Stratified Access and Experiences of Maternal Health Care in the United States-Mexico Border Region.

Abstract

Introduction: The United States (US) state of Texas uses two publicly funded programs to cover pregnant people-Medicaid for Pregnant Women and Children's Health Insurance Program (CHIP) Perinatal. While Medicaid offers more comprehensive coverage than CHIP Perinatal, it only includes US citizens and legally qualified residents. This tiered access to care, determined primarily by immigration status, generates stratified access. This paper explores how stratified access factors into reproductive experiences.

Methodology: Thirty-two pregnant and postpartum women who identified as first- or second-generation immigrants and had public insurance or no insurance coverage participated in a semi-structured in-depth interview. Interview questions explored topics related to immigration and border policies more broadly. This piece analyzes themes that emerged in relation to the type of healthcare coverage participants were able to access during pregnancy.

Results: Participants had a range of immigration statuses that factored into their eligibility for health programs. During pregnancy, 12 had CHIP Perinatal, 15 had Medicaid, and five had no coverage. Key themes shaping experiences of care included bureaucratic barriers in navigating health programs, inadequate coverage that reinforced health vulnerabilities, and feelings of limited autonomy.

Discussion: Women's narratives highlight the ways immigration status generates barriers to receiving health care coverage, including coverage for programs that individuals are entitled to regardless of immigration status. The type of coverage that a pregnant woman has dictates how comprehensive her care is and the degree to which she experiences coverage gaps outside of pregnancy.