A MULTIDISCIPLINARY BINATIONAL STUDY OF MIGRANT WOMEN IN THE CONTEXT OF A U.S.

MEXICO BORDER REPRODUCTIVE HEALTH CARE CONTINUUM
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Estudio Binacional de Mujeres Inmigrantes en la Frontera México-Estados Unidos: Integración Social y el Continuo de Salud Reproductiva

Final Report Submitted to: Programa de Investigación de Migración y Salud (PIMSA) Research Conducted Collaboratively by:
Anna Ochoa O’Leary Ph.D. University of Arizona, Tucson, AZ, USA Gloria Ciria Valdéz-Gardea, Ph.D. El Colegio De Sonora, Hermosillo, Sonora, México

December 2009

Final Report
A Multidisciplinary Binational Study of Migrant Women in the Context of a U.S. Mexico Border Reproductive Health Care Continuum ______________ Estudio Binacional de Mujeres Inmigrantes en la Frontera México-Estados Unidos: Integración Social y el Continuo de Salud Reproductiva

Co-Authors: Anna Ochoa O’Leary Ph.D. (Co-Principal Investigator) Binational Migration Institute/Dept. of Mexican American and Raza Studies César E. Chavez Bldg. University of Arizona, Tucson, AZ, USA 85721 Gloria Ciria Valdéz-Gardea, Ph.D. El Colegio De Sonora, Hermosillo, Sonora, México (Co-Principal Investigator) Ave. Obregón #54, Col. Centro Hermosillo, Sonora, México 83000 Submitted to: Programa de Investigación de Migración y Salud (PIMSA) HEALTH INITIATIVE OF THE AMERICAS 1950 Addison Street, Suite 203 UC BERKELEY SCHOOL OF PUBLIC HEALTH Berkeley, California 94704 Grant #GHN08W Start Date: February 25, 2008 End Date: December 31, 2009

©Anna Ochoa O’Leary ©Gloria Ciria Valdéz-Gardea ©Photography: Las fotos que aparecen en este reporte, incluyendo la portada, pertenencen al banco de datos del Seminario Niñez Migrante: www.seminarionm.blogspot.com. Fotos por: Marybel Gutiérrez y Gloria Ciria Valdéz-Gardea, ésta última coordinadora del seminario.
Binational Migration Institute BMI

Report Contents
Executive Summary..................................................................................................................................... 1 Theoretical Development ........................................................................................................................... 2 The Reproductive Health Care “Continuum” .......................................................................................... 2 Altar, Sonora: La antesala de espera ....................................................................................................... 2 Methods ..................................................................................................................................................... 3 Altar, Sonora ........................................................................................................................................... 3 Tucson, Arizona....................................................................................................................................... 4 Resultant samples and subsamples: Altar ............................................................................................... 4 Resultant samples and subsamples: Tucson ......................................................................................... 11 Methodological Considerations and Limitations ....................................................................................... 16 Limitations in Ascertaining Immigration status Amidst a Climate of Fear ......................................... 16 Community Partnerships .................................................................................................................. 17 Generalizability ................................................................................................................................. 17 Future Directions: ................................................................................................................................. 18 Student Support ........................................................................................................................................ 19 Student Researchers: ............................................................................................................................ 19 Scholarly Presentations............................................................................................................................. 20 Presentations ........................................................................................................................................ 20 Scholarly Papers in Development for publication ................................................................................. 22 Public Policy Recommendations ............................................................................................................... 22 Altar Sonora: ..................................................................................................................................... 22 Tucson, Arizona................................................................................................................................. 22 Principal Investigators ............................................................................................................................... 23 Works Cited .............................................................................................................................................. 24

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ACKNOWLEDGEMENTS
This project was funded by a grant from the Programa de Investigación de Migración y Salud (PIMSA) to the University of Arizona and El Colegio de Sonora, for which we are most appreciative. The Principal Investigators and authors of this report are Anna Ochoa O’Leary (University of Arizona, Tucson, AZ) and Gloria Ciria Valdéz-Gardea (El Colegio De Sonora, Hermosillo, Sonora, México), who also wish to acknowledge the efforts of many who helped assure that this research project was successfully completed. The authors are grateful for the support given by their institutions, the University of Arizona and El Colegio de Sonora, especially to administrative staff within our departments within those institutions who provided research team members with invaluable assistance in complying with the financial management of the grant. The authors would also like to express their gratitude to their research assistants (mentioned on page 19): students at our institutions who managed to negotiate overlapping commitments to studying and learning with those particular to the project’s goals and objectives. Without their dedication, this project would not have been possible. It would be negligent on our part not to recognize the help and contribution of our community partners in the places where our work was carried out. In Altar, we are grateful to the migrant shelter managers of The Centro Comunitario de Atencion al Migrante y Necesitado (CCAMYN) and the owners of the numerous Casas de Huésped, where migrant women were interviewed. In Tucson, we are most appreciative for the support and assistance given by the Mexican Consulate’s Office, Sr. Consul Juan Manuel Calderón Jaimes, and dedicated staff members Claisalia Robertson and Alma Castel de Oro. We are equally grateful to Dr. Arturo Martinez of El Rio Community Health Center for his cooperation. We are especially indebted to El Rio’s community health workers Josefina Medraza and Salvador Barraza, who, in view of the political climate spurred by recent anti-immigrant rhetoric, were fundamentally essential to the successful recruitment of respondents in Tucson. The extent of their contribution to the successful completion of the project is immeasurable. Finally, this study would not have been possible with the generous participation of the women in Altar and Tucson who welcomed interviewers and who willingly shared their personal information and details about their lives in was is arguably inhospitable environments. The authors extend their most heartfelt thanks to the 80 women in Tucson and the 87 women in Altar who took time away from their busy schedules to speak with us about their lives and hardships. All of them trusted the reach team enough to give up some of their valuable time and energy to enrich our data. They too shared our hope that the findings of this study will contribute to a future improvement in their lives and that of future generations, and ultimately enhance the quality of life of all those who find their way to U.S. Mexico borderlands.

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A MULTIDISCIPLINARY BINATIONAL STUDY OF MIGRANT WOMEN IN THE CONTEXT OF A U.S.MEXICO BORDER REPRODUCTIVE HEALTH CARE CONTINUUM
______________ Estudio Binacional de Mujeres Inmigrantes en la Frontera México-Estados Unidos: Integración Social y el Continuo de Salud Reproductiva

