Abstract
Background
Birth outcomes are worse for birthing people and infants in the USA than other high-income economies and worse still for underprivileged communities. Historically, the Latine community has experienced positive birth outcomes, despite low socioeconomic status and other socio-political disadvantages, leading to what has been termed as the Hispanic birth paradox. However, this perinatal advantage and protective effect appears to have been shattered by unfavorable policies, structural conditions, societal attitudes, and traumatic events impacting Latine immigrants, leading to negative effects on the health and well-being of birthing Latines—regardless of citizenship status and increasing rates of preterm birth and low birth weight infants.
Methods and Results
We conducted a comprehensive literature review and identified two pathways through which birth outcomes among Latine birthing persons may be compromised regardless of citizenship status: (1) a biological pathway as toxic levels of fear and anxiety created by racialized stressors accumulate in the bodies of Latines and (2) a social pathway as Latines disconnect from formal and informal sources of support including family, friends, health care, public health programs, and social services during the course of the pregnancy.
Conclusion
Future research needs to examine the impact of immigration climate and policies on health and racial equity in birth outcomes among Latines regardless of citizenship status. Attaining health and racial equity necessitates increased awareness among health providers, public health practitioners, and policy makers of the impact of larger socio-political pressures on the health of Latine birthing persons.
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Data Availability
Data is provided within the manuscript.
Code Availability
Not applicable.
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Acknowledgements
Thanks are due to our supporters, the University of Minnesota UROC Women and Girls of Color Critical Conversations, and the HRSA-funded Center for Leadership Education in Maternal and Child Health, for making this project possible. Special thanks are due to our community-based groups who generously gave us their time and space to conduct the listening sessions and to all the women who shared with us their lived experiences inspiring this project and this review. Thanks are due to Emerson Fuller for generously providing her editing expertise during the preparation of this manuscript.
Funding
Supported in part with a grant from the University of Minnesota Women and Girls of Color and Indigenous Women and Girls Initiative and the Health Resources and Services Administration (HRSA)-funded Center for Leadership Education in Maternal and Child Health.
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Contributions
NJS and ZB conceptualized the study. SLH conducted the literature search. NJS, SLH, and ZB analyzed the data and wrote, reviewed, and edited the paper.
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Ethics Approval
This study was not a human subject research.
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The authors declare no competing interests.
Disclaimer
A note about language: We are using the terms birthing person and Latine throughout this paper [114,115,116]. We acknowledge that our society is struggling with the acceptance of gender neutral and non-binary terminology and that the data available reflect this. Further, when directly discussing/describing manuscripts, we amend our language to be congruent with how the article presents their populations.
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Appendices
Appendix A. Search Strategy for Political Climate to Fear/Anxiety
Medline
Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Daily and Versions(R) <1946 to April 26, 2019> | |||
|---|---|---|---|
# | Search Statement | Results | Annotation |
1 | (latin* or chican* or hispan*).ti,ab,kf. | 81498 | |
2 | exp Hispanic Americans/ | 29774 | |
3 | 1 or 2 | 90511 | |
4 | (((Immigra* or migra* or anti-immigra* or anti-migra* or political) adj2 (climate* or polic* or control* or enforc*)) or law enforcement).ti,ab,kf. | 9646 | |
