Latina Immigrant Mothers Face Challenges in Receiving and Accessing Adequate Prenatal Care

BY EMILY NEIL WITH CONTRIBUTIONS FROM MICHELLE MYERS ON SEPTEMBER 23, 2022

Silvia Roldán Sarmiento with her daughter Amaya. (Courtesy of Silvia Roldán Sarmiento)

Reyna Guzmán Casarez, originally from Mexico, went to the program specifically designed for expecting Latina mothers at a hospital in Philadelphia. From the moment she was greeted in English, instead of Spanish, she felt that there was something off. 

And then came the materials provided to her during her first visit: Information on abortion and adoption options was available in Spanish-language pamphlets, while information on prenatal care, breastfeeding, and pregnancy-related health routines was available only in English.

“For me, instead of them making me feel happy and secure because I’m going to be a mother, they were already offering me the options of adoption or not having the baby,” Guzmán Casarez, recalled. 

Though she hopes that the discrimination she experienced as an expecting Latina immigrant mother in Philadelphia has been mitigated in the past nine years since she had her child, Guzmán Casarez is committed to making sure other Latina immigrant moms to have access to more information, resources, and support than she had when she was pregnant. 

Reyna with her daughter Ellie. (Courtesy of Reyna Guzmán Casarez)

And discrimination on the part of healthcare providers is one obstacle among many for Latina immigrant moms to receive adequate prenatal care and support. In recent years, for many expecting Latina immigrant mothers, even seeking prenatal care to begin with was seen as a risk, especially during the Trump Administration’s immigration policies. 

Immigrant mothers who do not have a regularized immigration status are also usually unable to access any kind of public health insurance, and have to figure out how to pay for prenatal appointments, or decide to skip prenatal appointments altogether because of the expense. This presents a significant barrier for immigrant moms who are seeking access to prenatal healthcare. 

In Guzmán Casarez’s case, these barriers were significant, but did not deter her from seeking prenatal healthcare. Working from 6 a.m. to 11 p.m. most days, in a position at a restaurant as well as working to clean homes, she had to plan to save money for her prenatal healthcare expenses. This included saving for the costs of a hospital birth, and funds to support her after she gave birth, since she wouldn’t be able to work and would have no family or partner to support her in caring for her child. 

The worries abounded and work was nonstop. But still, Guzmán Casarez would come home from work and sit down and relax, knowing that she needed to rest so her baby could also rest after a day spent jostling for space on a crowded SEPTA bus, running between tables, pressing down on the slippery floors of the restaurant where she worked to make sure she didn’t fall and potentially endanger her baby. It was then, in that precious quiet after the nonstop activity of the workday, that the expecting mom put on classical music, or read a kids’ Spanish Bible out loud. She would whisper to her little one growing inside of her of all they would do and see together once the baby girl was out in the world.

Growing. (Courtesy of Comadre Luna by the collective's graphic designer, Cristina Arancibia)

Lack of family support, separation from family support networks

For many immigrant mothers, the lack of support from family members, and having loved ones be far from home, is especially difficult. It represents a loss of not just support in the more difficult parts of pregnancy, but also a lack of shared joy in the preparation for the baby, and comfort in the face of the unknown of becoming a parent for the first time. 

Silvia Roldán Sarmiento, who is originally from Ecuador, had a “very good pregnancy,” and following the outbreak of COVID-19, was able to enjoy some positive aspect of the pandemic by working from home alongside her husband, Nico. They were able to spend more time together than usual and share in the pregnancy. Her gynecologist was located nearby, and she felt satisfied with her prenatal care. 

But she missed the support of her mother and the rest of her family — even the announcement of her pregnancy had to be shared on a video call, instead of in person. 

Silvia expecting her daughter Amaya. (Courtesy of Silvia Roldán Sarmiento)

“Having my mom be far away, it did impact me because I would have wanted her to also guide her and [tell her] how her pregnancy was,” Roldán said. Instead, “we did everything through Zoom,” Roldán recalled, adding that her mother was still able to send her traditional recipes to help with the morning sickness she had in the first three months.

