Giving birth across the border: the San Diego-Tijuana connection

Cross-border healthcare and prognosis of HIV infection in the triple border Brazil-Paraguay-Argentina

The act of crossing an international border for healthcare is a reality in border areas and the flow is in the direction of the city with more human and healthcare resources. Although several prognostic factors related to HIV+ patients are known, the prognostic value of this type of mobility for long term care is still neglected. This study compares the prognosis of HIV patients from three groups, one involved in regional mobility, another in cross-border mobility in search for healthcare and the reference group which is composed by patients living in the same city of the health facility. This is a retrospective cohort study using medical records from a healthcare service in Brazil. Following survival analysis with log-rank test and Cox proportional hazard models, overall survival had no significant difference between patients who were involved in regional (HR = 1.03; 95%CI: 0.69-1.54; p = 0.89) or international (HR = 1.07; 95%CI: 0.58-1.97; p = 0.83) mobility and those who were not. This lack of difference was kept when adjusted for known prognostic factors. In this retrospective cohort study, exposure to both regional and international migration did not have a significant association with the risk of death by any cause in crude or adjusted analyses for already known prognostic factors. This is the first study to consider the prognostic role of cross-border healthcare for HIV patients. Despite these findings, the need of monitoring the extent and the clinical and demographic characteristics of healthcare demand originated in the other side of the border and the use of these data for decision making in health management is emphasized.

Cross-border spatial accessibility of health care in the North-East Department of Haiti

BACKGROUND

The geographical accessibility of health services is an important issue especially in developing countries and even more for those sharing a border as for Haiti and the Dominican Republic. During the last 2 decades, numerous studies have explored the potential spatial access to health services within a whole country or metropolitan area. However, the impacts of the border on the access to health resources between two countries have been less explored. The aim of this paper is to measure the impact of the border on the accessibility to health services for Haitian people living close to the Haitian-Dominican border.

METHODS

To do this, the widely employed enhanced two-step floating catchment area (E2SFCA) method is applied. Four scenarios simulate different levels of openness of the border. Statistical analysis are conducted to assess the differences and variation in the E2SFCA results. A linear regression model is also used to predict the accessibility to health care services according to the mentioned scenarios.

RESULTS

The results show that the health professional-to-population accessibility ratio is higher for the Haitian side when the border is open than when it is closed, suggesting an important border impact on Haitians' access to health care resources. On the other hand, when the border is closed, the potential accessibility for health services is higher for the Dominicans.

CONCLUSION

The openness of the border has a great impact on the spatial accessibility to health care for the population living next to the border and those living nearby a road network in good conditions. Those findings therefore point to the need for effective and efficient trans-border cooperation between health authorities and health facilities. Future research is necessary to explore the determinants of cross-border health care and offers an insight on the spatial revealed access which could lead to a better understanding of the patients' behavior.

A realist synthesis of cross-border patient movement from low and middle income countries to similar or higher income countries

Patient travel across borders to access healthcare is becoming increasingly common and widespread. Patients moving from high income to middle income countries for healthcare is well documented, with patients seeking treatments that are cheaper or more readily available than at home. Less well understood is when patients move from one low income country to another or from a low income country to a higher income country. In this paper, a realist review was undertaken to explore why, in what contexts and how patients from lower income countries travel to countries with the same, or more advanced, economies for planned healthcare. Based on an initial scoping of the literature and discussions with key informants, we generated an initial theory and set of propositions about why, how, who and in what contexts people cross international borders for planned healthcare. We then systematically located and synthesized (1) peer-reviewed studies from the Scopus, Embase, Web of Science and Econlit databases; (2) non-indexed reports using key informants and Google; and (3) papers from the reference lists of included documents, to glean supportive or contradictory evidence for our initial propositions. As we reviewed the literature and extracted our data, we drew on the work of Pierre Bourdieu to understand the interplay between material and non-material capital and cognitive processes in decisions to cross borders for healthcare. Patient travel was largely undertaken due to a lack of services in the home country and/or unacceptability of local services, with decisions on when, and where, to travel, usually made within the patient's social networks. They were able to travel via use of multiple resources, including social networks, economic and cultural capital, and habitus. Those patients with greater volumes of the aforementioned factors had greater healthcare options; however, even those with limited resources engaged in patient travel. Patient movement challenges traditional ways of thinking about public health and the notion of health systems contained within the nation state. Further research is needed to better understand the effects of patient travel, and how to harness the benefits of patient travel without exacerbating existing health inequalities.

Mexican women seeking safe abortion services in San Diego, California

Except for in Mexico City, abortion is legally restricted throughout Mexico, and unsafe abortion is prevalent. We surveyed 1,516 women seeking abortions in San Diego, California. Of these, 87 women (5.7%) self-identified as Mexican residents. We performed in-depth interviews with 17 of these women about their experiences seeking abortions in California. The Mexican women interviewed were generally well-educated and lived near the U.S.-Mexican border; most sought care in the United States due to mistrust of services in Mexico, and the desire to access mifepristone, a drug registered in the United States for early medical abortion. Several reported difficulties obtaining health care in Mexico or reentering the United States when they had postabortion complications. Several areas for improvement were identified, including outreach to clinics in Mexico.

