Restricted accessResearch articleFirst published online 2025
Understanding the Impacts of Immigration Status on Access to Primary Healthcare Services: Evidence From the Lived Experiences of Ethiopian Immigrant Women in the United States
Health inequity is a significant and pressing concern in the United States, and multiple studies showed that immigrants are one of the groups with the poorest access to healthcare compared to native-born populations. This study focuses on developing an in-depth understanding of how immigration status impacts primary healthcare (PHC) access among African immigrant women, particularly Ethiopian immigrant women (EIW).
Design
A cross-sectional qualitative design was used to examine how immigration status shaped the healthcare experiences of EIW. In-depth interviews were conducted with 21 EIW in-person and virtually. The interviews were audio recorded and transcribed verbatim. Data analysis followed an inductive thematic analysis using NVivo 12 software.
Results
Four major themes emerged from the analysis, demonstrating how immigration and immigration status shape EIW’s healthcare access and experiences. These were: (1) Employment-based insurance, (2) Eligibility for primary healthcare services, (3) Work conditions and time, and (4) Fear of losing status and the unknown. Across all themes, participants’ experiences were deeply gendered and tied to broader labor and sociocultural conditions, highlighting the vitality of immigration status in determining healthcare access.
Conclusion
The findings demonstrated the crucial need to expand work authorization to all immigrant groups, streamline the application process, and extend document validity to mitigate healthcare access barriers and prevent immigrants from taking low-wage, unprotected, and hazardous jobs that heighten health risks. Expanding eligibility to different groups of immigrants for programs such as Medicaid and Children’s Health Insurance Program, and providing clear, comprehensive healthcare information tailored for immigrant populations are recommended.
FuentesLDesaiSDawsonR. New analyses on us immigrant health care access underscore the need to eliminate discriminatory policies. Guttmacher Institute, 2022. DOI: 10.1363/2022.33551.
AborodeATLawalLAgwunaFO, et al.Health disparities among illegal immigrants and homeless people in the USA: a struggle within. IJS Global Health2023; 6(6): e0362. DOI: 10.1097/GH9.0000000000000362.
5.
Woo BaidalJVachonMEHernandezA, et al.Health disparities among children in immigrant households: New York city 2009 and 2017. J Immigr Minority Health2024. DOI: 10.1007/s10903-024-01588-4.
6.
CastañedaHHolmesSMMadrigalDS, et al.Immigration as a social determinant of health. Annu Rev Publ Health2015; 36: 375–392. DOI: 10.1146/annurev-publhealth-032013-182419.
7.
ChangCD. Social determinants of health and health disparities among immigrants and their children. Curr Probl Pediatr Adolesc Health Care2019; 49(1): 23–30. DOI: 10.1016/j.cppeds.2018.11.009.
8.
MarmotM. Social determinants of health inequalities. Lancet2005; 365(9464): 1099–1104. DOI: 10.1016/S0140-6736(05)71146-6.
9.
DuYXuQ. Health disparities and delayed health care among older adults in California: a perspective from race, ethnicity, and immigration. Public Health Nurs2016; 33(5): 383–394. DOI: 10.1111/phn.12260.
10.
Commodore-MensahYSelvinEAboagyeJ, et al.Hypertension, overweight/obesity, and diabetes among immigrants in the United States: an analysis of the 2010-2016 National Health Interview Survey. BMC Public Health2018; 18(1): 773. DOI: 10.1186/s12889-018-5683-3.
11.
OkoroONWhitsonSO. Sexual health, HIV care and pre-exposure prophylaxis in the african immigrant population: a needs assessment. J Immigr Minority Health2020; 22(1): 134–144. DOI: 10.1007/s10903-019-00873-x.
12.
SabriB (2018). Perspectives on factors related to HIV risk and preventative interventions at multiple levels: a study of african immigrant women survivors of cumulative trauma, AIDS Educ Prev30(5): 419–433. DOI: 10.1521/AEAP.2018.30.5.419.
13.
TeferaGM. Exploring perceptions, barriers, and facilitators of access to primary health services among African immigrant women in the U.S.: a study of Ethiopian immigrant women. [Thesis]. University of Missouri--Columbia, 2023. DOI: 10.32469/10355/96126.
14.
AdigunSBarrosoCMixerS, et al.Minding the gaps: health care access for foreign-born people in the U.S.: an integrative review. J Health Care Poor Underserved2021; 32(4): 1653–1674.
15.
Gil-GonzálezDCarrasco-PortiñoMVives-CasesC, et al.Is health a right for all? An umbrella review of the barriers to health care access faced by migrants. Ethn Health2015; 20(5): 523–541. DOI: 10.1080/13557858.2014.946473.
16.
NgondwePTeferaGM. Barriers and facilitators of access to healthcare among immigrants with disabilities: a qualitative meta-synthesis. Healthcare2025; 13(3): 3. DOI: 10.3390/healthcare13030313.
