Sage Journals: Discover world-class research

Abstract

Many immigrants lose healthcare access postpartum including contraceptive methods and management. Community health centers (CHCs) fill gaps in preventive healthcare access for uninsured, but the transition from hospital to community settings for immigrants is complex and not well described. While parental healthcare access diminishes postpartum, infants have frequent pediatric visits during the first year of life. The pediatric office can offer a family-centered approach to care for immigrant parents with diverse cultural backgrounds and lived experiences. Our primary study goal was to describe family planning navigation experiences among recently postpartum immigrant Latine with contraceptive needs using the Levesque conceptual framework of healthcare access. Our secondary goal was to explore the perception of the pediatrician in family planning navigation. We conducted semi-structured interviews in Spanish with 19 mothers at an urban pediatric practice. Our results centered around five themes: there is no standard process of obtaining information about CHCs postpartum; the pediatrician is a trusted information source, but displacing time for child-focused needs is a concern; structural barriers impede family planning goals; lack of health insurance affects autonomy in contraceptive decision making; and CHC care is satisfactory when accessible. Postpartum Latine immigrants receive inconsistent information about CHC resources for family planning and face barriers to their contraceptive goals. Pediatricians are considered trusted sources for family planning information. Bridging gaps in contraceptive access can include up-to-date CHC resources, resource navigators, interventions in pediatric settings, and broader insurance coverage.

Keywords

Latina immigrant healthcare access contraceptive access maternal health

Get full access to this article

View all access options for this article.

References

AAP . (2023). Equitable access to sexual and reproductive health care for all youth. https://www.aap.org/en/patient-care/adolescent-sexual-health/equitable-access-to-sexual-and-reproductive-health-care-for-all-youth/?srsltid=AfmBOooMTyzWeWSDFeK-oMRY9nl-oFNSFgy0rqJbBFS2F-jYUir_Git6

ACOG . (2018). Importance of social determinants of health and cultural awareness in the delivery of reproductive health care: ACOG committee opinion.

ACOG . (2024). Policy priorities family planning. https://www.acog.org/advocacy/policy-priorities/family-planning

Asamoa

Rodriguez

Ginés

Varela

Dominguez

Mills

C. G.

Sotomayor

Beck-Sagué

C. M.

(2004). Report from the CDC. Use of preventive health services by Hispanic/Latino women in two urban communities: Atlanta, Georgia and Miami, Florida, 2000 and 2001. Journal of Women’s Health, 13(6), 654–661. https://doi.org/10.1089/jwh.2004.13.654

Batalova

(2024). Frequently requested statistics on immigrants and immigration in the United States. Migration Policy Institute. https://www.migrationpolicy.org/article/frequently-requested-statistics-immigrants-and-immigration-united-states#children-immigrants

Brehon

Miciak

Hung

Chen

S. P.

Perreault

Hudon

Wieler

Hunter

Hoddinott

Hall

Churchill

Brown

D. A.

Brown

C. A.

Bostick

Skolnik

Lam

Weatherald

Gross

D. P.

(2023). “None of us are lying”: An interpretive description of the search for legitimacy and the journey to access quality health services by individuals living with long COVID. BMC Health Services Research, 23(1), Article 1396. https://doi.org/10.1186/s12913-023-10288-y

Broder

(2024). Health care coverage (maps). National Immigration Law Center. https://www.nilc.org/resources/healthcoveragemaps/

Caballero

T. M.

Bou Delgado

Upadhya

Johnson

S. B.

DeCamp

L. R.

(2021). Mi Familia Entera: Contraceptive use among Spanish-speaking mothers of young children. Maternal and Child Health Journal, 26(1), 139–148. https://doi.org/10.1007/s10995-021-03300-6

Carvajal

D. N.

Gioia

Mudafort

E. R.

Brown

P. B.

Barnet

(2017). How can primary care physicians best support contraceptive decision making? A qualitative study exploring the perspectives of Baltimore Latinas. Women’s Health Issues, 27(2), 158–166. https://doi.org/10.1016/j.whi.2016.09.015

10.

Caskey

Stumbras

Rankin

Osta

Haider

Handler

(2016). A novel approach to postpartum contraception: a pilot project of Pediatricians’ role during the well-baby visit. Contraception and Reproductive Medicine, 1–7. https://doi.org/10.1186/s40834-016-0018-1

11.