But that still wasn’t enough. Sometimes Roldán would crave something that only her mom could make back home — but she would quickly redirect her mind to think of and crave something else because it’s bad luck in her culture, she says, for an expecting mother to crave something that she can’t eat.

Katherine Cartagena, originally from Bolivia, also experienced the sadness of becoming a mom while her own mother was far away. She craved her mom’s lentil soup, and she also wanted the support and advice of her mom. In place of that absence, throughout her pregnancy she began investigating on her own and taking birthing and breathing classes with her husband in preparation for the baby’s arrival.

“I mean, nobody is really prepared to deliver. But, married to an American man, he wanted to have all the classes, all the resources. It was like, ok, we need to Google research. Where do we need to sign up? What do we need to do? And so we took several classes for the first time, even for breastfeeding and, you know, swaddling the baby. And I can't even remember, but there were several classes that we took and they were very, very helpful,” Cartagena said.

Katherine Cartagena with her mother. (Courtesy of Katherine Cartagena)

For Cartagena, it also was helpful to have her husband’s support while she was pregnant, which allowed her to rest and take care of herself, prioritizing her health, after recently having been diagnosed with lupus, an autoimmune disorder, and the health of her baby.

Incorporating cultural knowledge into prenatal care

Women's circle. (Courtesy of Comadre Luna’s graphic designer Cristina Arancibia)

Dr. Jessica Kroes, an OBGYN at Holy Redeemer Women’s Care, says that providing culturally competent prenatal care starts with how medical students are trained and what is prioritized in the curriculum.

At Presente’s Encuentro Virtual in March, Dr. Kroes said that she believes doctors should learn about different cultures, how to treat different patients from different countries, and how to work with language barriers.

“There’s a lot more support that needs to be centered around that specific patient and their pregnancy in order for them to have the healthiest pregnancy that they can,” she said, adding that this development in the medical system is “a work in progress.”

Overall, throughout the U.S., the maternal mortality rate in 2018 was 17.4% — more than double that of most other wealthy countries. In 2020, it climbed to 23.8%. For non-Hispanic Black women, it was more than double the overall rate, at 55.3% in 2020, and for Hispanic women it was 18.2%.

As a recent investigation from The Philadelphia Inquirer shows, the racism and racial inequities in the medical system that particularly affect women of color have been embedded into the very structure of the institutionalized obstetric care — some of which has its roots in Philadelphia. 

Many Latina and Black healthcare providers are leading the move to change that, like Kateryn Nuñez, a Dominican-American registered midwife who works with women for home births, outside of the hospital setting, in part because of the “systemic failures” that exist in many hospitals for Black and/or Latina mothers. 

As a midwife who has studied and been certified at the Master’s level in the U.S., she says that she and other providers who study and are certified in midwifery often work hand-in-hand with the medical system, and are completely different from doulas.

Doulas, Nuñez explained at Presente’s March Encuentro Virtual, are a “new invention,” taking the place of what in the past would have been women family members who would have been present at a birth to provide emotional support to the mother.

“Doulas…are a byproduct of women being alone in birth,” Nuñez said, adding that their role now is to “fill more emotional gaps” in the birthing and postpartum process. 

Midwives, on the other hand, are medically trained and certified to assist in the medical care process before, during, and after birth. They have a key role in hospitals as well, where the doctors may not have time and resources to talk to expecting moms in more detail about their prenatal care and what to expect going forward. 

“The philosophy within midwifery is to care for women that need us most,” Nuñez said, and oftentimes, she added, the women who need them the most are immigrant mothers. 

“For midwives, it’s in the culture for us to search for all of the resources available to women and make those known to them.”

Facing prejudice

Katherine Cartagena with her husband and kids. (Courtesy of BURKETT PHOTOGRAPHY)

Though Katherine Cartagena said that overall her prenatal healthcare was a good experience, she noted a difference in the way medical practitioners treated her when her white husband was with her, than when she was by herself. 