Final Narrative Report
Executive Summary
This binational research project was designed to analyze the reproductive health care strategies of migrant women. Funding was awarded in the Spring of 2008, and the study was completed in the Fall of 2009. Binational teams of investigators and student assistants from the Colegio de Sonora (COLSON)1 and from the Binational Migration Institute (BMI),2 at the University of Arizona shared responsibility for gathering and analyzing data. The Sonoran component of the project conducted research in Altar, Sonora, and the U.S. component conducted research in Tucson, Arizona. Both research teams on each side of the border used a combination of qualitative and quantitative research methods to examine the reproductive health care strategies of migrant women who are increasingly active participants in transnational movement. These strategies were studied in light of some of the structural determinants of risk for women due to the increased exposure to various types of risks associated with migration— including the risk of death (O’Leary 2008, 2009a) and sexual assault (Falcon 2001), and the risks posed when access to health care services and resources in settlement communities are limited or denied. The research leveraged work in Sonora by Valdéz-Gardea (2007), who has documented the emergent concentration of migrants in Altar, Sonora, 120 miles south of the U.S. Mexico border, and the strain on services for migrants that this major staging area for the journey north has produced. North of the border and along the south-north migrant corridor, in Tucson, Arizona, there has been a curtailment of supportive services—largely driven by a highly politicized anti-immigrant sentiment and the implementation of anti-immigrant legislation like Proposition 200 in 2004, which requires that state and local governments verify the legal status of all applicants for certain state and local public benefits (Ferreira-Pinto, 2005; O’Leary 2009b, see also Wilson, 2008). As such, a theoretical concept, the “reproductive health care continuum,” was developed for the research. The “continuum” consists of im/migrant women’s repertoire of reproductive health care strategies and the associated knowledge that women draw upon in the context of their plans to migrate northward. The continuum is hypothesized as developing continually, beginning with plans to migrate and evolving in response to resource scarcity, social hostilities, and/or restrictive policies (Wilson & McQuiston, 2006). This binational approach is also consistent with Hannerz’s (1998) suggestion for organizing transnational research, where, instead of the conventional community study of migrants at the end or beginning of their migration journey, migrants are viewed as somewhere in between. The analysis of migrant women’s choices illustrate how their access to reproductive health care services is problematized in a range of ways by broader contradictory trends inherent in the transnational movement of labor and families, serving to inform policy makers agencies about reproductive health care practices and needs on both sides of the border.

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Theoretical Development
The Reproductive Health Care “Continuum”
The concept of a reproductive health care “continuum” was developed for the research. The reproductive health care “continuum” consists of the repertoire of strategies, epistemologies, and practices adopted by women that begin with plans to migrate northward and evolves in the context of their settlement in the U.S. Three areas of reproductive health have been singled out as the most catastrophic for women whose reproductive health is compromised by migration and settlement in communities where their choices, resources or support are restricted or denied. The first area involves pregnancy (including prevention, counseling, termination, and prenatal care). The second involves sexually transmitted diseases (including HIV/AIDs, detection, prevention, and treatment). The third involves post-partum care and the risks posed to mothers and children by conditions such as malnutrition, anemia, infection, or depression. In developing this concept, both binational teams employed a mixed methods approach.

Altar, Sonora: La antesala de espera
En este marco, en los últimos años el estado de Sonora se ha convertido en el principal punto de cruce para la migración internacional. No sólo estamos hablando de los migrantes que llegan a las comunidades fronterizas de Sonora con intención de cruzar hacia los Estados Unidos, hablamos también de la migración de cientos de mexicanos originarios de los estados del sur del país que ante la opción de trabajo que representa el noroeste de México deciden migrar a las ciudades y comunidades de esta región. La zona más crítica se localiza al suroeste del estado de Arizona, misma que se caracteriza por una mayor violencia y por un incremento en el número de paisanos fallecidos en el área desértica, principalmente, en las rutas y zonas despobladas del corredor Naco-Douglas; Lukeville-Sonoyta; Puerta de San Miguel, El Sásabe, Altar, La Ladrillera, Tinajas, El Bajío, límites de la reservación de los Tohono O´Odham y, recientemente por el municipio de Santa.
La zona más crítica se localiza al suroeste del estado de Arizona, misma que se caracteriza por una mayor violencia y por un incremento en el número de paisanos fallecidos en el área desértica, principalmente, en las rutas y zonas despobladas del corredor Naco-Douglas; Lukeville-Sonoyta; Puerta de San Miguel, El Sásabe, Altar, La Ladrillera, Tinajas, El Bajío, límites de la reservación de los Tohono O´Odham y, recientemente por el municipio de Santa Cruz
(Reporte del Programa de Repatriación Voluntaria, 2004).

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Lo anterior ha traído como consecuencia la movilización de personas, niños y adultos, a ciudades más “esperanzadoras” como las define Carrasco (2000) refiriéndose con ello a la población que busca formas precisas para ser absorbida y consumida en la ciudad, lo que provoca que “la ciudad central y lugar de recibimiento de migrantes sea desmitificada convirtiendo a la ciudad como un lugar que brinda momentos esperanzadores adosados a las nuevas formas de construir y apropiarse de ella” (Carrasco 2000, 3) tal es el caso de las ciudades fronterizas del norte de México y Estados Unidos.

Methods
Altar, Sonora
Research Goals: A. To assess the inequalities that migration supposes for women and whether or not migrant women are facing a generalized discriminatory public health situation due to structural determinants (in both Sonora and Arizona) that endangers their health and safety, and potentially that of their families. Evidence of this would provide the basis for seeking additional funding. B. To make a binational comparison of existing initiatives and reproductive health care and through this develop guidelines and recommendations that integrate gendered perspectives for improvement. C. To document case studies to analyze the limitations and impact of reproductive health programs from a gendered perspective and within binational social, economic and political contexts,

Para este estudio, se utilizó rapid appraisal techniques (RAT). Esta técnica maximiza la calidad de la información. RAT (Conway and McCracken 1990; Rhoades 1985) utiliza una metodología mixta que incluye una revisión de literatura secundaria, seguida por visitas cortas de trabajo de campo para identificar las variables importantes y los segmentos de la población que requieren de estudio. Esta fase inicial es seguida por trabajo de campo intensivo el cual se dirige esos grupos escogidos utilizando una variedad de técnicas etnográficas para recolectar datos tales como la observación participante, entrevistas a profundidad, entrevistas focales y entrevistas estructuradas. Esta combinación de técnicas mejora la descripción de fenómenos complejos como lo es la migración y la salud. Ello revela importantes preguntas sobre cómo interactúan las variables para producir ciertos patrones que le dan validez a la investigación. Se diseñó un cuestionario que fue aplicado a 66 mujeres con al menos 5 años de residencia en Altar. El instrumentó contaba con las siguientes secciones:  Sección A: La unidad de familia  Sección B: Sobre la travesía  Sección C: Sobre su estancia en la localidad cercana al punto de cruce  Sección D: Estado de Salud General

D. To disseminate good practices and experiences in the area.

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Tucson, Arizona
In the Tucson, Arizona field site, the goal was to examine two purposeful subsamples of im/migrant women to appreciate the relationship between immigration status and access to health care services in this settlement location. The first subsample of immigrant women (C) were those eligible for health services (n=40). The second subsample (D) of 40 respondents were to be immigrant women whose legal status (or that of someone in her care) might pose problems for accessing health care. Similar to Altar, the focus in Tucson was to use two purposeful subsamples of immigrant women to appreciate changes in the continuum as migrant women move northward. The questionnaire in the Tucson survey instrument (which included open-ended questions) was divided into the following sections:  Section A: The family unit  Section B: General health conditions  Section C: Pregnancy health care  Section D: Sexually transmitted diseases  Section E: Post-partum care In addition, a semi-structured interview guide was used at the end of the survey to allow interview to depart from the basic questions to pursue interesting, unexpected, or new information.
Subsamples C and D: Using a combination of variables and texts, it was determined with reasonable certainty that 41 of the participants were themselves, or had someone in their family “ineligible” for medical coverage, presumably due to immigration status. Another 30 were identified as “documented,” or, eligible for medical care through publically-funded health care programs. For nine of the respondents, no determination could be made using the answers given.