Coleman-Minahan

Potter

J. E.

(2019). Quality of postpartum contraceptive counseling and changes in contraceptive method preferences. Contraception, 100(6), 492–497. https://doi.org/10.1016/j.contraception.2019.08.011

12.

Coley

(2012). New baby in a new country: Supporting local immigrant pregnant mothers through “moms matter”. International Journal of Childbirth Education, 27(2), 57–62. https://www.proquest.com/scholarly-journals/new-baby-country-supporting-local-immigrant/docview/1039290725/se-2

13.

Committee on Hospital Care Institute For Patient- and Family-Centered Care . (2012). Patient- and family-centered care and the pediatrician’s role: Committee on hospital care. Pediatrics, 129(2), 394–404. https://doi.org/10.1542/peds.2011-3084

14.

Congdon

J. L.

Trope

L. A.

Bruce

J. S.

Chung

P. J.

Dehlendorf

Chamberlain

L. J.

(2020). Meeting the needs of postpartum women with and without a recent preterm birth: Perceptions of maternal family planning in pediatrics. Maternal and Child Health Journal, 24(3), 378–388. https://doi.org/10.1007/s10995-019-02829-x

15.

Cook

R. J.

Dickens

B. M.

(2009). From reproductive choice to reproductive justice. International Journal of Gynaecology & Obstetrics, 106(2), 106–109. https://doi.org/10.1016/j.ijgo.2009.03.018

16.

Darney

B. G.

Jacob

R. L.

Hoopes

Rodriguez

M. I.

Hatch

Marino

Templeton

Oakley

Cottrell

E. K.

(2020). Evaluation of Medicaid expansion under the Affordable Care Act and contraceptive care in US community health centers. JAMA Network Open, 3(6), Article e206874. https://doi.org/10.1001/jamanetworkopen.2020.6874

17.

Dehlendorf

Grumbach

Schmittdiel

J. A.

Steinauer

(2017). Shared decision making in contraceptive counseling. Contraception, 95(5), 452–455. https://doi.org/10.1016/j.contraception.2016.12.010

18.

Dobkin

L. M.

Gould

Barar

R. E.

Ferrari

Weiss

E. I.

Foster

D. G.

(2014). Implementing a prospective study of women seeking abortion in the United States: Understanding and overcoming barriers to recruitment. Women’s Health Issues, 24(1), e115–e123. https://doi.org/10.1016/j.whi.2013.10.004

19.

Downey

M. M.

Arteaga

Villaseñor

Gomez

A. M.

(2017). More than a destination: Contraceptive decision making as a journey. Women’s Health Issues, 27(5), 539–545. https://doi.org/10.1016/j.whi.2017.03.004

20.

DuBard

C. A.

Massing

M. W.

(2007). Trends in emergency Medicaid expenditures for recent and undocumented immigrants. JAMA, 297(10), 1085–1092. https://doi.org/10.1001/jama.297.10.1085

21.

Eide

K. T.

Morken

N. H.

Bærøe

(2020). Tensions and interplay: A qualitative study of access to patient-centered birth counseling of maternal cesarean requests in Norway. Midwifery, 88, Article 102764. https://doi.org/10.1016/j.midw.2020.102764

22.

Fortuna

L. R.

Noroña

C. R.

Porche

M. V.

Tillman

Patil

P. A.

Wang

Markle

S. L.

Alegría

(2019). Trauma, immigration, and sexual health among Latina women: Implications for maternal-child well-being and reproductive justice. Infant Mental Health Journal, 40(5), 640–658. https://doi.org/10.1002/imhj.21805

23.

Frost

J. J.

Sonfield

Zolna

M. R.

Finer

L. B.

(2014). Return on investment: A fuller assessment of the benefits and cost savings of the US publicly funded family planning program. The Milbank Quarterly, 92(4), 696–749. https://doi.org/10.1111/1468-0009.12080

24.

Fuentes-Afflick

Perrin

J. M.

Moley

K. H.

Díaz

Á.

