It is no longer in question that women have unique health needs, concerns and challenges. Among them are reproductive health, pregnancy and childbirth, sexual and intimate partner violence, and cancers that disproportionately affect women, including cervical and breast cancer. Women often face environmental and occupational health exposures both in the home and in the workplace that heighten health risks.
Migrant women face significant disparities with an additional layer of complexity and require different intervention strategies.
MCN has compiled resources that address these challenges and barriers to care with tools, education and programming for clinicians and migrant women. Please explore the following topics:
Migrant Women and Reproductive Health Issues Pregnancy
Family planning and contraception
Breast and cervical cancer screening and treatment
Migrant women face a high risk of breast and cervical cancer, and significant barriers to screening and education to enhance prevention. Latinas, a majority of this population, face a higher risk. They have lower rates of testing than white or African American women, especially recent immigrants: fewer mammograms and pap smears, and access to HPV vaccine. Once diagnosed, the gap between cancer discovery and delivery of treatment is greater (American Cancer Society, 2011).
Barriers to effective screening and care include lack of knowledge about breast and cervical cancers and the benefits of testing, cultural differences, language, and isolation, embarrassment, fear, discomfort, the cost or the lack of health insurance, the lack of a regular care or provider, lack of transportation, immigrant status, and mobility, which impedes follow up on test results.
Breast Cancer and Latina women:
the most commonly diagnosed cancer in Latina women the leading cause of cancer death Latinas are 20% more likely to die than non-Hispanic whites diagnosed at comparable stage, though they experience a 27% lower incidence rate than non-Hisp whites. Latinas are diagnosed at a more advanced stage of the disease Those uninsured are 2.3 times more likely to be diagnosed at a later stage They have a lower 5-year survival rate: 76% vs. 87%
Cervical Cancer and Latina Women
A large percentage of Hispanic/Latina women are diagnosed at an advanced stage of cervical cancer and this number increases with age. Death rate from cervical cancer 50% higher among Latina women than non-Hispanic whites (Am CA Society).
Culturally-specific training, screening tools, guidelines and resources for clinicians and others serving migrant women are available. See the box on the right for more information.
Cervical/breast cancer case study Sexually transmitted infections
Migrant Women and Environmental and Occupational Health Issues Pesticide exposure
Migrant farmworker women experience unique risks related to the physical demands and environmental exposures related to their work. Health risks to migrant women associated with exposure to pesticides has always been a concern of clinicians working with farmworkers. This concern was heightened by birth defects which occurred in babies born in 2005 to four women who worked as farmworkers at the same farms in both North Carolina and Florida. The investigation of these cases by the North Carolina Department of Health and Human Services concluded that “there is evidence…that the women’s work environment likely put them at an increased risk of over-exposure to pesticides”, and their recommendations included an initiative
“to strengthen efforts to educate farmworkers about their rights under the Worker Protection Standard, to develop pesticide education materials targeting women of childbearing age” (North Carolina DHHS, 2006).
It is essential that clinicians and others serving migrant and farmworker populations have access to research, training and culturally appropriate tools that can help them provide adequate care to their patients. See the resources in the box to the right for relevant resources.
Key resources for this section:
Lo Que Bien Empieza…
Reproductive Health Effects of Pesticide Exposure; MCN/FJ Monograph, 2008.
North Carolina Department of Health and Human Services, Occupational and Environmental Epidemiology Branch, Division of Public Health. (2006). Assessment of Maternal Occupational Pesticide Exposures during Pregnancy and Three Children with Birth Defects: North Carolina, 2004. Raleigh, North Carolina, May 18, 2006.
Link to MCN pesticides page
http://www.migrantclinician.org/issues/occupational-health/pesticides.html Other risks
In addition to pesticide exposure, migrant women experience other occupational and environmental risks associated with their working and living conditions. Exposure to lead and other chemicals pose threats to general and reproductive health, as do a wide range of other factors such as heat exposure, musculoskeletal disorders, dermatological problems, etc.
Occupational risk can also be transferred to women from family members through secondhand exposure to chemicals and through location of housing close to agricultural fields (Arcury & Quant, 2003; Arcury et al., 2005). Risk status can be complicated further by ethnic and/or racial minority status, limited English proficiency, lack of access to health care services and cultural beliefs related to gender and healthcare practices.
Arcury, T.A. and Quandt, S.A. (2003). Pesticides at work and at home: exposure of migrant farmworkers. Lancet, 362: 2021.
Arcury, T.A., Quandt, S.A., Rao, P., Doran, A.M., Snively, B.M., Barr, D.B., Hoppin, J.A. and Davis, S.W. (2005). Organophosphate Pesticide Exposure in Farmworker Family Members in Western North Carolina and Virginia: Case Comparisons. Human Organization. 64(1).
Key resources for this section:
MCN's Lead Clinical Guidelines for Migrant Pregnant Women
MCN's Lead Exposure Screening Form for Pregnant Migrant Women
Link to MCN heat illness page
Migrant Women and Violence Sexual and intimate partner violence
What You Can Do for Migrant Women
Contact: Candace Kugel, MS, CRNP, CNM firstname.lastname@example.org