Immigrant women’s sexual and reproductive health experiences differ from those of U.S.-born women, including those of the same race and ethnicity, according to a new analysis by Guttmacher researchers Athena Tapales, Ayana Douglas-Hall and Hannah Whitehead. For the first time, researchers compared nationally representative groups of foreign-born women with U.S.-born women of the same race and ethnicity on a number of sexual and reproductive health indicators, and their findings point to the complex factors that influence women’s lives.

The researchers used 2006–2015 data from the National Survey of Family Growth to compare foreign-born women aged 15–44 with U.S.-born women in the same age group on measures of sexual and reproductive health behavior, health insurance coverage, whether and how they used sexual and reproductive health services, and how they paid for those services. The researchers compared these two groups overall, and they also drew comparisons between foreign-born women and U.S.-born women by race and ethnicity.

“Our findings demonstrate that immigrant women in the United States are not a homogeneous group,” says Athena Tapales, lead author of the analysis. “Immigrant women have a wide range of different sexual and reproductive health experiences and needs.”

By several measures, immigrant women as a group were found to have comparatively limited access to sexual and reproductive health care. About one-third (33%) of foreign-born women aged 15–44 lacked health insurance coverage in the study period, compared with 16% of U.S.-born women. Immigrant women were less likely to use private insurance to pay for sexual and reproductive health services and nearly twice as likely to pay out of pocket (28% of foreign-born women paid for sexual and reproductive health services out of pocket, compared with 16% of U.S.-born women). Differences in insurance coverage and payment method between immigrant and U.S.-born women were particularly pronounced among Hispanic women.

Immigrant women also differed from U.S.-born women on contraceptive use and other sexual and reproductive health indicators. Fewer immigrant women had sexual intercourse or gave birth before age 20 (62% and 27%, respectively) than U.S.-born women (86% and 32%, respectively). Additionally, immigrant women at risk of an unintended pregnancy in some racial and ethnic groups (non-Hispanic black, non-Hispanic white and Asian) were less likely than U.S.-born women to use highly effective contraceptive methods, including sterilization, IUDs and implants. Among Hispanic women, immigrants were more likely to use highly effective contraceptive methods (53%) than their U.S.-born counterparts (41%).

The researchers suggest that immigrant experiences are likely even more complex than this analysis shows, varying not only by race and ethnicity, but also by country of origin. Sexual and reproductive health differences between immigrant and U.S.-born women are likely rooted in a mix of structural, cultural, economic and social factors. For example, federal and state policies that bar immigrant women from affordable health insurance coverage likely contribute to disparities. Our experts note that systemic factors like language barriers and a health care system that is difficult for many people in the country to navigate may also make it more difficult for immigrant women to affordably obtain care.

“Too many policy and programmatic barriers stand between immigrant women and sexual and reproductive health care, and the current political climate exacerbates those barriers,” says Kinsey Hasstedt, Guttmacher policy expert. “Policymakers and providers must act to help ensure that immigrant women are able to safely obtain the health care they need, and take into account the diversity of individual women’s preferences and needs.”

The Sexual and Reproductive Health of Foreign-Born Women in the United States,” by Athena Tapales, Ayana Douglas-Hall and Hannah Whitehead, is currently available online and will appear in a forthcoming issue of Contraception.

Support for this project was provided in part by the Guttmacher Center for Population Research Innovation and Dissemination (NIH grant 5 R24 HD074034).