When she was by herself, she was asked about abortion or adoption options. She also was asked about whether her husband abused her, and other questions which may have been standard questions for expecting mothers at that hospital, she says, but she said she felt like it wasn’t only that. 

“It was the first time I really felt this was profiling, because every time my husband came with me, the treatment was completely different,” Cartagena said. “I just remember feeling that even just by the fact that I was asked those questions, I was put down.”

“Every time my husband came to the appointment or the first time he came to the appointment with me, everything changed, everything changed because he's white and you know, it was like, ‘Oh, OK,’” Cartagena recalled.

Guzmán Casarez said that she also felt a continued disinterest on the part of medical staff that she saw, and at times faced outright racism. There was the time when she asked questions about breastfeeding, and a nurse told her that she shouldn’t worry about anything because she was Mexican — implying that because she’s Mexican, taking care of a baby would be natural for her, and she didn’t need any additional medical support or advice.

Who is helping Latina immigrant moms in Philadelphia now?

Reyna Guzmán Casarez, Katherine Cartagena, and Silvia Roldán were not connected with a community of Latina immigrant moms when they were going through their pregnancies, and didn’t have other women they could lean on or turn to for support.

Reyna celebrates Ellie's birthday. (Courtesy of Reyna Guzmán Casarez)

Over the years, many Latina women, some of whom are mothers as well, have been working to change that. Guzmán Casarez, for example, coordinates a Whatsapp group that provides support and resources for Latina immigrant mothers in the community.

Comadre Luna is another resource and community-rooted entity that seeks to cultivate a network of Latina women. The feminist collective, started in Philadelphia in 2019, was founded in response to a lack of resources for immigrants in Philadelphia, in order to better connect Latina immigrants with resources and build community.

Sara Giraldo is a member of the Comadre Luna collective, and an immigrant mother herself, originally from Colombia.

Giraldo says the organization is “unique” because of its horizontal structure, in which all members of the collective are involved in decisions and initiatives. She is a member of, and leads, the sustainability committee of the collective, which involves applying for grants and funds, among other responsibilities.

Sara teaching yoga to kids. (Courtesy of Comadre Luna)

Giraldo began to get involved in Comadre Luna as a yoga instructor. On International Women’s Day, March 8, 2020, right before the pandemic, Giraldo offered a yoga class in Spanish for Comadre Luna’s meeting. Throughout the pandemic, she began meeting with them regularly, on Mondays at 9 a.m. for yoga classes.

Then, she began to experience domestic violence from her partner. Comadre Luna helped her to find a safe place for her and for her child. “The Comadre Luna women extended a hand for me, completely,” Giraldo said.

From there, Giraldo started working with Comadre Luna.

Many of the women in Comadre Luna are immigrant moms like herself, Giraldo says. And though there is a diversity in their experiences, stemming from their different backgrounds, family situations, and more, the collective does a lot to accommodate the needs of moms, and care for one another in a way that supports them in that path.

“It’s very challenging to be an immigrant mom,” Giraldo says, noting that for her, the hardest part is being able to care for her six-year-old or find childcare while also working. In contrast, in Colombia, where all of her family lives, it would be normal for the rest of the family to pitch in and watch or care for children as they grow up.

But collectives and community-rooted initiatives like Comadre Luna make a difference in addressing that sense of isolation which many immigrants can feel, far from their homes and extended families. 

“We’re in this, to nurture ourselves, nurture the community, nurture ourselves as friends,” she says. 

Comadre Luna offers two podcasts, available on Spotify: La Canasta, which comes out once a month, full of resources for the community touching on everything from mental health, COVID-19, domestic violence, and more, and La Cacerola, which are longer podcasts that dive into a particular topic in an investigative format. 

Members also share resources and connect with one another in a Whatsapp group, and organize events and meetings. 

Giraldo also says that anyone interested in joining the collective can connect with them on Instagram or via their email on their website.