17.
KemppainenLKemppainenTSkogbergN, et al.Immigrants’ use of health care in their country of origin: the role of social integration, discrimination and the parallel use of health care systems. Scand J Caring Sci2018; 32(2): 698–706. DOI: 10.1111/scs.12499.
18.
OmenkaOIWatsonDPHendrieHC. Understanding the healthcare experiences and needs of African immigrants in the United States: a scoping review. BMC Public Health2020; 20(1): 27. DOI: 10.1186/s12889-019-8127-9.
19.
CloughJLeeSChaeDH. Barriers to health care among Asian immigrants in the United States: a traditional review. J Health Care Poor Underserved2013; 24(1): 384–403. DOI: 10.1353/hpu.2013.0019.
20.
TeferaGMYuM. Immigrant women’s access to healthcare services in the United States: a qualitative meta-synthesis. J Soc Serv Res2022; 48(2): 285–299. DOI: 10.1080/01488376.2022.2035300.
21.
DoshiMLopezWDMesaH, et al.Barriers & facilitators to healthcare and social services among undocumented Latino(a)/Latinx immigrant clients: perspectives from frontline service providers in Southeast Michigan. PLoS One2020; 15(6): e0233839. DOI: 10.1371/journal.pone.0233839.
HackerKAniesMFolbBL, et al.Barriers to health care for undocumented immigrants: a literature review. Risk Manag Healthc Policy2015; 8(null): 175–183. DOI: 10.2147/RMHP.S70173.
26.
World Health Organization. (2010). A Conceptual Framework for Action on the Social Determinants of Health. WHO.
27.
Viruell-FuentesEAMirandaPYAbdulrahimS. More than culture: structural racism, intersectionality theory, and immigrant health. Soc Sci Med2012; 75(12): 2099–2106. DOI: 10.1016/j.socscimed.2011.12.037.
28.
LinS. Access to health care among racialised immigrants to Canada in later life: a theoretical and empirical synthesis. Ageing Soc2022; 42(8): 1735–1759. DOI: 10.1017/S0144686X20001841.
29.
GagnonMKansalNGoelR, et al.Immigration status as the foundational determinant of health for people without status in Canada: a scoping review. J Immigr Minority Health2022; 24(4): 1029–1044. DOI: 10.1007/s10903-021-01273-w.
30.
CrenshawK. Demarginalizing the intersection of race and sex: a black feminist critique of antidiscrimination doctrine, feminist theory and antiracist policies. Univ Chicago Leg Forum1989; 1989(1): 139–167.
31.
ObinnaDN. Confronting disparities: race, ethnicity, and immigrant status as intersectional determinants in the COVID-19 era. Health Educ Behav2021; 48(4): 397–403. DOI: 10.1177/10901981211011581.
32.
YongAGermainS. Ethnic minority and migrant women’s struggles in accessing healthcare during COVID-19: an intersectional analysis. J Cult Res2022; 26(1): 65–82. DOI: 10.1080/14797585.2021.2012090.
33.
WandschneiderLMianiCRazumO. Decomposing intersectional inequalities in subjective physical and mental health by sex, gendered practices and immigration status in a representative panel study from Germany. BMC Public Health2022; 22(1): 683. DOI: 10.1186/s12889-022-13022-1.
34.
Viruell-FuentesEAMirandaPYAbdulrahimS. More than culture: structural racism, intersectionality theory, and immigrant health. Soc Sci Med2012b; 75(12): 2099–2106. DOI: 10.1016/j.socscimed.2011.12.037.
35.
AhmedSShommuNSRumanaN, et al.Barriers to access of primary healthcare by immigrant populations in Canada: a literature review. J Immigr Minority Health2016; 18(6): 1522–1540. DOI: 10.1007/s10903-015-0276-z.
36.
GonçalvesMMatosM. Prevalence of violence against immigrant women: a systematic review of the literature. J Fam Violence2016; 31(6): 697–710. DOI: 10.1007/s10896-016-9820-4.
37.
ReynoldsMMChernenkoAReadJG. Region of origin diversity in immigrant health: moving beyond the Mexican case. Soc Sci Med2016; 166: 102–109. DOI: 10.1016/j.socscimed.2016.07.018.
38.
WafulaEGSnipesSA. Barriers to health care access faced by black immigrants in the US: theoretical considerations and recommendations. J Immigr Minority Health2014; 16(4): 689–698. DOI: 10.1007/s10903-013-9898-1.
39.
TeferaGMDavidIMajeeW. A social-ecological perspective on understanding facilitators to access primary health care services among Ethiopian immigrant women in the United States. J Health Care Poor Underserved2024; 35(2): 707–725.
40.