McCormick

M. C.

(2021). Optimizing health and well-being for women and children. Health Affairs, 40(2), 212–218. https://doi.org/10.1377/hlthaff.2020.01504

25.

GMR Transcription Services . (2025). https://www.gmrtranscription.com/

26.

Gomez

A. M.

Mann

E. S.

Torres

(2017). ‘It would have control over me instead of me having control’: Intrauterine devices and the meaning of reproductive freedom. Critical Public Health, 28(2), 190–200. https://doi.org/10.1080/09581596.2017.1343935

27.

Gregory

E. F.

Upadhya

K. K.

Cheng

T. L.

Psoter

K. J.

Mistry

K. B.

(2020). Enabling factors associated with receipt of interconception health care. Maternal and Child Health Journal, 24(3), 275–282. https://doi.org/10.1007/s10995-019-02850-0

28.

Harris

Sivamurthy

Mohiuddin

Aguila Gonzalez

Bui

Andrews

Cohen

McConnell

Ahlers-Schmidt

(2020). Contraceptive counseling in the postpartum period: Could pediatricians have a role? Maternal and Child Health Journal, 24(7), 923–931. https://doi.org/10.1007/s10995-020-02947-x

29.

Hainmueller

Lawrence

Martén

Black

Figueroa

Hotard

Jiménez

T. R.

Mendoza

Rodriguez

M. I.

Swartz

J. J.

Laitin

D. D.

(2017). Protecting unauthorized immigrant mothers improves their children’s mental health. Science, 357(6355), 1041–1044. https://doi.org/10.1126/science.aan5893

30.

Hasstedt

Desai

Ansari-Thomas

(2018). Immigrant women’s access to sexual and reproductive health coverage and care in the United States. The Commonwealth Fund.

31.

KFF . (2023). State-funded health coverage for immigrants as of July 2023. https://www.kff.org/racial-equity-and-health-policy/fact-sheet/state-funded-health-coverage-for-immigrants-as-of-july-2023/

32.

Kumaraswami

Rankin

K. M.

Lunde

Cowett

Caskey

Harwood

(2018). Acceptability of postpartum contraception counseling at the well baby visit. Maternal and child Health Journal, 22(11), 1624–1631. https://doi.org/10.1007/s10995-018-2558-2

33.

Levesque

J.-F.

Harris

M. F.

Russell

(2013). Patient-centred access to health care: Conceptualising access at the interface of health systems and populations. International Journal for Equity in Health, 12(1), Article 18. https://doi.org/10.1186/1475-9276-12-18

34.

Liu

Chao

M. T.

Jostad-Laswell

Duncan

L. G.

(2017). Does centering pregnancy group prenatal care affect the birth experience of underserved women? A mixed methods analysis. Journal of immigrant and minority health, 19(2), 415–422. https://doi.org/10.1007/s10903-016-0371-9

35.

Lloyd

Davis

Moses

(2020). Recognizing and sustaining the value of community health workers and promotores. Center for Health Care Strategies, 13.

36.

Logan

R. I.

Castañeda

(2020). Addressing health disparities in the rural united states: advocacy as caregiving among community health workers and promotores de Salud. International Journal of Environmental Research and Public Health, 17(24), 9223. https://doi.org/10.3390/ijerph17249223

37.

Merriam-Webster . (2025). Latine. https://www.merriam-webster.com/dictionary/Latine

38.

Migration Policy Institute . (2019). Migration Policy Institute (MPI) profile of the unauthorized population: United States. Analysis of US Census Bureau data from pooled 2015-19. American Community Survey. https://www.migrationpolicy.org/data/unauthorized-immigrant-population/state/US

39.

Noe-Bustamante

Moslimani

(2023). Facts on Latinos in the U.S. Pew Research Center. https://www.pewresearch.org/hispanic/fact-sheet/latinos-in-the-us-fact-sheet/#:∼:text=TableofContents&text=Therewere62.5millionLatinos,ofhetotalU.S.population

40.

Oldfield

B. J.

Rosenthal

M. S.

Coker

T. R.

(2020). Update on the feasibility, acceptability, and impact of group well-child care. Academic Pediatrics, 20(6), 731–732. https://doi.org/10.1016/j.acap.2020.02.029

41.

