With the recent passage of possibly the most far-reaching state immigration law in the country, Arizona and the immigrants who live there are on everyone’s minds. Among many extreme policies, the law allows for local law enforcement to detain anyone about whom they have a “reasonable cause” to believe may be in the state illegally. Reasonable cause is left up to the discrimination (no pun intended) of each individual police officer – it could be the color of one’s skin or someone’s accent. As Silvia Henriquez, the executive director of the National Latina Institute for Reproductive Health writes, “The law goes beyond encouraging racial profiling; it demands local police seek out “foreign characteristics” in order to hunt down immigrants without documents…” That is, it also requires residents to carry their immigration papers at all times; or face state criminal penalties if one is caught.

For feminists, women’s rights and health advocates and women’s media outlets, the question posed most frequently about the Arizona law seems to be a variation on: “Is immigration a women’s issue?” The consensus? Of course it is. But, why? Don’t we care about the immigrant men who have, for so long, toiled away in the U.S. at low-paying jobs, treated unfairly in the workplace, and struggled for dignity? It’s not about the invisibility of the male immigrant experience, of course. It’s about the unique story of women who are now emigrating to the United States in greater numbers than ever before, while still remaining dependent more often than not on a male partners’ visa to remain in this country. It’s about the vulnerability of the female experience as it relates to her body and health. It’s about the fact that a woman is exposed to vastly different, dangerous scenarios because of her sex. And it’s about telling the stories of individual women who may not only encounter threatening situations and barriers to health care for themselves, but are in unique positions as caretakers and protectors of their children’s lives and health as well.

Miriam Yeung of the National Coalition for Immigrant Women’s Rights (NCIWR), a group that includes her own organization--the National Asian Pacific American Women’s Forum, the National Institute for Reproductive Health and the Service Employees International Union (SEIU)--says, “…Immigrant women are the ones who make health care and child care decisions in their families – this law is cutting off communities at the knees.”

Consider this story, told by Henriquez to illustrate the ways in which the immigrant women’s experience is often uniquely connected to her health and the lives of her family members:

“Just two years ago Juana Villegas was arrested for a routine traffic violation in Nashville after leaving a clinic for a pre-natal visit and detained when she was unable to produce a license. Despite the fact that driving without a license is a misdemeanor in Tennessee that generally leads to a citation, Ms. Villegas was taken into custody due to suspicions about her immigration status. Ms. Villegas was jailed for six days, during which time she gave birth to a little boy while shackled to a bed under the watchful eye of the sheriff’s officer. Barred from speaking to her husband, her baby was taken from her upon birth, leading to a number of health repercussions for both mother and baby. Local police stood by their actions, calling Nashville “a friendly and open city to our new legal residents.” In a chilling display of Nashville’s “friendliness,” local police also confiscated Villegas’ breast pump.”

Debra Haffner of the Religious Institute, a multi-faith organization dedicated to sexual health and justice answers people’s questions about why she’s speaking out against the Arizona law, given that her work is primarily on issues of sexual health and justice: “Because all of these issues are interconnected, and because as long as there is injustice for any group, there cannot be, "liberty and justice for all."”

Immigration Has A Female Face

Sure, the story of immigration into the United States has traditionally been of a man leaving home, with dreams of a decent-paying job dancing in his head, while a wife and maybe children wait patiently at home for the fruits of his labor to arrive each month. But by the end of the 20th century, says New American Media’s 2009 report, Women Immigrants: Stewards of the 21st Century Family, this arrangement no longer suited women and women’s desire to keep ones’ relationship and family intact.

Over the last decade, the number of women migrating to the United States has not only increased dramatically, women now make up more than half of all immigrants coming to this country. More women than ever before are crossing the border into the United States, and doing so during their prime reproductive years. These are young women seeking opportunities for their families, to improve their lives and the lives of their current or future children.

One-third of immigrant women who enter this country are also acting as heads of households once they are here, finds a New American Media poll, and women have been “remarkably successful” during this time at keeping their families together:

“Some 90 percent of women immigrants interviewed (30 percent of whom are undocumented) report their family units are intact – their husbands live with them, and their children were either born here or have joined them in this country.”

With so many women emigrating to this country and balancing the responsibility for work and family life once they are here, immigration is undoubtedly a “women’s issue” any way you look at it.