Resultant samples and subsamples: Altar
El objetivo fue combinar en el análisis datos emanados de los cuestionarios con datos de corte subjetivo de las entrevistas a profundidad. La idea era presentar las voces de las mujeres y sus percepciones en cuanto a la percibida vulnerabilidad en el proceso migratorio, su estancia en Altar, el acceso a los servicios de salud, entre otros temas, lo anterior con el fin de presentar algunas recomendaciones de políticas públicas en beneficio de este grupo. Summary Statistics Los datos de los 66 cuestionarios aplicados a mujeres muestran como esta región representa una alternativa para mejorar su calidad de vida. A continuación presentamos (Fig. 1) los resultados cuando se les preguntó sobre las razones para venirse a esta ciudad fronteriza:

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Figure 1

Resulta interesa observar las diferentes respuestas que dieron Figure 2 las mujeres en la gráfica de arriba. La mayoría de las respuestas van encaminadas a tener una “mejor vida.” Muy pocas mujeres comentaron abiertamente que el objetivo principal era cruzar hacia Estados Unidos, otras no contestaron. Sin embargo, en la gráfica, (Fig. 2), mostramos los resultados ante la pregunta de a qué ciudad en Estados Unidos se dirige o dirigía cuando llegó a la comunidad lo que muestra que en su mayoría, independientemente de las razones por las que se decidieron quedarse a vivir posteriormente en la comunidad, llegaron a esta con la intención inicial de cruzar. 5|P age

Antecedentes Desde los años sesenta se ha incrementado el flujo migratorio mexicano hacia Estados Unidos. Según datos del Consejo Nacional de Población (CONAPO) se ha calculado que el flujo de emigrantes entre 260 mil y 290 mil personas en la década de 1960-1970, entre 1.20 y 1.55 millones de 1970-1980, entre 2.10 y 2.60 millones en el decenio 1980-1990 y poco más de tres millones de personas de 1990-2000. La nuevas tendencias del fenómeno migratorio en México muestra una mayor participación de migrantes de origen urbano y de mujeres solteras o casadas (Marcelli y Cornelius, 2001; Woo, 2003). Según la CONAPO, las pautas de migración Mujer migrante e hija inspeccionados en su camino a El femenina se están alejando del patrón tradicional Sásabe. de acompañamiento, puesto que 58 por ciento de las trabajadoras migrantes en Estados Unidos son solteras (Fig. 3) y 42 por ciento envía dinero a sus familiares ya que se encuentran en etapa de vida de mayor capacidad de trabajar y producir (Fig. 4). Es decir, cada vez cobra importancia el grupo de mujeres que se mueven solas en el marco de una red de apoyo femenina. Perfil demográfica de la Muestra de Altar (66 cuestionarios)
Figure 4: EDAD

Figure 3: ESTADO

CIVIL

30 20 10 0

28

27
3

2

35 30 25 20 15 10 5 0

33

13

14
4

2

Una de las características importantes del fenómeno migratorio actual en nuestro país es la diversificación de los corredores de migración y la importancia que están tomando en éste las ciudades medianas y pequeñas las cuales cumplen un rol trascendental para la migración internacional, que se caracteriza, entre otras cosas, por la presencia de actores antes no documentados pero siempre presentes en el proceso, como las mujeres y los menores migrantes 3. Esto tiene que ver con la instrumentación de políticas migratorias estadounidenses desde finales de la década de los noventa las cuales se han dedicado a vigilar con más fuerza las zonas tradicionales de cruce, reorientando el tránsito migratorio hacia regiones de alto riesgo como la zona fronteriza de Sonora-Arizona (Cornelius 2001, Nevins 2002, Rubio-Goldsmith, McCormick, Martinez and Duarte 2006).

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El panorama anterior nos habla del rol activo de la mujer en la migración internacional. Este grupo está integrado por mujeres de diversas clases sociales y niveles de educación que desafía el estereotipo del actor migrante tradicional (Valdéz-Gardea, 2005). El aumento de la 9 migración femenina está ligada por una parte, al 6 continuo empobrecimiento del campo en México 4 4 4 (especialmente en áreas del centro y en el sur del 3 2 2 3 3 2 2 país como muestra la Figura 5), y a la falta de 1 1 1 creación de empleos y carencia de oportunidades de estudio para las mujeres y, en otros casos, ligado a violencia doméstica que sufren las mujeres en sus lugares de origen. Las mujeres entrevistadas a profundidad y a las que se les aplicó el cuestionario, expresaron sentirse inseguras en la comunidad, algunas prefirieron no contestar como si sintieran que ello las delataría ante algo, o alguien. Además, se entrevistaron a profundidad a 21 mujeres en tránsito que habían llegado a la comunidad con el propósito de cruzar hacia Estados Unidos (Cuadro 1).
20 18 16 14 12 10 8 6 4 2 0 19

Figura 5: ESTADO DE ORIGEN

Cuadro 1: Sitios en Altar en donde se reclutaron a las entrevistadas y se realizaron las entrevistas Sitio Casa de huéspedes Lupita Plaza Casa de huéspedes Javier Otros: CCAMYN, Comedor El Chiapaneco y Hotel Santa Ana TOTAL No. de entrevistadas 7 7 4 3 21

Local de venta de comida y artículos localizado al lado de la plaza en Altar.

Fue el objetivo de la encuesta en Altar recabada información de dos distintas muestras de mujeres. Dentro la muestra de 80, 40 estarán en tránsito (muestra A), y las otras 40 serán asentadas en la comunidad en los últimos 5 años (muestra B). Se espera que de de esta segunda muestra, haya casos en que mujeres hayan estado en tránsito en alguna vez. A continuación mostramos una gráfica basada en los 66 cuestionarios sobre las experiencias de las mujeres que en ese momento se encontraban en Altar, (Fig. 6), y información sobre sus estancias en torno al tiempo que permanecían en ese lugar (Fig. 7):

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Figure 6

Figure 7

Acceso de los Altarenses y Mujeres migrantes a los Servicios de Salud Los paisanos además de satisfacer sus necesidades alimenticias y de hospedaje, también se ven necesitados de los servicios de salud, ante los cuales se ven en gran desventaja, ya que estos servicios se concretan en una unidad móvil de la Cruz Roja, atendida por un solo paramédico, (que evidentemente no es suficiente para la cantidad de migrantes que necesitan de los servicios), y en una clínica de la Secretaría de Salubridad y Asistencia. Se les preguntó a las mujeres encuestadas si contaban con algún tipo de seguro médico o servicio médico y estas fueron sus respuestas (Fig. 8):

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Figure 8

Figure 9

Existe también en la comunidad más de media docena de Qualitative data consultorios médicos particulares, Aasí como the research was to goal of una clínica privada. El migrante, que regularmente viaja also qualitatively document con studies económicos case recursosin order to analyze limitados, tiene poco o nulo the limitations and impact of acceso a la práctica programs reproductive healthmédica privada. Lo anterior origina la from a gendered perspective peligrosa práctica de la and within each of the social, automedicación por parte del economic and political contexts migrante, quien recurre al in which they take place. boom Preliminary content analyses of farmacéutico en la comunidad, these narratives indicate that con más de media docena de the following farmacias ubicadas por todo Altar, para comprar desde penicilina para una infección de garganta, hasta neomelubrina para la temperatura1.

