemic. For example, the Trump Administration’s new “public charge” policy might constitute an additional threat to health and health care access if it is allowed to move forward under the Biden presidency. Under the Trump guidelines, which have been challenged in the courts, immigrants who earn less than 125% of the federal poverty threshold and/or who apply for public assistance such as Medicaid could be deemed a public charge, which would make them ineligible to renew a visa or to adjust to legal permanent resident (“green card”) status or other immigration benefits. Because of its breadth, this new interpretation of public charge would impact undocumented and lawfully present immigrants as well as individuals who have not immigrated yet. If this rule is allowed to be implemented, the chilling effect on immigrants seeking COVID-19 testing would be yet another stressor on Latinas. In a recent successful challenge to the new rule, U.S. District Judge George Daniels stated, “As a result of the rule, immigrants are forced to make an impossible choice between jeopardizing public health and personal safety or their immigration status” (Narea, 2020b).

At a time when Latinas may lack access to health insurance and may fear that using health services may have a negative impact on their immigration status, the high rates of COVID-19 cases in the Latina community are not unsurprising. As a comparative example of the impact of stress, a recent study by epidemiologists in Iowa following a 2008 immigration raid (Novak et al., 2017) found that Latinas had a 34% higher probability of having low-birth-weight infants compared to whites in the same 37-week interval following the raid. Researchers posited that stress from this raid contributed to low birth weights.

Work Stressors

Throughout the COVID-19 crisis, while Americans are encouraged to stay home, many Latinas continue to care for the sick; provide childcare; harvest, transport, and prepare food; clean hospitals and other buildings; deliver food; and fill other vital roles. Immigrant women are overrepresented in many of the occupations within the industries vital to the COVID-19 response including home health aides and medical assistants, pharmacy technicians, and cashiers. Many are working in less-than-ideal conditions; they must be in close contact with the sick and/or with the general public. These workers must often risk their own health and that of their families in order to care for the sick, elderly, and disabled. Rodriguez-Diaz et al. (2020) found that occupational exposure was an important factor in Latino COVID rates. A greater share of Latinos are of prime working age and are overrepresented in workplaces that are deemed “essential” and where it is difficult to isolate. Monolingual Spanish speakers were also found likely to have higher rates of COVID-19 cases but not higher death rates. Again, these monolingual Spanish speakers are more likely to work in occupations where they experience more potential exposure to COVID.

Among Latino essential workers, undocumented workers are particularly vulnerable. Undocumented immigrants make up approximately 5% of the U.S. workforce but account for a significant share of essential workers, making them vulnerable in terms of their physical and economic health (Kerwin et al., 2020). The Center for Migration Studies estimated that pre-COVID, approximately 850,000 unauthorized immigrants worked in restaurants; 311,000 worked in agriculture and farms; 268,000 were building cleaners, 194,000 worked in food processing and manufacturing, 137,000 worked in hotels and other accommodations, and 103,000 worked in warehousing, distribution, and fulfillment of online orders (Kerwin et al., 2020). According to Passell and Cohn (2018), 24% of all workers in farming, fishing, and forestry occupations were unauthorized immigrants. Unauthorized immigrants also make up a disproportionately high share of workers in service, transportation, and production occupations. Because they lack legal work authorization, undocumented workers tend to be poorly paid and lack benefits such as sick leave, health insurance, and unemployment insurance, leaving them particularly vulnerable during times of economic distress.

While exposing themselves and their families to the same danger, Latinas in these jobs likely make less than other similarly situated workers. Studies have found that Latinas earn considerably less than white non-Latino males, making as little as 53 cents on the dollar; the pay disparity narrows slightly when controlling for education levels, and Latino men make an average of 66 cents on the dollar (Gould, 2019). Undocumented immigrant women face additional obstacles in the U.S. labor market; scholars have found that they are concentrated in a few highly disadvantaged occupations, are more likely to work part-time, and earn less than white non-Latina, native Latina, and immigrant Latino males, regardless of education and experience (Catanzarite & Aguilera, 2002).

Not only are undocumented immigrant workers more likely to be exposed to COVID in “essential” jobs while earning less, but they are also more likely to experience unemployment. The Migration Policy Institute (MPI) identified seven industries facing major layoffs due to the COVID-19 economic downturn (Gelatt, 2020). Immigrant women account for more than half of all immigrant workers in these hard-hit industries and are concentrated in certain including maids and housekeepers, waiters and waitresses, food preparation workers, fast-food workers, and manicurists and pedicurists. MPI further found that among Latinos, foreign-born Latinas experienced the highest unemployment rate—22%—of any group, in April 2020 (Capps et al., 2020). U.S.-born Latinas suffered 20% unemployment. In contrast, foreign-born Latino men experienced 17% and U.S.-born white men experienced 11% unemployment (Capps et al., 2020).

Immigrants in the hardest hit industries are more likely than their native-born counterparts to live in low-income households, lack health insurance, and have a minor child living at home (Gelatt, 2020). Despite their level of hardship, they may be ineligible for many existing safety-net programs and may be ineligible to benefit from the relief provided by the Coronavirus Aid, Relief, and Economic Security (CARES) Act (Narea, 2020a). This law also denied aid to approximately 18.3 million individuals living in “mixed-status” households if one member of the family lacked an SSN (Kerwin et al., 2020).