But is it being looked at, on a policy level, as a women’s issue? Miriam Yeung says, “…all of our immigration policies have been crafted without any gender analysis or any focus or thought about women.”

And while it’s empowering to recognize how successful women have been at keeping their families together as they work to build new and better lives for themselves in a new land, it’s critical to acknowledge that the female immigrant life in America is a fragile one that needs a stronger foundation, not more cracks. Strengthening immigrant women’s lives in the United States strengthens families. With passage of laws like the one in Arizona, we’re setting women and families down a backwards path of disruption and discord.

A Need For – And A Fear of - Help

Immigrant women face particularly challenging and sometimes horrendous scenarios, because they are female.

As Irin writes on Jezebel about immigration as a women’s issue, “From the beginning, these women are more vulnerable than their male counterparts, particularly if they lack documentation to enter this country.”

Women are far more likely to enter this country dependent upon a male partner’s employment visa: Seventy-two percent of those who hold employment visas in the United States are men.

Vulnerability comes in many forms: sexual violence that can start on a woman’s journey to the U.S. to domestic violence once in this country made worse when a woman is dependent upon a male partner to stay in this country; and extreme barriers to reproductive and sexual health care so critical to immigrant women who are here during their childbearing and parenting years. A law like the one in Arizona exacerbates all of these situations.

M. Elizabeth Barajas-Román, Policy Director for the National Latina Institute of Reproductive Health (NLIRH) says,

“We know that women who are here on a male partner’s visa have limited choices. You don’t have to be a US citizen or legal resident to get a protection order and most courts did not ask about immigration status. However, if local police [in Arizona] are now empowered to turn in “suspected” undocumented immigrations – it obviously will reduce if not totally cutoff undocumented immigrant women’s ability to seek help.”

For women who find themselves in a violent relationship, the Arizona law will undoubtedly put them in an even more dangerous place. The resources they may have visited for help, prior to the passage of the law, will now be eyed with extreme suspicion and fear. Says Bryan Howard, CEO of Planned Parenthood Arizona,

“For some of our patients, we’re understood to be a safe place; maybe we’re the only person they can talk to about an abusive or coercive relationship…Do patients [with this new law] …come to us now for health care but then don’t disclose a situation because they are afraid of what we’ll do with it? Will they be thinking, “Will PP contact the authorities?” Do they start withholding information? Of course, they’d prefer to get help but are afraid.”

It’s not only the emergency services, such as those so important to women in a domestic violence situation, which may be inaccessible to immigrant women under this law. It’s the critical reproductive and sexual health care that women need to attend to regularly which may be sacrificed because of fear of being “caught.”

Says Howard, “the tendency of people to go underground” whether they have documentation or not, will be made worse. In Arizona, legal permanent residents qualify for Medicaid including children and pregnant women under SCHIP, but only after they’ve been in the country for five years.

But those individuals who are undocumented are only eligible for Emergency Medicaid, aays Barajas-Roman, where “treatment is limited to serious health emergencies such as labor and childbirth. Therefore, most undocumented women forgo routine health care, including prenatal care and other preventive reproductive health services.”

Title X-funded family planning programs in Arizona do not require that legal residency is verified in order to provide services. Says Barajas-Roman, “When they do get sexual and repro health services, they usually turn to Community Health Centers, Title X centers and School Based Health Centers because these providers will rarely ask for documentation status.”

However, says Howard,

“Our experience over recent years is that people who either aren’t here legally or who have family members who aren’t here legally try to avoid what they think of as “official institutions,” like health care. In this state, there are a high number of deportations, families broken up. So, of course, there’s a real fear that if you come to the attention of authorities that it will put you or someone you love at risk. It’s frustrating because it’s a basic tenet of public health - that you don’t drive people underground.”

As mentioned above, although women who are in this country for more than five years qualify for public programs like Medicaid, the five-year bar, says, Barajas-Roman, is a restriction which creates “near-impossible barriers to basic reproductive health care such as regular cancer screening, contraceptives and abortion services.”

It’s something Howard worries about with both documented and undocumented women, who use Planned Parenthood services or who would benefit from their services.

“I have no doubt there will be patients who would have come in but who are now sufficiently fearful, with the passage of this law, that they either are going to forego, for example, birth control or have a relative get it for them.