Módulo de la Cruz Roja para la Atención al migrante

Las mujeres encuestadas hicieron ver en sus respuestas que hacen uso de la infraestructura de salud con la que cuenta la comunidad, son las mujeres en tránsito las que expresan su mayor vulnerabilidad ya que la mayoría que entrevistamos no cuentan con recursos económicos para consultar al médico particular o el tiempo suficiente para ir al centro de Salud o Clínica del IMSS, por el tiempo que se requiere y el protocolo administrativo. La solución rápida para ellas es ir al Módulo de la Cruz Roja (Fig. 9) o auto medicarse.

La escasez de servicios públicos para atención a la salud en Altar ocasiona que las mujeres migrantes se sientan más vulnerables ante las pocas posibilidades de recibir atención médica cuando lo necesitan o de encontrar medicamentos en las farmacias de la localidad. Algunas de las mujeres entrevistadas a profundidad comentaron que usan remedios caseros como opciones para aliviar algún malestar. Otras comentaron su frustración ante la carencia de medicamentos en la comunidad como comenta Mariana, quien tuvo que cambiar de método anticonceptivo que utilizaban en el lugar de origen, al método del “ritmo” por no encontrar las pastillas en Altar:
“Yo me cuidaba con pastillas, pero las dejé de tomar porque no encontré, porque hasta de eso carece Altar, no había de mi marca ni de ninguna, ahora tengo que andar contando”.

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A continuación presentamos las respuestas de las 66 mujeres encuestadas ante la pregunta de a donde se dirigen cuando están enfermas (Fig. 10): Figure 10

En la figura 11, se muestra que una gran porción de los habitantes en Altar no tienen derecho a los servicios del IMSS (Instituto Mexicano del Seguro Social), o el ISSSTE (Instituto de seguridad y servicios sociales de trabajadores del estado) como trabajador(a), o pensionado(a) o como miembro, para que reciban atención médica a través de los servicios que estas instituciones ofrecen.

Figure 11: ACCESO DE LOS ALTARENSES A LOS SERVICIOS DE SALUD (FUENTE:http://www.inegi.gob.mx) DERECHOHABIENCIA POBLACIÓN Población sin derechohabiencia a servicios 4743 de salud Población derechohabiente a servicios de 2480 salud, que consiste de: Población derechohabiente del IMSS 1294 Población derechohabiente del ISSSTE 199 Población derechohabiente por el 789 Seguro Popular

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Resultant samples and subsamples: Tucson
Arizona provides a unique context for understanding the threat to immigrants’ and migrants’ wellbeing.4 Since the mid-1990s, Arizona’s border with Mexico has garnered national attention as a major migration corridor, and more recently, it has been the focus of media reports and negative images depicting the border as a lawless wasteland. The challenges that emerge doing this research is thus indelibly linked to the political climate on the Arizona side of the U.S. Mexico border. Summary Statistics and Preliminary Findings The data gathering instrument for the Tucson field work consisted of a survey instrument with both open ended and closed-ended questions. The final section of this instrument consisted of a semistructured question guide that could be used to probe deeper into issues raised by women through the open-ended questions. The open-ended questions offered the opportunity for women to speak about their engagement with health care facilities and allowed researchers to explore further lines of inquiry. State of Health Few women claimed that they were experiencing poor health (Fig. 12)
Figure. 12: Self-reported "Estado de salud" (state of health) for each subsample Subsample C D Total “Excelente” 2 5 7 “Muy Bueno” 8 8 16 “bueno” 13 16 29 “Regular” 13 10 23 “Malo” 2 2 4 Total 38 41 79

Access to Services How the sociopolitical environment affects access to health care was a central question of the study. In this respect, we found a wide range of practices as women sorted through complicated bureaucracies of gaining access. Some were more successful than others. One of the women interviewed had been a nurse when she lived in Mexico. Having advanced beyond the preparatory level (“prepa”), her education level was higher than many of the other respondents (see Figure 13 and 14). Figure 13 Education Levels Altar Sample Figure 14 Education Levels: Tucson Sample

EDUCACIÓN

40 30 20 10 0

33 17 2
12

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However, she also knew that her working (in the US) entitled her to some accommodation and that the rights of her children to health care needed to be respected and in spite of her family being of low-income. She made sure to let us know during in the interview that two of her children were US For other women, accessing citizens. For immigrant women, having children who were U.S. health care services was an born was not uncommon (Fig. 15). intimidating experience, as one interviewee recounts: Figure 15: Number of children born in the U.S., Respondent
Pues cuando uno va, yo llevaba temor. Llevaba miedo por si me decían que no, o por ser indocumentada. No sé, tenia temor. Por ir, a pedir un servicio médico o algo…no sé por qué. Cuando yo pedí mis AHCCCS, la última persona, no se como que la intimida, la ponen de nervios. Me imagino que es Latina, que es mexicana, no sé. Hasta Y cuando pedí los AHCCCS para mi niña, sabe me dio temor, como diciendo “hay, si me dices mentiras te vamos a investigar. Y cuando me tocaban otras personas que eran de acá, de EEUU, gringo, ellos no, y esa (la Latina), si. …por no estar legal en este país. Lo mismo pues a mi familia.

The Role of Fear and Intimidation The onslaught of anti-immigrant legislative propositions in Arizona’s state legislature that began in 2004 with Proposition 200 (“Prop 200) grew out of the myths that immigrants overburdened healthcare programs (King 2007). In part perpetuated by a highly charged debate over immigration reform compounded by the nation’s post9/11 fears,5 Arizona policy makers have amended state laws to require applicants to show proof of citizenship to access a number of services and to require agencies administering state and local public benefits, under penalty of law, to verify applicants' immigration status. These laws fail to consider those within families who may be eligible for services, and thus creates a “chilling effect” in accessing services (FerreiraFigure 16

N = 358 With Subsamples C and D combined

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Pinto 2005). Figure 16 above compares subsamples C and D, showing, as is true for all statistics, as the sample size goes up, even small differences can become highlight significant. In other words although only 80 women were interviewed, the slightly larger number of women who were categorized as subsample D (where at least one member of the household is thought to be undocumented: n= 41) translates into a total of 209 when all household members are considered. By comparison, the lower number of women who were categorized as subsample C (where immigration status does not seem to be an issue: n= 30) translates into a total of 107 when all household members are considered. Thus, the total number of those more likely to be affected by adverse health policy restrictions is nearly twice than that where health service eligibility is not an issue (figure 17).

Figure. 17

Respondents were asked if they had any type of health insurance and these responses were examined according to subsample (C and D). Following the idea that the combined anti-immigrant rhetoric and the ensuing restrictions in health service deliver policies (such as Prop 200) produces a “chilling effect” on health care access (Ferreira-Pinto 2005), our null hypothesis posits that there is no difference between subsamples C and D. Figure 18 shows the preliminary X2 (Chi-Square) test results of the comparison of these responses. The table indicates that a 2 x 2 table yields ample cell size frequencies, but that further analysis of the data is warranted. The Pearson X2 and Fisher’s tests yield significant differences between the two samples. However, the (Yates) Continuity Correction gives a slightly higher confidence interval level (p < .012), so the null hypothesis cannot be rejected without further analysis.
Figure. 18: Preliminary Chi-Square Tests for Subsample (C and D) Differences in Access to Insurance

Value Pearson Chi-Square Continuity Correctionb Likelihood Ratio Fisher's Exact Test Linear-by-Linear Association N of Valid Cases 71 7.514 7.622
a

df 1 1 1

Asymp. Sig. (2-sided) .006 .012 .005

Exact Sig. (2-sided)

Exact Sig. (1-sided)