Palmer-Wackerly

A. L.

Chaidez

Wayment

Baker

Adams

Wheeler

L. A.

(2019) Listening to the voices of community health workers: a multilevel, culture-centered approach to overcoming structural barriers in U.S. Latinx communities. Qualitative Health Research, 30(3):423–436. https://doi.org/10.1177/1049732319855963

42.

Pereira

K. C.

Fortuny

Pedroza

J. M.

Ulvestad

Weiland

(2012). Barriers to immigrants access to health and human services program. https://aspe.hhs.gov/reports/barriers-immigrants-access-health-human-services-programs-0#climates

43.

Pillai

Artiga

(2024). State health coverage for immigrants and implications for health coverage and care. https://www.kff.org/racial-equity-and-health-policy/issue-brief/state-health-coverage-for-immigrants-and-implications-for-health-coverage-and-care/

44.

Platt

R. E.

Acosta

Stellmann

Sloand

Caballero

T. M.

Polk

Wissow

L. S.

Mendelson

Kennedy

C. E.

(2022). Addressing psychosocial topics in group well-child care: A multi-method study with immigrant latino families. Academic pediatrics, 22(1), 80–89. https://doi.org/10.1016/j.acap.2021.05.001

45.

Potter

J. E.

Hopkins

Aiken

A. R.

Hubert

Stevenson

A. J.

White

Grossman

(2014). Unmet demand for highly effective postpartum contraception in Texas. Contraception, 90(5), 488–495. https://doi.org/10.1016/j.contraception.2014.06.039

46.

Potter

J. E.

Hubert

Stevenson

A. J.

Hopkins

Aiken

A. R.

White

Grossman

(2016). Barriers to postpartum contraception in Texas and pregnancy within 2 years of delivery. Obstetrics & Gynecology, 127(2), 289–296. https://doi.org/10.1097/aog.0000000000001201

47.

Pullyblank

Scribani

Krupa

Chapman

Kern

Brunner

(2023). Exploring multiple dimensions of access to and preferences for Telehealth use. Telemedicine Reports, 4(1), 348–358. https://doi.org/10.1089/tmr.2023.0049

48.

Rao

Rocca

C. H.

Muñoz

Chambers

B. D.

Devaskar

Asiodu

I. V.

Stern

Blum

Comfort

A. B.

Harper

C. C.

(2023). “She should support me, she’s my doctor:” Patient perceptions of agency in contraceptive decision-making in the clinical encounter in Northern California. Perspectives on Sexual and Reproductive Health, 55(2), 94–103. https://doi.org/10.1363/psrh.12226

49.

Redd

S. K.

Hall

K. S.

Aswani

M. S.

Sen

Wingate

Rice

W. S.

(2022). Variation in restrictive abortion policies and adverse birth outcomes in the United States from 2005 to 2015. Women’s Health Issues, 32(2), 103–113. https://doi.org/10.1016/j.whi.2021.10.006

50.

Rodríguez

M. A.

Bustamante

A. V.

Ang

(2009). Perceived quality of care, receipt of preventive care, and usual source of health care among undocumented and other Latinos. Journal of General Internal Medicine, 24(Suppl 3), 508–513. https://doi.org/10.1007/s11606-009-1098-2

51.

Rogers

H. J.

Hogan

Coates

Homer

C. S. E.

Henry

(2020). Responding to the health needs of women from migrant and refugee backgrounds—Models of maternity and postpartum care in high‐income countries: A systematic scoping review. Health and Social Care in the Community, 28(5), 1343–1365. https://doi.org/10.1111/hsc.12950

52.

Saloner

Wilk

A. S.

Levin

(2019). Community health centers and access to care among underserved populations: A synthesis review. Medical Care Research and Review, 77(1), 3–18. https://doi.org/10.1177/1077558719848283

53.

Shi

Stevens

G. D.

(2007). The role of community health centers in delivering primary care to the underserved: Experiences of the uninsured and Medicaid insured. The Journal of Ambulatory Care Management, 30(2), 159–170. https://doi.org/10.1097/01.JAC.0000264606.50123.6d

54.

Snyder

A.H.

Weisman

Leslie

Chuang

C.H.