Barriers to HIV care in the context of cross-border health care utilization among HIV-positive persons living in the California/Baja California US-Mexico border region

We studied barriers to HIV care among HIV-positive Latinos in the US-Mexico border region, where HIV prevalence is increasing. HIV-positive participants receiving HIV care were recruited from clinics in Southern California and underwent structured interviews (n = 157). Logistic regression explored covariates associated with > or =1 barrier to HIV care. HIV-positive patients were mostly male (84.7%), of Mexican-origin (82.8%), and had a mean age of 37.3 years. Among males (n = 133), 67% identified as men who have sex with men. In the prior year, patients received the following care in Mexico: HIV care (33.1%), non-HIV care (43.3%), prescription medications (51.6%), and traditional medications/herbs (17.2%). The most common barriers to HIV care included stigma and medication side effects concerns. Factors independently associated with > or =1 barrier to HIV care were HIV diagnosis >1 year ago; being of Mexican-origin; crossing the US-Mexico border <5 times in the past year; obtaining medications in Mexico; and age. Findings illustrate that bi-national health care utilization is common, which has implications for HIV service delivery in both countries. Additional studies are needed to better understand individual, provider and system level barriers to HIV care in the San Diego/Tijuana border region.

Managing US-Mexico "border health": an organizational field approach

During World War II Mexican and US health professionals and organizations constructed a transnational organizational field to manage the border's public health problems. Despite barriers to inter-organizational cooperation, including disparate administrative structures and North-South stratification, the field's transnational approach to health on the border has continued for 60 years. Using archival data to track changes in the number and types of organizations, this article argues that the field practitioners call "border health" reconfigured during the North American Free Trade Association (NAFTA) decade from an era of loosely organized professionals to a specialized bureaucracies era. This change brought new vitality to border health, with transnational ties increasing and diversifying, but has not weakened entrenched cross-border inequalities. The organizational history of the US-Mexico border health field demonstrates how macro-politics and inter-organizational stratification shape transnational public health problems.

Understanding the increased risk of neural tube defect-affected pregnancies among Mexico-born women in California: immigration and anthropometric factors

Mexico-born women in the United States have an unexplained twofold increased risk of neural tube defect (NTD)-affected pregnancies. We examined whether immigration characteristics were associated with the NTD risk and whether anthropometric factors contributed to the increased risk among Mexico-born women. Data were derived from a large population-based case-control study in California. In-person interviews were conducted with mothers of 538 (88% of eligible) NTD-affected fetuses/infants and mothers of 539 (88%) randomly selected non-malformed control infants. The crude odds ratio (OR) for NTDs among all Mexico-born women, women residing <2 years in the US, and women >16 years old at immigration compared with non-Hispanic white women was 2.4 [95% confidence interval (CI) = 1.8, 3.3], 7.2 [95% CI = 3.7, 14.0] and 3.0 [95% CI = 2.0, 4.4], respectively. Risk for second- or third-generation Mexican-Americans was similar to that of white women. The crude OR for all Mexico-born women was reduced from 2.4 to 2.0 [95% CI = 1.3, 3.0] and for those residing <2 years in the US from 8.4 to 7.1 [95% CI = 3.2, 15.3] after adjustment for maternal body mass index (BMI), height, compromised diet, diabetes, and other known risk factors. In term pregnancies, additional adjustment for pregnancy weight gain reduced the OR in all Mexico-born women and recent immigrants by 16% and 25%, respectively. Low pregnancy weight gain (<10 vs. 10-14 kg) was particularly associated with increased NTD risk among Mexico-born women (OR(ADJ) = 5.8; 95% CI = 2.1, 15.8). Findings indicate that recent Mexican immigrants have a sevenfold increased risk for NTDs. Maternal BMI and height contributed very little, and inadequate weight gain contributed modestly to the NTD risk disparity for Mexican immigrants.

Health issues associated with the smuggling and trafficking of migrants

Approximately 4 million persons annually may be smuggled illegally across international borders. In 1997 it was estimated that 700,000 women or children were smuggled across international borders, of whom 175,000 were estimated to come from the former Soviet bloc; approximately 45,000-50,000 smuggled women and children arrived in the United States in that year. This article develops a framework to consider the impact of human trafficking on health within the context of migrant health and the destination population's health. Health risks are assumed by the individual being smuggled during the pre-journey, migratory, and arrival phases. In addition, the recipient country's population may also incur additional health burdens related to illegal arrivals from higher disease prevalence areas of the world. Some of this disease risk potential may be from transmissible agents, but there is increasing concern, and some evidence, that noncontagious diseases may be a significant problem associated with human trafficking. The global consideration of human smuggling and the individual and social impact on health are the focus of this paper.