6.338 7.893

.008 1 .006

.005

a. 0 cells (.0%) have expected count less than 5. The minimum expected count is 12.68. b. Computed only for a 2x2 table

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The apparent curtailment of supportive services comes at a time when the immigration of women who contribute to the growth of subsample D is increasing. Figure 19 shows that women belonging to subsample D—having entered the U.S. after 2000—are more recent arrivals that those from subsample C. Women from subsample D are on average younger, which places them closer to important childbearing and child-rearing stages of their lives (Fig. 20). Once settled, they are not only confronted by economic constraints, but also social hostilities, and/or restrictive policies (Wilson & McQuiston 2006; Wilson 2008; 2000). Figure 19 To avoid being saddled with medical care costs, some women relied heavily on home remedies using herbs and teas to keep them healthy and out of the doctor’s hospital. As one women explained: Yo—puros tés. Siempre mis remedios me funcionan perfectamente. De nuestros antepasados porque antes no había médicos, no había medicina tan avanzada como ahora Y como la hacían antes? … Hojas de limón, y hojas de eucalipto, con flores de bougambillia, nosotros no los daba mi abuelita, desde hace años, mas de 100 años, yo ahorita tengo ya casi 50.

Figure 20

A content analysis of the narratives show that for some respondents the issue was not that they did not have the documents, but that they did not have all of the documentation necessary and with them at the time they attempted to obtain assistance. 59% stated that they had dealt with this difficulty for accessing services, and 41% did not report having issues. In addition, a majority of the respondents (65%) stated that they had felt in some way unwelcomed, discriminated, or otherwise made to feel uncomfortable by medical staff. 14 | P a g e

Family Planning and Changing Gendered Norms Figure 21

As previously noted, many women had children who were born in the U.S., but many also had children who came with them from Mexico (Fig. 21). However, the research also suggests that gendered norms with regard to family size and family planning are undergoing change. Women represented by subsample D, who tend to be younger on average, more educated (Fig 14b.), and who have arrived later on average than those from subsample D, were more likely to report that they have had tubal ligations as a birth control measure (Fig. 22). The decision to limit the number of children was based on realities in terms of finances and time, as one woman, Karla, remarked, “La decisión de operarme, es: ‘pocos hijos para darles mucho.’

Fig 17

Figure 22

It was not uncommon to find women speak favorably about what they perceived as an emerging ability to openly discuss reproductive health issues with medical personal and with their adolescent children, such as the use of birth control and condoms, as expressed in the words of one interviewee: “Pues, cuando comienza uno en la edad de la “punzada” que nosotros le decimos, es cuando ve3s que ya el niño empieza a definirse su sexualidad. Entonces, a menos en mi hogar, nosotros nos sentamos en la mesa y platicamos de ésas cosos. No hay vergüenza……. Porque allá (en México) no muchas personas están preparadas…”.

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Methodological Considerations and Limitations
Limitations in Ascertaining Immigration status Amidst a Climate of Fear An early article by Cornelius (1982) points out some of the methodological challenges inherent in locating and interviewing undocumented immigrants, where personal interviewing is the primary datagathering technique. As such, an inescapable feature of this research was respondents’ fear of reporting self-incriminating information. Marchevsky and Theoharis (2008) argue that because officials are influenced by the public discourse and prejudices, their decisions result in the denying of eligible applicants from applying and receiving much-needed public benefits. A prevailing assumption that informed the research and its design, therefore, was that respondents would be fearful of divulging information that might jeopardize their access to and participation in health care programs, and and potentially, their well-being or that of their families. According to Cornelius, fear introduces bias into the research results in two ways. The first is that fear produces “extremely high” non-response rates. In response to this first issue, researchers must often accept smaller samples that can improve response rates. However, in doing so, the ability to generalize is weakened. To achieve a better response rate, researchers must also work harder to locate and engage participants. This usually involves more-often complex, time-consuming, approaches (e.g. ethnographic) designed to both locate undocumented populations who reside in the U.S. and build trust at the same time. Such compromises are necessary “if *researchers+ want to find answers to many of the empirical questions that are at the heart of the debate over undocumented immigration…” (Cornelius 1982: 381). The accuracy and reliability of the data collected can thus be improved by adopting appropriate field-work strategies, as well as employing well-trained interviewers who have extended personal contacts within the community and subscribe to an ethic of respect for respondents who, because of the proliferation of anti-immigrant rhetoric and media, may already suffer low-level but constant assault on their dignity and may be more reluctant to cooperate. The second way in which fear introduce systematic bias is through the reluctance to answers to questions that may incriminate. As noted above, for undocumented immigrants, fear of becoming targets of scrutiny stems from the adverse socio-political climate that increasingly pressures service agencies to ascertain applicants’ legal status. This same issue is discussed by Cornelius (1982) in the context of his early 1978 fieldwork among undocumented migrants in California, where less threatening questions were asked to ascertain the legal status of respondents. In the current study also, no question about respondents’ legal status was made. Instead, combination of questions about health care access and behaviors—informed by assumptions about undocumented immigrants’ struggle to adapt in the host country—were built into the survey instrument. In the absence of outright admission from the respondent that they did not have documents, combinations of questions could be use to infer the respondents immigration status. Upon inspection of the responses, certain patterns emerge to allow us to claim with reasonable certainty that we had met our goal of interviewing at least 40 respondents in which at least one member of the household was undocumented. However, in adopting such a method, the research assumes certain limitations in terms of its resulting data.

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Community Partnerships The research team from the University of Arizona leveraged relationships with local agencies (the Mexican Consulate, Ventanilla de Salud, Luz Social Services, and El Rio Community Health Center), where immigration status of potential clients does not always preclude them from accessing services. In the initial phase of the research in Tucson, a variation of the snowball technique as described by Cornelius (1982) was adopted. This consisted of the use of community health workers (promotores de salud) of the El Rio Community Health Center. The promotores served a dual role in this project: they provided safe [social] spaces in which to conduct research, and through these spaces and through their far-reaching social networking skills, assisted in the recruitment of study participants. The high response rate (100%) of those invited to participate by the promotores is attributable to their years of experience in working in such settings. By comparison, without the use of promotores as recruiting agents, initial response rates were extremely low (around 15%-25%). The El Rio Community Health workers were actively engaged in the community by conducting diabetes education and support group education. The networks they had access to thus favored a sample in which individuals had already taken an interest to improving their knowledge to improve health. However, by the study’s dependence on community agents for recruiting participants introduces bias in the resulting sample in several ways. First, it favors members of the community already engaged in health education programs, and who are more likely to be conscious of the benefits of health-seeking behaviors. Secondly, it favors individuals who are long-term residents (as opposed to temporary or recent immigrants), and as such, families who have steady year-round urban-based employment. Repeated attempts to reduce this bias by urging respondents to refer other potential respondents to the research team were unsuccessful. Seeking participants at other sites also proved inadequate due to the inability to secure privacy for interviewees to answer intimate questions about sensitive topics such as those related to reproductive health and sexually transmitted diseases. The survey instrument offered an attempt to reduce this bias by incorporating numerous open-ended questions that gave respondents ample opportunities to tell their own story (Cornelius Figure 23 1982). Generalizability The fact that most of the women interviewed in the Tucson site were from the Mexican state of Sonora (Fig. 23) is explained it part by the history of the region and the historic relationship between Arizonan and Sonoran territories. However, it also signals a limitation of the study to make predictions about the reproductive health care continuum without further research, especially when most of the women coming through the Altar-Sonora corridor came from Mexico’s southern and central states (Fig. 5). 17 | P a g e

Future Directions:
In addition to continued exploration into the themes already mentioned (Access to Service, Fear and Intimidation, and Changing Gendered Norms), the following recurring themes will undergo further analysis using statistical tests and content analysis of the narratives. Experiencing and assessing difference between US and Mexican Health Care cultures In developing the reproductive health care continuum, we are interested in how im/migrant women make adjustments with the changing environments. To this end, women were asked if they noticed differences in the culture of health care service in the U.S. and Mexico. Exploiting Binational/Border Contexts With the threat of entering into debt looming large, many women exploit their living close to the border to help them avoid health care utilization. Health care service utilization It appears that health care utilization also requires overcoming an assault to indignities created by the health care service application process, where many women expressed indignation with the added scrutiny that they underwent. This process is repeated many times through the course of their lives and with each renewal for coverage. Language barriers Women needed to work around language barriers for communicating their concerns to health care professional, understanding their course of treatment, directives, and for resolving billing and payment issues.