(2018). The impact of the affordable care act on contraceptive use and costs among privately insured women. Womens Health Issues, 28(3), 219–223. https://doi.org/10.1016/j.whi.2018.01.005

55.

Solinger

Ross

(2017). Reproductive justice: An introduction. University of California Press.

56.

Spencer

J. C.

Noel

Shokar

N. K.

Pignone

M. P.

(2023). Understanding the role of access in Hispanic cancer screening disparities. Cancer, 129(10), 1569–1578. https://doi.org/10.1002/cncr.34696

57.

Srinivasan

(2019). Well-child visits provide physicians opportunity to deliver interconception care to mothers. American Family Physician, 99(12), Article 731. https://www.aafp.org/afp/2019/0615/p731a.pdf

58.

Steenland

M. W.

Fabi

R. E.

Bellerose

Desir

White

M. S.

Wherry

L. R.

(2023). State public insurance coverage policies and postpartum care among immigrants. JAMA, 330(3), 238–246. https://doi.org/10.1001/jama.2023.10249

59.

Tapales

Douglas-Hall

Whitehead

(2018). The sexual and reproductive health of foreign-born women in the United States. Contraception, 98(1), 47–51. https://doi.org/10.1016/j.contraception.2018.02.003

60.

Torres

M. E.

Smithwick-Leone

Willms

Franco

M. M.

McCandless

Lohman

(2013). Developing a culturally appropriate preconception health promotion strategy for newly immigrated Latinos through a community-based program in South Carolina. American Journal of Health Promotion, 27(3 Suppl), S7–S9. https://doi.org/10.4278/ajhp.120117-CIT-42

61.

Trope

L. A.

Congdon

J. L.

Bruce

J. S.

Chung

P. J.

Dehlendorf

Chamberlain

L. J.

(2022). Meeting the needs of postpartum women: Provider perspectives on maternal contraceptive care in pediatric settings. Academic Pediatrics, 23(4), 821–828. https://doi.org/10.1016/j.acap.2022.08.013

62.

Tully

K. P.

Stuebe

A. M.

Verbiest

S. B.

(2017). The fourth trimester: a critical transition period with unmet maternal health needs. American Journal of Obstetrics and Gynecology, 217(1), 37-41. https://doi.org/10.1016/j.ajog.2017.03.032

63.

Tunison

(2023). Content analysis. In Mola Okoko

Tunison

Walker

K. D.

(Eds.), Varieties of qualitative research methods (pp. 85–90). Springer. https://doi.org/10.1007/978-3-031-04394-9_14

64.

Upadhya

K. K.

Burke

A. E.

Marcell

A. V.

Mistry

Cheng

T. L.

(2015). Contraceptive service needs of women with young children presenting for pediatric care. Contraception, 92(5), 508–512. https://doi.org/10.1016/j.contraception.2015.07.004

65.

Venkataramani

Cheng

T. L.

Solomon

B. S.

Pollack

C. E.

(2017). Addressing parental health in pediatrics: Physician perceptions of relevance and responsibility. Clinical Pediatrics, 56(10), 953–958. https://doi.org/10.1177/0009922817705189

66.

Verbiest

Bonzon

Handler

(2016). Postpartum health and wellness: A call for quality woman-centered care. Maternal and Child Health Journal, 20(Suppl 1), 1–7. https://doi.org/10.1007/s10995-016-2188-5

67.

Wolff

McHugh

Qadir

Lassar

Tao

Stulberg

D. B.

(2024). Reproductive care in community health centers: Multi-method evaluation of the Illinois Contraceptive Access Now (ICAN!) demonstration program. Contraception, 129, Article 110305. https://doi.org/10.1016/j.contraception.2023.110305

68.

WHO . (2021). World Health Organization 6 priorities for women and health. https://www.who.int/news-room/spotlight/6-priorities-for-women-and-health

69.

Young

M.-E. D. T.

Madrigal

D. S.

(2017). Documenting legal status: A systematic review of measurement of undocumented status in health research. Public Health Reviews, 38(1), Article 26. https://doi.org/10.1186/s40985-017-0073-4

Latina Immigrants’ Experiences Accessing Contraceptive Services Beyond the Postpartum Period and the Role of Community and Pediatric Settings

Abstract

Keywords

Get full access to this article

References