We’re already seeing patients with interrupted health care. Women are asking for longer-term contraception because they aren’t sure where they’re going to be getting their health care next. They’re asking for IUDs or seeing if they can get 6 or 12 months of oral contraception. They talk to our clinicians about that and will say - our family is leaving and we’re not sure where we’re going so you can help with this? Our two concerns, then, are the continued disruption in people’s lives, the disruption of established health care relationships as well as the real risk of further driving people away from institutions that feel “public” out of fear that they will get noticed by authorities.”

When a woman accesses needed family planning services, regularly, it also means she’s receiving care like an annual exam; which includes a Pap smear, breast exam and more. It means she’s seeing a qualified provider who knows her medical history and can advise on appropriate birth control options. It means knowing whether one form of contraception may be medically contra-indicated for a particular woman. When a woman, for example, comes in to get birth control for a relative who is too fearful, and passes it on to that relative, the relative is not getting an exam, and is not being assessed for whether the form of contraception is appropriate for her, notes Howard.

Abortion Access

And when it comes to immigrant women who need abortion services in Arizona?

When it comes to minors, Arizona has a parental consent law. It means that minors must either have the consent of a parent to access an abortion or seek a judicial bypass (and it’s hard to imagine the daughter of an undocumented parent showing up in a courtroom). Providers like Planned Parenthood must verify age before a procedure – but not necessarily residency status.  But abortions cost money and as medical procedures go, they are not cheap. Arizona does not offer state funds for abortion care though there is an abortion fund in the state that will pay for up to one-third the cost. It’s still not nearly enough.

The National Latina Institute for Reproductive Health’s Barajas-Roman says,

“Undocumented immigrant women’s access to abortion services is even more limited than their access of sexual and reproductive health services. The fact is, abortion through safe and legal channels is inaccessible for many low-income and immigrant Latinas.

Many health centers do not provide abortion services, and when they do, the cost of the procedure is prohibitive. And for new immigrants that do qualify for Medicaid, the Hyde Amendment will bar them from getting federal assistance for an abortion.”

If it seems like impeded access to abortion, contraception, prenatal care, childbirth care, annual exams, STI checks, and family planning are just pebbles in a pond compared to the larger issues facing immigrant women in Arizona after the passage of the new law, think again. With women making up the majority of immigrants, increasingly acting as heads of household and central figures in their community once in the U.S., and, finally, coming to this country during their prime reproductive health years, it’s likely one of the most important issues facing immigrant women. Raising extreme barriers to health care for immigrant women means endangering their health and lives but also the health and lives of their children –whether their children are legal residents or not. If a woman is too afraid to seek health care for fear of being “caught” it’s hard to imagine she’ll feel comfortable bringing her child to seek regular health services or accompanying a pregnant relative as she seeks prenatal care or medical assistance during childbirth.

As you would imagine, advocacy organizations, coalitions and providers like Planned Parenthood are doing all they can to help immigrant women and their families receive care while also challenging the law.

The National Latina Institute for Reproductive Health and the National Coalition for Immigrant Women’s Rights are working hard to get the word out about the impact of the Arizona law on women’s lives and the lives of their families. Barajas-Roman says,

“We look forward to working with Senate leadership in amending their immigration outline so that it goes beyond enforcement-only mandates and instead takes a balanced, comprehensive approach that acknowledges the central role immigrant women play in their families and communities.”

Planned Parenthood of Arizona says they are involved with various provider and social service networks that work on improving access to care for immigrants in the state and they are working within their organization to make sure they get the word out to women:

“We have a statewide call center that takes 20,000 phone calls/month…Women are calling with questions about their health. Our 16 full-time call center representatives have been briefed about how to answer questions and give information to reassure callers that if they need care, that they can come to us without concern.”

And Yeung reminds us,

“This is a stigmatization of immigrant women period … We want to raise this issue as dire as it is and to remember that…When Arizona attacks the pillars of community, you’re tearing away the underpinning of strong families and of strong communities.”

Because the Arizona immigration law targets women – as heads of household, as child-bearers and primary parental figures, and as critical central figures in family and community life – women’s rights and health activists must stand strong in opposition to the biased and stigmatizing law together.

Cross posted from RHRealityCheck blog.