Paying the Price

The impact of Immigration Raids on America’s Children

According to a 2007 report by the Urban Children in mixed immigration status household. Institute, there are approximately 5 The research suggests a need to better understand how million U.S. children who have at least one policies impact even those who may be eligible for services parent who is undocumented. such as U.S.-born children in households where an undocumented family member lives. This study is only the beginning of an emerging scholarship that addresses contemporary gaps in public policy procedures affecting children of mixed immigration status families (See inset above). Recent reports have recently exposed immigration enforcement irregularities that affect the health and welfare of children. As such, findings from this and future research in this area should have far-reaching implication for U.S. policies and immigration policy development. As in many parts of the world, U.S. political rhetoric ignores decades of migration in response to the demand for labor in more developed nations (MDNs) and the progressive impoverishment in less developed nations (LDNs).

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Student Support
The funding made it possible to hire students to help with the research as well as provide them opportunities to learn and gain experience in research methods, fieldwork, and data analyses, help prepare project reports, and in the case of Tucson, showcase Spanish language skills. In addition to conducting weekly interviews with women who have migrated/immigrated to Tucson, the research assistants transcribed each of the interviews into a word processing document in the language of the respondent (presumably Spanish), entered and processed data on the software program, Statistical Package for the Social Sciences (SPSS), and performed a content analysis of the qualitative portion of the data.

Student Researchers:
The PIMSA funds made it possible to hire students to help with the research. In so doing, the project created opportunities for students to apply their skills and knowledge, and to learn about fieldwork, research methodology, and data analyses. In the case of Tucson, the project offered the opportunity for students to showcase their Spanish language skills. The following are the students who participated in this project: Katherine Ann Careaga, El Colegio de Sonora, concluyó su Tesis de doctorado titulada: “Construcciones de vulnerabilidad y agencia de las mujeres ante las enfermedades de transmisión sexual (ETS) en el proceso migratorio de Altar, Sonora, 2006-2007). Doctorado en Ciencias Sociales en la línea de investigación de Epidemiología Sociocultural de El Colegio de Sonora, Generación 2005-2007. Fecha de la defensa: Septiembre, 2009, en Hermosillo, Sonora. Valeria Elizabeth Figueroa Rodríguez, El Colegio de Sonora, maestra en ciencias colaboró en el trabajo de campo que se realizó en la comunidad de Altar, Sonora, con el diseño del instrumento metodológico de las encuestas aplicadas en la comunidad, y hacer las transcripciones de las entrevistas que se realizaron. Por otro lado, participó en la incorporación y procesamiento de los datos obtenidos en las encuestas, en el programa informático: paquete estadístico para las ciencias sociales (SPSS).

Azucena Sanchez, University of Arizona, is an advanced undergraduate Marketing Major student at the Eller College of Management at the University of Arizona (UA). She has previous experience searching and translating historical documents for the Pascua Yaqui Court of Appeals and acting as the office clerk under the supervision of Professor James Hopkins. Born and raised in the Arizona-Sonora border towns of Nogales, her duties with the PIMSA project combined a personal background and interest in Mexican-American culture and immigration with skills in interviewing, and data transcription, entry, and analysis. Yvette Quijada, University of Arizona, is a graduate student in the Mexican-American Studies & Raza Studies Department. She also teaches at Luz Social Services, Inc. a private, non-profit community based corporation founded in 1971 to provide health and human services to the Latino communities in Tucson, Arizona.

Estudiante de maestría del Colegio de Sonora en entrevista en Altar

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Scholarly Presentations
Presentations
The study, at different stages of the research, has been presented at the following venues and events:

Date
October 7, 2008

Venue/event
VIII Semana Binacional de Salud: Foro de Políticas Públicas PIMSA/Health Initiatives of the Americas (HIA)/Programa de Salud y Migración. Zacatecas, Zac. México.

Presentation
“Un Estudio Binacional de Mujeres Inmigrantes en el Contexto de un Continuum de Cuidado de Salud Un Estudio Binacional de Mujeres Inmigrantes en el Contexto de un Continuum de Cuidado de Salud Reproductiva en la Frontera México-EU.” (Binational Team Mid-term Report) Anna Ochoa O’Leary Universidad de Arizona Gloria Ciria Valdéz-Gardea, Colegio de Sonora “Women at the Intersection: The Struggle for Family Reunification at the Margins of the U,.S. and Mexico Border” Anna Ochoa O’Leary Universidad de Arizona

October 4, 2008

Community Report: What you taught us about Migration and Health., Binational Migration Institute (BMI) El Pueblo Neighborhood Center, Tucson, AZ Foro niñez migrante y derechos humanos. Matamoros, Tamaulipas Primer Congreso Internacional de Ciencias Sociales en el Sureste mexicano. Cancún, Quintana Roo. V Congreso Internacional sobre Migración y Desarrollo Campus Central de la Universidad Rafael Landívar, Guatemala, Guatemala

Octubre 20, 2008

“Menores migrantes en tránsito por Sonora”. Gloria Ciria Valdéz-Gardea, Colegio de Sonora

Octubre 23-25, 2008

“La antropología de la migración; poblaciones complejas, trabajo de campo y actores”. Gloria Ciria Valdéz-Gardea, Colegio de Sonora Mesa: Procesos de Detención y deportación o Retorno. “Encuentros mortales en la frontera: Mujeres inmigrantes en situación de abandono” Anna Ochoa O’Leary, Universidad de Arizona, y Gloria Ciria ValdézGardea, Colegio de Sonora “Anécdotas de burreros, jornaleros y cuatreros: narrativas de migrantes en el uso de sustancias como mecanismo ante la vulnerabilidad y coyotaje en Altar, Sonora”. Gloria Ciria Valdéz-Gardea, Colegio de Sonora “Desafíos metodológicos dentro el un ámbito discriminatorio estadounidense: Práctica y ética en un estudio de salud reproductiva entre mujeres inmigrantes en Tucson, Arizona” Anna Ochoa O’Leary and Azucena Sanchez, Universidad de Arizona (UofA) Josefina Meranza y Salvador Barrajas, El Rio Community Health Center, Tucson, AZ Tucson, AZ

Noviembre 78, 2008

May 23-25, 2009

II Encuentro Internacional: Migración y Niñez Migrante. (Colegio de Sonora Hermosillo, Sonora, Mexico).