5 | exp Fear/ | 30853 | |
6 | exp Anxiety/ | 78250 | |
7 | exp Stress, Psychological/ | 121962 | |
8 | (fear* or anxiet* or psychological).ti,ab,kf. | 403156 | |
9 | 5 or 6 or 7 or 8 | 513910 | |
10 | 3 and 4 and 9 | 59 | |
PsycINFO
PsycINFO <1987 to April Week 4 2019 > | |||
|---|---|---|---|
# | Search Statement | Results | Annotation |
1 | exp Fear/ | 16058 | |
2 | exp Anxiety/ | 53708 | |
3 | (fear* or anxiet* or psychological).ti,ab,id. | 435250 | |
4 | (((Immigra* or migra* or anti-immigra* or anti-migra* or political) adj2 (climate* or polic* or control* or enforc*)) or law enforcement).ti,ab,id. | 9614 | |
5 | (latin* or chican* or hispan*).ti,ab,id. | 46041 | |
6 | exp "LATINOS/LATINAS"/ | 24040 | |
7 | exp Mexican Americans/ | 4140 | |
8 | 5 or 6 or 7 | 50508 | |
9 | exp psychological stress/ | 6995 | |
10 | 1 or 2 or 3 or 9 | 440518 | |
11 | 4 and 8 and 10 | 90 | |
Academic Search Premier
AB ( ( (fear* OR anxiet* OR psychological) AND ( latin* OR chican* OR hispan* ) AND ( ( ( immigra* OR migra* OR anti-immigra* OR anti-migra* OR political ) N2 ( climate* OR polic* OR control* OR enforc* ) ) OR “law enforcement” ) ) OR TI ( ( (fear* OR anxiety* OR psychological) AND ( latin* OR chican* OR hispan* ) AND ( ( ( immigra* OR migra* OR anti-immigra* OR anti-migra* OR political ) N2 ( climate* OR polic* OR control* OR enforc* ) ) OR “law enforcement” ) )
Scopus
TITLE-ABS ( ( fear* OR anxiet* OR psychological ) AND ( latin* OR chican* OR hispan* ) AND ( “immigration climate” OR “immigration policy” OR “immigration policies” OR “immigration control” OR “immigration enforcement” OR “immigration laws” OR “migration climate” OR “migration policy” OR “migration policies” OR “migration control” OR “migration enforcement” OR “migration laws” OR “anti-immigration climate” OR “anti-immigration policy” OR “anti-immigration policies” OR “anti-immigration control” OR “anti-immigration enforcement” OR “anti-immigration laws” OR “anti-migration climate” OR “anti-migration policy” OR “anti-migration policies” OR “anti-migration control” OR “anti-migration enforcement” OR “anti-migration laws” OR “political climate” OR “law enforcement” ) )
PAIS Index
ab((fear* OR anxiet* OR psychological) AND (latin* or chican* or hispan*) AND (“immigration climate” or “immigration policy” or “immigration policies” or “immigration control” or “immigration enforcement” or “immigration laws” or “migration climate” or “migration policy” or “migration policies” or “migration control” or “migration enforcement” or “migration laws” or “anti-immigration climate” or “anti-immigration policy” or “anti-immigration policies” or “anti-immigration control” or “anti-immigration enforcement” or “anti-immigration laws” or “anti-migration climate” or “anti-migration policy” or “anti-migration policies” or “anti-migration control” or “anti-migration enforcement” or “anti-migration laws” or “political climate” or “law enforcement”))
Appendix B. Search Strategy for Political Climate ➔ Support Networks
Medline
Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Daily and Versions(R) <1946 to April 22, 2019> | |||
|---|---|---|---|
# | Search Statement | Results | Annotation |
1 | exp Social Support/ | 66643 | |
2 | exp "Patient Acceptance of Health Care"/ | 139909 | |
3 | exp Health Services Accessibility/ | 103984 | |
4 | exp Social Welfare/ | 56110 | |
5 | (((Informal or formal or social or famil* or support or peer* or professional* or safety or healthcare or health care or government*) adj2 (support or network* or service* or program* or utiliz* or access* or barrier*)) or kinship or welfare).ti,ab,kf. | 1039068 | |
6 | 1 or 2 or 3 or 4 or 5 | 1302698 | |
7 | exp Hispanic Americans/ | 29736 | |
8 | (latin* or chican* or hispan*).ti,ab,kf. | 81389 | |
9 | 7 or 8 | 90395 | |
10 | (((Immigra* or migra* or anti-immigra* or anti-migra* or political) adj2 (climate* or polic* or control* or enforc*)) or law enforcement).ti,ab,kf. | 9630 | |
11 | 6 and 9 and 10 | 95 | |
PsycINFO
PsycINFO <1806 to April Week 3 2019> | |||
|---|---|---|---|
# | Search Statement | Results | Annotation |
1 | exp Social Support/ | 34139 | |
