Access and utilisation of social and health services as a social determinant of health: the case of undocumented Latin American immigrant women working in Lleida (Catalonia, Spain)

Abstract

Although Spain has social and healthcare systems based on universal coverage, little is known about how undocumented immigrant women access and utilise them. This is particularly true in the case of Latin Americans who are overrepresented in the informal labour market, taking on traditionally female roles of caregivers and cleaners in private homes. This study describes access and utilisation of social and healthcare services by undocumented Latin American women working and living in rural and urban areas, and the barriers these women may face. An exploratory qualitative study was designed with 12 in-depth interviews with Latin American women living and working in three different settings: an urban city, a rural city and rural villages in the Pyrenees. Interviews were recorded, transcribed and analysed, yielding four key themes: health is a tool for work which worsens due to precarious working conditions; lack of legal status traps Latin American women in precarious jobs; lack of access to and use of social services; and limited access to and use of healthcare services. While residing and working in different areas of the province impacted the utilisation of services, working conditions was the main barrier experienced by the participants. In conclusion, decent working conditions are the key to ensuring undocumented immigrant women's right to social and healthcare. To create a pathway to immigrant women's health promotion, the 'trap of illegality' should be challenged and the impact of being considered 'illegal' should be considered as a social determinant of health, even where the right to access services is legal.

A systematic review on the use of healthcare services by undocumented migrants in Europe

“…A French cohort study reported that almost half of undocumented women received inadequate prenatal care (e.g. only half of the recommended visits or no first-trimester examination) [ 14 , 33 ], while another cohort study in Geneva found that undocumented migrant women had more unintended pregnancies, used preventive measures less frequently and delayed prenatal care more than legal residents [ 34 ].…”

“…Yet, even with regard to maternal healthcare, to which undocumented migrants are entitled in many European countries, a number of studies found underutilization and inadequate care (e.g. the late appearance of pregnant undocumented women in a clinic) [ 14 , 23 , 24 , 32 ]. Furthermore, the differences between the countries regarding healthcare services provision to undocumented migrants could be due to differences in entitlements to healthcare, divergent interpretations of concepts such as ‘basic healthcare’, ‘right to healthcare’ and ‘healthcare accessibility’ or lack of awareness of legal requirements for delivering care to undocumented migrants [ 27 ].…”

The Health Consequences of Neocolonialism for Latin American Immigrant Women Working as Caregivers in Spain: A Multisite Qualitative Analysis

“…This is a multisite qualitative study based on secondary data analysis from four critical qualitative health studies [46,47,50,51] aimed to better understand diverse aspects of the health and wellbeing of Latin American immigrant domestic workers living in six Spanish regions (Table 1).…”

“…Consistently, immigrant female workers score very low in the SF-36 questionnaire dimensions of physical and emotional roles (used to measure the perceived quality of life) [38], and their narratives illustrate the concurrent negative impact on their physical (e.g., muscle aches), mental (e.g., desperation) and social (e.g., isolation) wellbeing [46]. Additionally, their low SES as immigrant women working in IL has been associated with difficulties in accessing and using social and health care services in Spain [47].…”

Health Services Access Inequalities Between Native and Immigrant in a Southern European Region

“…Consistent with previous studies, 14,23 we considered as covariates age (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44), and 45-59 years), length of stay in Spain (<5, 5-10, and >10 years), administrative or legal situation (permanent resident, nonpermanent resident, and irregular resident), understanding of Spanish (no difficulty/fluent and very little/with difficulty), educational attainment (primary or less, secondary, and graduate or higher), employment status (employed, unemployed, and others), living arrangement (couple and other), and self-rated health as good (very good or good) and poor (fair, bad, or very bad). For Spanish natives, it was assumed that they were permanent residents and spoke Spanish.…”