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Scholarly Presentations (con’t)

Date
October 5-6, 2009

Venue/event
PIMSA/Health Initiatives of the Americas (HIA)/Programa de Salud y Migración (Binational Team Presentation), Santa Fe, NM IX Semana Binacional de Salud: Binational Policy Forum (Santa Fe, NM)

Presentation
“A Multidisciplinary Binational Study of Migrant Women in the Context of a US-Mexico Reproductive Health Care “Continuum” (Oct. 5) Anna Ochoa O’Leary, Gloria Ciria Valdéz-Gardea “Migration and Women on the U.S.- Mexico Border: Environment, Access, and the Reproductive Health Care “Continuum” (Oct 6) Anna Ochoa O’Leary, Universidad de Arizona “Revisitando fronteras: actores y lugares de la migración”. Gloria Ciria Valdéz-Gardea, Colegio de Sonora

Marzo 5-6, 2009

XIII Reunión Internacional, La Frontera, una nueva concepción cultural. San Cristóbal de las casas, Chiapas, México XIII Reunión Internacional, La Frontera, una nueva concepción cultural. San Cristóbal de las casas, Chiapas, México. 27 Aniversario del Departamento de Psicología y Ciencias de la Comunicación. Hermosillo, Sonora. Taller internacional “Ética y metodología en la investigación fronteriza binacional” (BBREM), organizado por la Universidad de Arizona. El Rancho La Osa ubicado en el Sásabe, Arizona.

Marzo 5-6, 2009

“Desafíos metodológicos en el estudio de poblaciones móviles: menores migrantes en tránsito por Sonora” Gloria Ciria Valdéz-Gardea, Colegio de Sonora

Marzo 24, 2009

“Investigación Cultural en Sonora”. Gloria Ciria ValdézGardea, Colegio de Sonora

Octubre 8-10, 2009

"Reflexiones antropológicas en poblaciones móviles: frontera, actores y trabajo de campo”, Gloria Ciria Valdéz-Gardea, Colegio de Sonora “Sin Papeles: Reflections on Methods and Ethics in a Study of Reproductive Health and Migration in the U.S.Mexico Border Region.” Anna Ochoa O’Leary Ph.D., University of Arizona Borderscapes of Practice: Im/migrant Women and the U.S.-Mexico Reproductive Health Care Continuum (Invited Session) Narrativas de salud en la periferia fronteriza: Mujeres migrantes en tránsito y el acceso a la salud. Gloria Ciria Valdéz-Gardea, Colegio de Sonora

December 27, 2009

American Anthropological Association Annual Meeting (Philadelphia, PA) Society of Applied Anthropology (Merida, Yucatán, Mexico). (acceptance pending)

April 13-17, 2010:

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Scholarly Papers in Development for publication
Valdéz-Gardea, Gloria Ciria “Current Trends in Mexican Migration: The Altar-Sasabe Corridor, Taking the Lead on the Border’s Periphery.” Special Edition, Journal of the Southwest. The University of Arizona, Forthcoming 2010. O’Leary Anna Ochoa. Mujeres en el Cruce/Women at the Intersection: Mapping Family Separation at a time of Global Uncertainty,” Journal of the Southwest. Forthcoming 2010. O’Leary Anna Ochoa, and Azucena Sanchez, “Sin Papeles: Methodological and Ethical Reflections on a Study of Reproductive Health and Migration in the U.S.-Mexico Border Region.” O’Leary Anna Ochoa and Yvette Quijada. “Borderscapes of Practice: Im/migrant Women and the U.S.Mexico Reproductive Health Care Continuum.”

Public Policy Recommendations
One of the goals of this research was to make comparisons of existing policy initiatives and reproductive health care resources and through this analysis develop guidelines and recommendations that integrate gendered perspectives for improvement. Altar Sonora:  Ajustar los programas de salud pública (prevención de ETS/VIH/SIDA) para que tomen en cuenta las relaciones de género de manera crítica, reflexiva y constante.   Incrementar la accesibilidad a los exámenes médicos, los tratamientos a las ETS, los condones y la vacuna de VPH a todas las mujeres en Altar. Trabajar con los líderes en el proceso e industria migratoria, incluyendo ONG’S, dueños de hospedajes, guías, autoridades y militares. Desmilitarizar las fronteras y/o transformar profundamente las políticas militares, ya que son violadores sistemáticos de los derechos de las mujeres. Capacitar a los trabajadores del Desarrollo Integral de la Familia (DIF) locales sobre las leyes y protocolos relevantes, así como sobre las mujeres migrantes. Difundir información sobre la pastilla del día siguiente y hacerla accesible.

 

Tucson, Arizona • Develop popular education workshop curriculum and materials specific to reproductive health care for immigrant women, for use in community group settings • Develop educational materials for employees of social service agencies that will help dispel myths about widespread beliefs that immigration enforcement policies punish only those who have entered the U.S. without official inspection. • Compare the economics of im/migrant women reproductive health care strategies with mainstream populations, especially in light of a high rate of sterilization (permanent tubal ligation) among immigrant women for as a preferred method of contraception.

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Principal Investigators
Anna Ochoa O’Leary, Ph.D. received her degree in Anthropology from the University of Arizona in 1999, where she also received training at the Bureau of Applied Research in Anthropology (BARA). She is currently an Assistant Professor of Practice at the Department of Mexican American Studies and Raza Studies at the University of Arizona, where she is also affiliated with the Binational Migration Institute, an association of scholars dedicated to the study of how immigration enforcement affects Latino populations regardless of legal status. She is also involved in the grass-roots organization, the Coalición de Derechos Humanos, a immigrant rights group. Her current research, teaching, and publications focus on immigration, gender issues, education, culture, the urban politics of Mexican/U.S.-Mexican populations, and the political economy of the U.S.-Mexico border. In 2006 she was awarded a Fulbright Scholarship to research migrant women’s encounters with immigration enforcement agents, “Women at the Intersection: Immigration Enforcement and Transnational Migration on the U.S.-Mexico Border.” Gloria Ciria Valdéz-Gardea, Ph.D., comunicóloga por la Universidad de Sonora, maestra en artes y doctora en filosofía por el Departamento de Antropología de la Universidad de Arizona. ProfesorInvestigador en El Colegio de Sonora. Miembro del Sistema Nacional de Investigadores desde el 2007 y es Perfil PROMEP. Ha conducido varios proyectos binacionales de investigación en el tema migratorio. Sus libros recientes son: "Soy pescadora de almeja: respuestas a la marginación en el Alto Golfo de California", y "Achicando Futuros: Actores y lugares de la migración", editados por El Colegio de Sonora. Ha publicado artículos de investigación en revista mexicanas indexadas así como en revistas internacionales. Es coordinadora General del Seminario Permanente Niñez Migrante, y del Encuentro Internacional Migración y Niñez Migrante. Su próxima publicación (2010) es una edición especial del Journal of the Southwest sobre el tema migratorio. La doctora Valdéz-Gardea recibió el reconocimiento de la USCD Raza Graduates por su desempeño como docente en la University of California, San Diego.