2 | (((Informal or formal or social or famil* or support or peer* or professional* or safety or healthcare or health care or government*) adj2 (support or network* or service* or program* or utiliz* or access* or barrier*)) or kinship or welfare).ti,ab,id. | 545546 | |
3 | exp help seeking behavior/ | 9164 | |
4 | exp health care utilization/ | 14999 | |
5 | exp treatment barriers/ | 4399 | |
6 | exp Health Care Utilization/ | 14999 | |
7 | exp social services/ | 42781 | |
8 | exp government programs/ | 11960 | |
9 | 1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 | 594067 | |
10 | (((Immigra* or migra* or anti-immigra* or anti-migra* or political) adj2 (climate* or polic* or control* or enforc*)) or law enforcement).ti,ab,id. | 10340 | |
11 | (latin* or chican* or hispan*).ti,ab,id. | 48679 | |
12 | exp "LATINOS/LATINAS"/ | 26864 | |
13 | exp Mexican Americans/ | 5789 | |
14 | 11 or 12 or 13 | 54788 | |
15 | 9 and 10 and 14 | 141 | |
Academic Search Premier
AB ( ( ( informal OR formal OR social OR famil* OR support OR peer* OR professional* OR safety OR healthcare OR “health care” OR government* ) N2 ( support* OR network* OR service* OR program* OR utiliz* OR access* OR barrier* ) ) OR kinship OR welfare ) AND ( latin* OR chican* OR hispan* ) AND ( ( ( immigra* OR migra* OR anti-immigra* OR anti-migra* OR political ) N2 ( climate* OR polic* OR control* OR enforc* ) ) OR law AND enforcement )
Scopus
TITLE-ABS ( (“informal support” or “informal network” or “formal support” or “formal network” or “social support” or “social network” or “social service” or “social program” or famil* or “support network” or “support program” or “peer support” or “peer network” or “professional support” or “professional network” or “safety network” or “healthcare utilization” or “utilize healthcare” or “healthcare services” or “access to healthcare” or “healthcare accessibility” or “barriers to healthcare” or “healthcare barriers” or “barriers to care” or “health care utilization” or “utilize health care” or “health care services” or “access to health care” or “health care accessibility” or “barriers to health care” or “health care barriers” or “government programs” or “government services” or kin* or welfare) AND (latin* or chican* or hispan*) AND (“immigration climate” or “immigration policy” or “immigration policies” or “immigration control” or “immigration enforcement” or “immigration laws” or “migration climate” or “migration policy” or “migration policies” or “migration control” or “migration enforcement” or “migration laws” or “anti-immigration climate” or “anti-immigration policy” or “anti-immigration policies” or “anti-immigration control” or “anti-immigration enforcement” or “anti-immigration laws” or “anti-migration climate” or “anti-migration policy” or “anti-migration policies” or “anti-migration control” or “anti-migration enforcement” or “anti-migration laws” or “political climate” or “law enforcement”) )
PAIS Index
ab((“informal support” or “informal network” or “formal support” or “formal network” or “social support” or “social network” or “social service” or “social program” or famil* or “support network” or “support program” or “peer support” or “peer network” or “professional support” or “professional network” or “safety network” or “healthcare utilization” or “utilize healthcare” or “healthcare services” or “access to healthcare” or “healthcare accessibility” or “barriers to healthcare” or “healthcare barriers” or “barriers to care” or “health care utilization” or “utilize health care” or “health care services” or “access to health care” or “health care accessibility” or “barriers to health care” or “health care barriers” or “government programs” or “government services” or kin* or welfare) AND (latin* or chican* or hispan*) AND (“immigration climate” or “immigration policy” or “immigration policies” or “immigration control” or “immigration enforcement” or “immigration laws” or “migration climate” or “migration policy” or “migration policies” or “migration control” or “migration enforcement” or “migration laws” or “anti-immigration climate” or “anti-immigration policy” or “anti-immigration policies” or “anti-immigration control” or “anti-immigration enforcement” or “anti-immigration laws” or “anti-migration climate” or “anti-migration policy” or “anti-migration policies” or “anti-migration control” or “anti-migration enforcement” or “anti-migration laws” or “political climate” or “law enforcement”))
