Women’s Health and Reproductive Health

1. Women’s Health and Reproductive Health Claire Brindis, Dr. P.H. UCSF First Annual Research Training Workshop Center for Expertise on Migration and Health (COEMH) University of California

2. Cross Cutting Themes • Explaining complex phenomena – “Hispanic Paradox” and the negative impact of increasing time lived in the U.S. • “Timing” within the life-course when migration occurs, length of time in country, as well as cultural/value reinforcements on health • Non-linearity of acculturation – and SES influences on patterns • Understanding the migrant – who, when, what motivates, personal, inter-personal and external factors impacting migration experience • Increased focus on individual characteristics (health selectivity), as well as life circumstances in “sending” and “receiving” communities • Changing environmental context- socio-political, changes in stigma, cross-border “ease of access” shaping individual and families’ health status (from deportation to greater emphasis on couples/women migrants to decreasing “influence” with crisis in border crossing)

3. Methodologies • Focus on the use of multiple sources of data to build a science of bi-national research • Triangulation of data sources- quantitative, qualitative, individual to key informants • Development of new conceptual frameworks to further illuminate complex human interactions/experiences • Untangling an ever moving target of socio-political context impacting health outcomes • Focusing on health indicators – reproductive health and women’s cancers – as the “tip” of the iceberg. • Translation of research into policies, programs, and action

4. Social Disparities in Cancer among Mexican Women Living in Mexico and the United StatesGloria Giraldo • Use of EncuestaNacional (ENSANUT) and California Health Interview Survey (CHIS) - data collection approaches and potential impact • Cervical and Breast Cancer – indicators serving as the “smoke detector” of disparities • Socio-ecological framework extending traditional cultural and structural explanations—important highlight rural vs. urban • “Pre-immigration conditions are not considered at all”—examine reproductive health literature for insights and research approaches • Policies and programs that exist in California focused on breast/pap cancer screening may not be included in the CHIS variables (thus, health coverage may not fully reflect available care (episodic!). • Changes in U.S. policies – Cervical Screening • Research contribution to building bi-national data collection

5. U.S. Migration and Reproductive Health among Mexican WomenAlexandra Minnis • Focused effort to further understand “health selectivity” (lower risk women migrate and already have a strong sense of “self” as motivated to migrate vs. acculturation process) and how construct impacts sexual risk and reproductive healthoutcomes • Importance of the comparison- compare to which groups? Intent to migrate; those who stayed behind • Use of two important sources of data –Mexico Family Life Survey (longitudinal and bi-national follow up) and NSFG (both in person) • Incorporation of potential confounders, such as “marginalization” levels (9 non-monetary, community-levels of measures of poverty)—implications for US data collection • Detailed profile of ‘motivated’ migrants – younger, less married, less sexual activity, fewer partners, less children (motivated to have children in the U.S.?) as compared to those who stayed behind (not as bad circumstances?) • Potential for lifecourse and timing of immigration

6. Health Issues of Deported WomenMayadaVallet • Courage and Historical Timeliness • Data sources – access to populations, use of multiple sources of information to overcome potential bias in sample • Focus on individual and family impact • Length of time in country – > 5 years • Use of partners to help identify additional participants with varying levels of living in the U.S. (Kino, Coalicion de DerechosHumanos

7. Contraceptive Use in a Community of International Migration (Katie Kessler, Liliana Quezada, Shira Goldenberg) • Focus on distinctions in “unmet” contraceptive need—use/non-use, access, unintended, unplanned/mistimed • Focus on Tiacuitapenos living in both Mexico and US; use of Mexican Migration Field Research Project—focus on interviewing full community – including stakeholders • Impact of decreasing residential separation of couples • Non-linearity patterns of contraceptive use and pregnancy intendedness • Cultural adaptation and generational impact – greater acceptance of contraceptives among younger and more acculturated populations • Comparisons (Mexican to all women; need to compare to specific sub-groups living in US, including teen births among Mexican teens) • Sex education has been shown not to be the only explanation of high teen rates

8. Future Vision • Development of new bi-national research data collection efforts, including longitudinal data collection • Continued focus on multi-method data collection to inform both quantitative and qualitative research • Historical ecological models – familial and group generational patterns of migration • Socio-cultural context – and the changing “reframing” of immigrants (waves of acceptance and rejection) • Translation of research into policy, program, and practice