Domestic Violence Stressors

Several organizations have reported that stay-at-home orders may result in increased incidents of domestic violence (Cone, 2020; Landis, 2020). For many, the home is not a safe environment, and for immigrant women, the situation may be even more complex as abusers able to use immigration status to control their partners (Menjivar & Salcido, 2002). Immigrant women may be dependent on their spouses to remain in status as a dependent or obtain a green card through a family relationship. Even in cases where all individuals are undocumented, an abusive individual can use the threat of immigration enforcement against a vulnerable partner or family member. Immigrant victims of domestic abuse are often hesitant or fearful to report the abuse out of fear of exposing the immigration status of herself or the abuser. Prior to the pandemic, in the context of increased immigration enforcement by the Trump Administration, Houston’s police chief Art Acevedo reported a 16% drop in domestic violence reports from the Latino community in that city. During the COVID-19 crisis, it may be even more difficult for an abused immigrant to leave the home and find shelter elsewhere, and even under the best of conditions, it is difficult to find linguistically and culturally appropriate shelters and assistance. It is critical to note here that transgender/nonbinary populations may be at particular risk during the pandemic. Even before COVID-19 escalated risk for undocumented Latinas, a national survey by the National Center for Transgender Equality (2015) of Latino/Latina respondents (n = 27,715) found that 54% of respondents had suffered some form of interpersonal violence in relationships.

Recommendations for Social Work

As is evident by the disproportionate disease and mortality burden borne by Latinas in the United States in the wake of the COVID-19 pandemic, this population’s social location renders in uniquely vulnerable. Work in essential occupations, a lack of affordable and accessible health care, ineligibility for the coronavirus stimulus program, potential victimization in the home, and the threat of deportation are psychosocial stressors for a population that also must now face the threat of infection and possible mortality. Social workers have the opportunity to mobilize for needed reform by aligning with the organizing the Latina community has led for years and joining forces with community-led efforts (Alvarez, 2020; Menjivar, 2006; Shapiro, 2014; Silliman et al., 2016). One example for partnership is Cosecha, an immigrant rights organization that was established in 2015 to organize boycotts against companies that do business with U.S. Immigration and Customs Enforcement as well as advocacy on other issues including immigrant rights to obtain driver’s licenses.

In its Ethical Standard 6.02, the National Association of Social Workers (NASW, 2008) notes that voting is an essential function that social workers should use to shape policy, although engagement should not end there. “The embodiment of standard 6.02 in the political process is to influence traditionally disenfranchised populations to go to the polls and vote” (National Association of Social Workers, 2008, para. 1). As this statement implies, social workers should aim to shape policy. Although immigrants are not among the disenfranchised populations who can vote, social workers can engage in efforts to ensure that voters who support pro-immigration rights candidates go to the polls.

Although U.S. Citizenship and Immigration Services recently released a statement promising that immigrants seeking treatment for COVID-19 would not be counted for consideration as a public charge in determining eligibility for legal permanent residency, it is plausible that many might not be aware of this position or would be skeptical, given the anti-immigrant tenor of the former Trump Administration. Advocacy for needed reforms could include the repeal of discriminatory policies to include rolling back the public charge order. Similarly, social work advocacy should address the discrimination embedded in the prohibition against federal tax rebate through the CARES Act and push for individuals living in mixed-status families to be included in future relief efforts. Similarly, social work advocacy should address the discrimination embedded in the prohibition against federal tax rebate through the CARES Act, which denied a stimulus check to Americans who happen to live in “mixed-status” households.

This discussion has also noted the fact that many Latina workers do jobs that pay poorly, including work in facilities such as nursing homes. Although some states and cities with high cost of living have incrementally raised minimum wages, such as San Francisco with a $12.25 minimum wage, others including Kentucky and Louisiana retain the federal standard at a paltry $7.25 per hour (Bernstein & Spielberg, 2016). A meta-analysis of 200 studies found strong evidence that raising the minimum wage not only helps families escape poverty but typically proves disproportionately beneficial to women, who are disproportionately represented in low-paying jobs (Belman & Wolfson, 2014). As the term “essential worker” implies, economic policies such as the minimum wage should reflect these workers needed roles in the economy, regardless of COVID-19. A living wage may also help alleviate domestic violence in some situations; women might feel more empowered to leave an abusive situation if they at least knew their wages would sustain them.

Finally, social workers should advocate for a path to legal status for undocumented immigrants. Although on its face, such a proposal may seem untenable, it does in fact have legal precedence. The Immigration Reform and Control Act of 1986 allowed 2.7 of 3 million undocumented immigrants who applied to receive legal status through an amnesty program. Although the law also provided for felony charges for employers who knowingly hire undocumented immigrants, it created a pathway to legalization. Those granted amnesty showed earnings growth, and a third of them had become American citizens by 2001 (Rytina, 2002).

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Carol Cleaveland

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COVID-19: Threat and Vulnerability Among Latina Immigrants

Abstract

Keywords

Theoretical Considerations

Health Disparities as an Accumulation of Assaults

Health Care Stressors

Work Stressors

Domestic Violence Stressors

Recommendations for Social Work

Footnotes

Declaration of Conflicting Interests

Funding

ORCID iD

References