Does community context influence reproductive outcomes of Mexican origin women in San Diego, California?

An increasing body of literature documenting what has become known as "the Epidemiological Paradox" has shown that some immigrant groups to the United States tend to have healthier birth outcomes than would be expected given their sociodemographic profiles. Furthermore, the children of these immigrants do not seem to enjoy the same advantage in reproductive health that their parents did. This phenomenon, though amply documented in the literature, has not been sufficiently explained. We investigate the role of assimilation in this paradox, and we do so within a spatial framework. We examine the effect of residence in a Mexican enclave in the attenuation of risk of low birth weight (LBW) for Mexican-origin mothers in San Diego County, California. We find that Mexican-origin women do seem to enjoy a reduced risk of giving birth to an LBW baby when they live in a Mexican enclave.

The effect of passing an "anti-immigrant" ballot proposition on the use of prenatal care by foreign-born mothers in California

This study examines whether the passage of California's Proposition 187, a proposition designed to restrict undocumented immigrants from using public services, had a negative effect on the use of prenatal care and birth outcomes. Comparisons of prenatal care use and birth outcomes before and after the passage of the proposition are made between low-education foreign-born and U.S.-born mothers using California's Birth Public Use files. Multivariate linear and logistic regressions were used to control for regional and maternal characteristics. We find a significant but small decline in the use of prenatal care by low-education foreign-born women after Proposition 187 passed; however, there was no detectable deterioration of birth outcomes. Whether future reductions in the availability of prenatal care would damage the health of children is unclear.

Crossing the border for health care: access and primary care characteristics for young children of Latino farm workers along the US-Mexico border

OBJECTIVES

To examine prevalence and correlates of cross-border health care for children of Latino farm workers in counties near the US-Mexico border and to compare access and primary care in the United States and Mexico.

METHODS

Two hundred ninety-seven parents at Head Start centers in San Diego and Imperial counties were surveyed regarding percentage of health care received in Mexico and the United States, access, and primary care characteristics.

RESULTS

More than half of all health care was reported as received in Mexico. Reasons for Mexican use revolved around cost, accessibility, and perceptions of effectiveness. Parents of insured children reported slightly more US care, yet even this group reported approximately half of health care in Mexico. Insurance status was related to having a regular source of care, while uninsured children reporting most care in Mexico were less likely than uninsured children in the United States to have had a routine health care visit. Primary care characteristics were related to insurance status and source of care. Uninsured children reporting most care in Mexico fared better in some aspects of primary care than uninsured children reporting most care in the United States and as well as children with insurance receiving care in the United States or Mexico.

CONCLUSIONS

Children of farm workers living along the US-Mexico border, almost irrespective of insurance status, receive a large proportion of care in Mexico. Especially for uninsured children, parent reports of Mexican care characteristics compare favorably with that received in the United States. Mexican health care might be a buffer against vulnerability to poor health outcomes for these children.

Crossing the border for abortion services: the Tijuana-San Diego connection

In this study we created a profile of women living on both sides of the US-Mexico border who terminated pregnancies in San Diego at the largest clinic providing abortion services in California. Sociodemographic and reproductive history data were collected on all 1558 women terminating pregnancies in 1996. Using country of residence, language use, and surname, the sample was stratified into four comparison groups: Tijuana residents, U.S. Non-Latinas, U.S. English-speaking Latinas, and U.S. Spanish-speaking Latinas. These data were supplemented by interviews with field experts. Compared to U.S. residents, crossborder abortion seekers were older, had healthier habits, were less likely to terminate in the second trimester, and more likely to pay cash for their procedure. While crossborder abortion seekers in San Diego face multiple barriers to access abortions, they posed no increased risk for complications, nor did they represent a financial burden on California.

Fetal deaths in Mexican-American, black, and white non-Hispanic women seeking government-funded prenatal care

Hispanics of Mexican origin constitute the largest minority population in the Southwestern United States, yet little is known about their reproductive health. This study assessed ethnic differentials in fetal mortality at 20 or more weeks gestation and identified the social and behavioral predictors associated with this outcome among low-income Hispanic, black non-Hispanic and white non-Hispanic women. Records were used of 80,431 patients attending federally funded prenatal care clinics in California from 1984 through 1989. The fetal death rate per 1,000 live births and fetal deaths was 7.8 for Hispanic, 8.4 for white non-Hispanic and 20.5 for black non-Hispanic women. These rates indicated favorable reproductive outcomes for Mexican Americans despite their social risk profile. An analysis of stillbirths by gestational age showed that Hispanic women stood a significantly lower risk of short-gestational stillbirths than non-Hispanics. In contrast, Hispanic women had a higher proportion of term stillbirths. Hispanic acculturation was a significant predictor of short-term gestation fetal deaths only. The inability to pay for health care was a strong predictor of fetal deaths for all ethnic groups, underscoring the need to ensure adequate access to maternity care for low-income women.