Addressing Access Barriers to Sexual and Reproductive Health Care for Irregular Migrant Women in the United States and Italy – Incorporating an Intersectional Human Rights-Based Social Work Framework

Irregular migrant women in the United States and Italy face overlapping difficulties when seeking sexual and reproductive healthcare. To improve our understanding of irregular migrant women’s SRH in order to develop strategies to improve health and well-being, a key gap identified in the research was the lack of evaluating and comparing the impact of national healthcare and welfare policies on access to services. Correspondingly, research scientists Caiola, Docherty, Relf, and Barroso (2014) have stated that when studying SRH care needs of migrant women, within-in country and between-country analyses can show how SDH, such as gender, occupation, income, and race/ethnicity can radically influence health outcomes to create hierarchies of health and illness. Therefore, to contribute to this discourse in the literature an multiple-case study in the US and Italy was conducted to gain an in-depth understanding of the experiences and perceived needs of irregular migrant women when accessing SRH and to identify potential key policies solutions that can address health inequalities. An exploratory qualitative study was designed with 34 in-depth ad hoc interviews with irregular migrant women, healthcare providers, and social workers. The barriers were understood in terms of discrimination and inequitable access to healthcare under international human rights law. To detect the root causes of healthcare inequalities and lack of human rights fulfillment, we relied on an intersectionality perspective to analyze and understand the multiple sources of discrimination and how they overlap and create multiple levels of social injustices in the lives of the women. Interviews were audio-recorded, transcribed verbatim, and thematically analyzed through the software NVivo. The research yielded six key themes: hostile discourse on migration; limited legal entitlements, rights and administrative barriers; inadequate resources and financial constraints; poor living and working conditions; cultural and linguistic barriers; and stigma and discrimination based on migration status, gender, sex and ethnicity. The results showed that while a nation’s health care polices impact irregular migrant woman’s access to healthcare, other interconnected barriers were present that were mutually reinforcing sources of marginalisation. Therefore, the need to go beyond the sole focus on an women’s immigration status in their access to sexual and reproductive healthcare confirms the usefulness of intersectionality in analysing the discriminatory processes through a gender lens and in framing equality and social justice, whilst making reference to a human rights paradigm. Keywords: Irregular migrant women; undocumented migrant women; sexual and reproductive healthcare; sexual and reproductive health and rights; social determinants of health; barriers to healthcare services; health inequalities; social justice; human rights; international human rights law; right to health; human rights-based approach; critical feminist theory; intersectionality theory; intersectionality-based public policy analysis; healthy public policy; social work; community development; bottom-up approach; qualitative health research; case study research; multiple-case study design; most different method; Philadelphia; United States; Bologna; Italy