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Works Cited
Canales, Alejandro. 1999. “Industrialización, Urbanización y crecimiento Demográfico en la Frontera”. (Archivo pdf). Conway G.R .y McCracken, A.J. 1990. “Rapid rural apraisal and agroecosystem análisis”. In: Altieri, MA and Hecht BS (editors). Agroecology and small farms development. Boca Ratón, Ann Arbor, Boston, USA. CRC Press. Boston, USA. 221-234. Cornelius, Wayne A. 2001. Death at the Border: Efficacy and Unintended Consequences of U.S. Immigration Control Policy. Population and Development Review 27(4): 661-685. --------------- 1982. Interviewing Undocumented Immigrants: Methodological Reflections Based on Fieldwork in Mexico and the U.S. International Migration Review, 16 (2): 378-411. Ferreira-Pinto, J. B. 2005. Impact of Arizona’s Proposition 200: Final report for the US-Mexico border health commission. El Paso: Border Planning and Evaluation Group. Unpublished Manuscript. Falcon, Sylvia. 2001. Rape as a weapon of war: Advancing human rights for women at the U.S.-Mexico border. Social Justice, 28(2), 31-51. Fuentes-Afflick, E. Korenbrot, & C.C., Greene, J. 1995. Ethnic Disparity in the Performance of Prenatal Nutrition Risk Assessment Among Medicaid-Eligible Women. Public Health Report 110, pp. 764-773. Guendelman, S., Thornton, D., Gould, J., & Hosang, N. 2005. Social disparities in maternal morbidity during labor and delivery between Mexican-born and US-Born White Californians, 1996-1998. American Journal of Public Health, 95(12), 2218-2224. Hannerz, Ulf. 1998. Transnational research. In Bernard, H. R. (Ed), Handbook of Methods in Cultural Anthropology (pp. 235-256). London: Sage. Inda, Jonathan Xavier. 2006. Targeting Immigrants: Government, Technology and Ethics. Malden, MA: Blackwell Publishing Ltd. King, Meredith L. 2007. Immigrants in the U.S. Health Care System: Five Myths That Misinform the American Public. Center for American Progress. Available at http://www.americanprogress.org/issues/2007/06/immigrant_health_report.html. Accessed July 21, 2008. Marcelli, Enrico; Wayne, Cornelius. 2001. “The Changing Profile of Mexican Migrants to the United States”, Latin American Research Review, col. 36, Albuquerque, pp. 105-131. Marchevsky, Alejandra and Theoharis, Jeanne. 2008. Dropped From the Rolls: Mexican Immigrants, Race, and Rights in the Era of Welfare Reform. Journal of Sociology & Social Welfare. 15(3): 71- 96. Marshall, K. J., Urrutia-Rojas, X., Mas, F. S., Soto, & Coggin, C. 2005. Health status and access to health care of documented and undocumented immigrant Latino women. Health Care for Women International, 26(10), 916-936. 24 | P a g e

Nevins, Joseph. 2002. Operation Gatekeeper: The Rise of the “Illegal Alien” and the Making of the U.S.Mexico Boundary. NY: Routledge. Ojeda, N. 2006. Abortion in a Transborder Context. In In D. J. Mattingly & E. R. Hansen (Eds.), Women and Change at the U.S.-Mexico Border (pp. 53-69). Tucson, AZ: University of Arizona Press. O’Leary, Anna Ochoa. 2008. Close Encounters of the Deadly Kind: Gender, Migration, and Border (In)Security, Migration Letters 15(2): 111-122. ----------------------2009a. “In the Footsteps of Spirits: Migrant Women’s Testimonios in a Time of Heightened Border Enforcement”. In Violence, Security, and Human Rights at the Border, Kathleen Staudt, Tony Payan, and Z. Anthony Kruszewski (Eds.). Tucson, AZ: University of Arizona Press, 91112. --------------------- 2009b. Arizona’s Legislative-Imposed Injunctions: Implications for Immigrant Civic and Political Participation. Mexico Institute at the Woodrow Wilson International Center for Scholars. Available on-line www.wilsoncenter.org. Rubio-Goldsmith, M. Melissa McCormick, Daniel Martinez, Inez Magdalena Duarte. 2006. The “Funnel Effect” and Recovered Bodies of Unauthorized Migrants Processed by the Pima County Office of the Medical Examiner, 1990-2005. Report submitted to the Pima County Board of Supervisors, October 2006. Washington D.C: Immigration Policy Center Brief, available at http://www.ailf.org/ipc/policybrief/policybrief_020607.pdf. Accessed 2/18/07. Santibáñez, Jorge Migración Internacional. Congreso de la Sociedad Sonorense de Historia, Hermosillo, Sonora 2004. www.inegi.gob.mx www.conapo.gob.mx Urrutia, Alfonso (2004), “Altar, pueblo pollero, última base urbana antes de cruzar hacia EU por el Sásabe”, La Jornada, 16 de junio. Valdéz-Gardea, G. C. 2005. Mujeres y Nacionalismos en América Latina. De la independencia a la nación del nuevo milenio. Región y Sociedad XVI (30): 1. -------------------- 2007. Geografías rurales olvidadas: menores migrantes en tránsito por Altar-El Sásabe, expresión moderna del proceso globalizador. Primer acercamiento. En Arquitecturas de la globalización. Eloy Méndez, Coordinador. Mora-Cantúa Editores. Hermosillo, Sonora. --------------------- 2008. “Achicando futuros: actores y lugares de la migración”. In “Achicando futuros, El Colegio de Sonora. Von Maren y Susana Pastrana. 2004. Migración y derechos de las mujeres. La región de Altar-El Sásabe, Ponencia presentada en el Seminario Internacional “Mujer y Migración”, Federación Mexicana de Universitarias, FEMU, A.C. Hermosillo, Sonora, 2004. 25 | P a g e

Wilson, E. K. & McQuiston, C., 2006. Motivations for pregnancy planning among Mexican immigrant women in North Carolina. Maternal and Child Health Journal, 10(3), 311-320. Wilson, Tamara. D. 2008. Research Note: Issues of production vs. reproduction/maintenance revisited: Towards an understanding of Arizona’s immigration policies. Anthropological Quarterly, 81, 713-718. --------------- 2000. Anti-immigrant sentiment and the problem of reproduction/maintenance in Mexican immigration to the United States. Critique of Anthropology, 20(2), 191-213. Woo Morales, Ofelia. (2003). Reseña de “A Courtship after Marriage: Sexuality and Love in Mexican Transnational Families” de Jennifer S. Hirsch. Berkeley, University of California Press.

1

Colegio de Sonora, Obregón 54, Centro Hermosillo, Sonora, México 83000.

2

The Binational Migration Institute at the Department of Mexican American and Raza Studies at the University of Arizona, (César E. Chávez Build., PO Box 210023, Tucson, Arizona USA 85721) seeks to comprehensively document and analyze the interaction between migrants and immigration enforcement authorities.
3

Valdéz, Gloria (2007). Periódico Expreso. Fuera de Ruta “ Altar, Sonora: geografías rurales olvidadas”. Hermosillo, Sonora. 7 de Julio.
4

“Immigrant” is used in a deliberate way to refer to persons who come to a country to take up permanent residence. Within the context of the United States, the more narrow designation of “migrant” as a person who moves from place to place to work can be incorporated into the former category of immigrant in view of border enforcement policies that have disrupted ancient patterns of circular migration in the classic sense by making it more difficult for migrants to move across political boundaries. Due to the policies making border crossing more difficult, former migrants are forced to assume more lengthy stays in the United States, that are pseudo permanent in character, making them immigrants in the absence of any intention to reside permanently.
5

For a comprehensive discussion of how the militarization of the border and the heightening of the terror of border crossing are related to the development of anti-immigrant sentiment, see Wilson (2000).

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