OlukotunO.Navigating complex realities: barriers to health care, law enforcement and mental health concerns of undocumented african immigrant women in the United States. Theses and Dissertations. Milwaukee: The University of Wisconsin -Milwaukee, 2018. https://dc.uwm.edu/etd/2003.
41.
TeferaGM.Understanding access and utilization of healthcare services among african immigrant women in the United States: the application of health belief model. Applied Research in Quality of Life2024; 19: 1097–1115. DOI: 10.1007/s11482-024-10283-3.
42.
HabeckerS (2012). Not black, but Habasha: Ethiopian and Eritrean immigrants in American society, Ethn Racial Stud35(7): 1200–1219. DOI: 10.1080/01419870.2011.598232.
43.
OliphantSM. Voices of Ethiopian immigrant women. Int Soc Work2019; 62(2): 581–594. DOI: 10.1177/0020872817742700.
44.
SullivanMSenturiaKNegashT, et al.“For us it is like living in the dark”. J Interpers Violence2005; 20(8): 922–940. DOI: 10.1177/0886260505277678.
45.
CreswellJWCreswellJD. Research design: qualitative, quantitative, and mixed methods approaches. Sage Publications, 2017.
46.
CreswellJWClarkVLP. Designing and conducting mixed methods research (Issue 2). Sage, 2018.
47.
GroenewaldT. A phenomenological research design illustrated. Int J Qual Methods2004; 3(1): 42–55.
48.
ChaumbaJ. Health status, use of health care resources, and treatment strategies of Ethiopian and Nigerian immigrants in the United States. Soc Work Health Care2011; 50(6): 466–481. DOI: 10.1080/00981389.2011.581999.
49.
YaoNHillemeierMM. Disparities in mammography rate among immigrant and native-born women in the U.S.: progress and challenges. J Immigr Minority Health2014; 16(4): 613–621. DOI: 10.1007/s10903-013-9798-4.
50.
RoyseDDDavidD. Research methods in social work. Cognella Academic Publishing, 2020.
51.
SaleJEMCarlinL. The reliance on conceptual frameworks in qualitative research - a way forward. BMC Med Res Methodol2025; 25(1): 36. DOI: 10.1186/s12874-025-02461-0.
52.
FeredayJMuir-CochraneE. Demonstrating rigor using thematic analysis: a hybrid approach of inductive and deductive coding and theme development. Int J Qual Methods2006; 5(1): 80–92. DOI: 10.1177/160940690600500107.
53.
BirtLScottSCaversD, et al.Member checking. Qual Health Res2016; 26(13): 1802–1811. DOI: 10.1177/1049732316654870.
54.
McKimC. Meaningful member-checking: a structured approach to member-checking. American Journal of Qualitative Research2023; 7(2): 41–52.
55.
SyedIU. Labor exploitation and health inequities among market migrants: a political economy perspective. J Int Migrat Integrat2016; 17(2): 449–465. DOI: 10.1007/s12134-015-0427-z.
56.
PessinLArpinoB. Navigating between two cultures: immigrants' gender attitudes toward working women. Demogr Res2018; 38: 967–1016. DOI: 10.4054/DemRes.2018.38.35.
57.
AbregoLJLakhaniSM. Incomplete inclusion: legal violence and immigrants in liminal legal statuses. Law Pol2015; 37(4): 265–293. DOI: 10.1111/lapo.12039.
58.
ParetM. Legality and exploitation: immigration enforcement and the US migrant labor system. Lat Stud2014; 12(4): 503–526. DOI: 10.1057/lst.2014.53.
59.
BayehE. Human rights in Ethiopia: an assessment on the law and practice of women’s rights. Humanit Soc Sci2015; 3(2): 2. DOI: 10.11648/j.hss.20150302.13.
60.
O’mahonyJDonnellyTT. A Postcolonial Feminist Perspective inquiry into immigrant women’s mental health care experiences breast cancer screening view project Community Health Improvement project. Issues Ment Health Nurs2010; 31(7): 440–449. DOI: 10.3109/01612840903521971.
61.
Rocha-JiménezTTorresICabiesesB, et al.Intersectionality, racism, and mental health of migrants arriving at borders in Latin America: a qualitative study based on in-depth interviews with key informants of the cases of Ecuador and Chile. The Lancet Regional Health – Americas2025; 44. DOI: 10.1016/j.lana.2025.101040.
62.
CabralJCuevasAG. Health inequities among latinos/hispanics: documentation status as a determinant of health. J Racial Ethn Health Dispar2020; 7(5): 874–879. DOI: 10.1007/s40615-020-00710-0.
63.
GarciniLMNguyenKLucas-MarinelliA, et al.“No one left behind”: a social determinant of health lens to the wellbeing of undocumented immigrants. Curr Opin Psychol2022; 47: 101455. DOI: 10.1016/j.copsyc.2022.101455.
