Structural racism and sexual and reproductive healthcare experiences: A qualitative study among undocumented Asian and Latina

Structural racism in sexual and reproductive healthcare (SRH) has been linked to poor quality of maternal care among Black and Latina groups. Few studies have captured this from the perspective of undocumented female-identifying individuals, who experience compounding barriers from their intersecting minoritized identities including immigration status, race, and gender. This study aims to: 1) reframe Hardeman and colleagues' Racism and Maternal Healthcare framework to center the voices of undocumented Asian and Latina female-identifying individuals; 2) identify historical and contemporary examples of the impact of structural racism on their SRH access; and 3) describe manifestations of structural racism that lead to poor quality of SRH care for this group. Between February and July 2022, 30 semi-structured interviews were conducted with undocumented female-identifying Asian (n = 14) and Latina (n = 16) individuals. Both deductive and inductive thematic analysis of transcripts were conducted in Dedoose. Lack of health insurance, fear of seeking care instilled by immigration enforcement, and mistrust in the healthcare system due to historical and present-day experiences of racism in obstetrics and gynecology emerged as factors impeding access to SRH. Manifestations of structural racism in the health care setting included disrespectful care, ignored pain, dismissed concerns, lack of informed consent, bodily violations, and lack of person-centered SRH education and resources. This study provides valuable insights into how structural racism shapes SRH seeking behaviors and experiences of Latina and Asian undocumented female-identifying individuals. Findings will help guide healthcare providers' and policymakers’ decision-making in addressing current barriers that stem from structural racism.