Appendix C. Search Strategy for Fear/Anxiety to Birth Outcomes
Medline
Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Daily and Versions(R) <1946 to August 05, 2019> | |||
|---|---|---|---|
# | Search Statement | Results | Annotation |
1 | exp Fear/ | 31314 | |
2 | exp Anxiety/ | 79645 | |
3 | exp Stress, Psychological/ | 123927 | |
4 | (fear* or anxiet* or psychological).ti,ab,kf. | 412323 | |
5 | 1 or 2 or 3 or 4 | 524526 | |
6 | exp Premature Birth/ | 12481 | |
7 | exp Obstetric Labor, Premature/ | 24885 | |
8 | exp Infant, Premature/ | 53176 | |
9 | exp Infant, Extremely Premature/ | 2002 | |
10 | exp Infant, Low Birth Weight/ | 32809 | |
11 | exp Infant, Very Low Birth Weight/ | 9614 | |
12 | ((prematur* or preterm or pre-matur* or pre-term) adj2 (birth or labor or neonatal)).ti,ab,kf. | 28792 | |
13 | birth outcome*.ti,ab,kf. | 5033 | |
14 | low birth weight*.ti,ab,kf. | 26462 | |
15 | 6 or 7 or 8 or 9 or 10 or 11 or 12 or 13 or 14 | 118255 | |
16 | 5 and 15 | 2684 | |
17 | (latin* or chican* or hispan*).ti,ab,kf. | 83769 | |
18 | exp Hispanic Americans/ | 30256 | |
19 | 17 or 18 | 92870 | |
20 | 16 and 19 | 71 | |
PsycINFO
PsycINFO <1987 to July Week 5 2019> | |||
|---|---|---|---|
# | Search Statement | Results | Annotation |
1 | exp Fear/ | 16245 | |
2 | exp Anxiety/ | 54956 | |
3 | (fear* or anxiet* or psychological).ti,ab,id. | 441144 | |
4 | exp Psychological Stress/ | 7043 | |
5 | 1 or 2 or 3 or 4 | 446459 | |
6 | (latin* or chican* or hispan*).ti,ab,id. | 46723 | |
7 | exp "LATINOS/LATINAS"/ | 24285 | |
8 | exp Mexican Americans/ | 4159 | |
9 | 6 or 7 or 8 | 51219 | |
10 | exp Premature Birth/ | 4801 | |
11 | exp Birth Weight/ | 2964 | |
12 | ((prematur* or preterm or pre-matur* or pre-term) adj2 (birth or labor or neonatal)).ti,ab,id. | 3159 | |
13 | birth outcome*.ti,ab,id. | 1225 | |
14 | low birth weight*.ti,ab,id. | 2904 | |
15 | 10 or 11 or 12 or 13 or 14 | 9454 | |
16 | 5 and 9 and 15 | 28 | |
Academic Search Premier
AB (fear* OR anxiet* OR psychological) AND ( latin* OR chican* OR hispan* ) AND ( “premature birth” or “premature labor” or “premature infant” or “low birth weight” or “birth outcome” or “preterm birth” or “preterm labor” or “neonatal prematurity”) )
Scopus
TITLE ( ( fear* OR anxiet* OR psychological ) AND ( latin* OR chican* OR hispan* ) AND ( “premature birth” OR “premature labor” OR “premature infant” OR “low birth weight” OR “birth outcome” OR “preterm birth” OR “preterm labor” OR “neonatal prematurity” ) ) ) OR ( ABS ( ( fear* OR anxiety* OR psychological ) AND ( latin* OR chican* OR hispan* ) AND ( “premature birth” OR “premature labor” OR “premature infant” OR “low birth weight” OR “birth outcome” OR “preterm birth” OR “preterm labor” OR “neonatal prematurity” ) )
Appendix D. Search Strategy for Support Networks ➔ Birth Outcomes
Medline
Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Daily and Versions(R) <1946 to August 23, 2019> | |||
|---|---|---|---|
# | Search Statement | Results | Annotation |
1 | exp Premature Birth/ | 12540 | |
2 | exp Obstetric Labor, Premature/ | 24948 | |
3 | exp Infant, Premature/ | 53307 | |
4 | exp Infant, Extremely Premature/ | 2024 | |
5 | exp Infant, Low Birth Weight/ | 32888 | |
6 | exp Infant, Very Low Birth Weight/ | 9638 | |
7 | ((prematur* or preterm or pre-matur* or pre-term) adj2 (birth or labor or neonatal)).ti,ab,kf. | 28870 | |
8 | birth outcome*.ti,ab,kf. | 5054 | |
9 | low birth weight*.ti,ab,kf. | 26524 | |
10 | 1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 | 118524 | |
11 | (latin* or chican* or hispan*).ti,ab,kf. | 84009 | |
12 | exp Hispanic Americans/ | 30328 | |
13 | 11 or 12 | 93127 | |
14 | (((Informal or formal or social or famil* or support or peer* or professional* or safety or healthcare or health care or government*) adj2 (support or network* or service* or program* or utiliz* or access* or barrier*)) or kinship or welfare).ti,ab,kf. | 1066443 | |
15 | exp Social Support/ | 67807 | |
16 | exp "Patient Acceptance of Health Care"/ | 142885 | |
17 | exp Health Services Accessibility/ | 105626 | |
18 | exp Social Welfare/ | 56485 | |
19 | 14 or 15 or 16 or 17 or 18 | 1333842 | |
20 | 10 and 13 and 19 | 235 | |
PsycINFO
PsycINFO <1987 to August Week 3 2019> | |||
|---|---|---|---|
# | Search Statement | Results | Annotation |
1 | exp Premature Birth/ | 4814 | |
2 | exp Birth Weight/ | 2976 | |
3 | ((prematur* or preterm or pre-matur* or pre-term) adj2 (birth or labor or neonatal)).ti,ab,id. | 3174 | |
4 | birth outcome*.ti,ab,id. | 1227 | |
5 | low birth weight*.ti,ab,id. | 2912 | |
6 | 1 or 2 or 3 or 4 or 5 | 9483 | |
7 | (latin* or chican* or hispan*).ti,ab,id. | 46879 | |
8 | exp "LATINOS/LATINAS"/ | 24346 | |
9 | exp Mexican Americans/ | 4165 | |
10 | 7 or 8 or 9 | 51380 | |
11 | (((Informal or formal or social or famil* or support or peer* or professional* or safety or healthcare or health care or government*) adj2 (support or network* or service* or program* or utiliz* or access* or barrier*)) or kinship or welfare).ti,ab,id. | 502971 | |
12 | exp Social Support/ | 32063 | |
13 | exp Help Seeking Behavior/ | 11316 | |
14 | exp Health Care Utilization/ | 14678 | |
15 | exp Treatment Barriers/ | 4496 | |
16 | exp Social Services/ | 75934 | |
17 | exp Government Programs/ | 11638 | |
18 | 11 or 12 or 13 or 14 or 15 or 16 or 17 | 564881 | |
19 | 6 and 10 and 18 | 107 | |
Academic Search Premier
AB (((( informal OR formal OR social OR famil* OR support OR peer* OR professional* OR safety OR healthcare OR "health care” OR government* ) N2 ( support* OR network* OR service* OR program* OR utiliz* OR access* OR barrier* ) ) OR kinship OR welfare ) AND ( latin* OR chican* OR hispan* ) AND ( “premature birth” or “premature labor” or “premature infant” or “low birth weight” or “birth outcome” or “preterm birth” or “preterm labor” or “neonatal prematurity”))
Scopus
TITLE ( (“informal support” or “informal network” or “formal support” or “formal network” or “social support” or “social network” or “social service” or “social program” or famil* or “support network” or “support program” or “peer support” or “peer network” or “professional support” or “professional network” or “safety network” or “healthcare utilization” or “utilize healthcare” or “healthcare services” or “access to healthcare” or “healthcare accessibility” or “barriers to healthcare” or “healthcare barriers” or “barriers to care” or “health care utilization” or “utilize health care” or “health care services” or “access to health care” or “health care accessibility” or “barriers to health care” or “health care barriers” or “government programs” or “government services” or kin* or welfare) AND ( latin* OR chican* OR hispan* ) AND ( “premature birth” OR “premature labor” OR “premature infant” OR “low birth weight” OR “birth outcome” OR “preterm birth” OR “preterm labor” OR “neonatal prematurity” ) ) ) OR ( ABS ( (“informal support” or “informal network” or “formal support” or “formal network” or “social support” or “social network” or “social service” or “social program” or famil* or “support network” or “support program” or “peer support” or “peer network” or “professional support” or “professional network” or “safety network” or “healthcare utilization” or “utilize healthcare” or “healthcare services” or “access to healthcare” or “healthcare accessibility” or “barriers to healthcare” or “healthcare barriers” or “barriers to care” or “health care utilization” or “utilize health care” or “health care services” or “access to health care” or “health care accessibility” or “barriers to health care” or “health care barriers” or “government programs” or “government services” or kin* or welfare) AND ( latin* OR chican* OR hispan* ) AND ( “premature birth” OR “premature labor” OR “premature infant” OR “low birth weight” OR “birth outcome” OR “preterm birth” OR “preterm labor” OR “neonatal prematurity” ) )
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Santaularia, N.J., Hunt, S.L. & Bonilla, Z. Exploring the Links Between Immigration and Birth Outcomes Among Latine Birthing Persons in the USA. J. Racial and Ethnic Health Disparities (2024). https://doi.org/10.1007/s40615-024-01999-x
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DOI: https://doi.org/10.1007/s40615-024-01999-x