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Cultural Barriers to Prenatal Care among Indigenous Migrant and Seasonal Farmworkers

Monday, February 12, 2018   (0 Comments)
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Colleen Pacheco, Special Populations Program Manager, Sea Mar Community Health Centers, and Ileana Ponce, Executive Director, Community Health Worker Coalition for Migrants and Refugees


Colleen and Ileana are presenting on this topic at NWRPCA's Western Forum for Migrant and Community Health


Many female indigenous Migrant and Seasonal Agricultural Workers (MSFW) in Northwest Washington tend to access late prenatal care.  Yet evidence demonstrates that early and regular prenatal care improves the chances of a healthy pregnancy and birth. There is limited understanding of the reasons for this delay, which is the catalyst for an exploratory pilot study on barriers to prenatal care being conducted by Sea Mar’s MSFW Promotores Program in collaboration with the Community Health Worker Coalition for Migrants and Refugees (CHWCMR), and funded by the UW Latino Center for Health.



Of the approximately 30,000 MSFW in Skagit and Whatcom Counties, close to 80% are Aztec and Mayan contemporaries from Southern Mexico and Guatemala.  The majority speak Mixtec and Triqui languages from the Mexican states of Oaxaca and Guerrero, and from Guatemala, at least eight distinct languages. Indigenous workers face worse health disparities and barriers to access to care than the general population or other MSFW, including long work hours, lack of transportation, and work hazards. Their migratory status, linguistic and cultural isolation, low literacy (including Spanish), lack of preventive health, reliance on traditional healers and remedies, and low utilization of health clinics beyond emergency care present additional challenges to accessing the health care system. This study’s purpose is to identify barriers to accessing early prenatal care among three of the largest indigenous communities and the findings will contribute to the development of innovative approaches for early (first trimester) prenatal care visits among indigenous women.


Methods: This 18 month exploratory mixed method study captured data from 82 women from three unique indigenous communities –Mixtec and Triqui communities from Mexico, and Aguacatecos from Guatemala. 24 Sea Mar clinicians who work with indigenous prenatal patients were also interviewed. This study, conducted in three phases, began in late 2016. In the first phase, a low literacy survey was developed with questions designed to identify cultural differences and variations in prenatal care practices, knowledge, attitudes, and perceptions. Questions were translated into three indigenous languages (Mixteco, Triqui and Aguacateco), plus English and Spanish. Seven indigenous staff and CHW’s were involved in the survey design, but only five females were involved in survey implementation. One male joined the Mixteco translation team to ensure broadest comprehension as dialects are unique to each town, and between the team members they spoke five. Indigenous interpreters and CHW’s worked closely with staff to translate into their indigenous language to ensure clarity and question intent. They were trained in prenatal care, survey implementation, and confidentiality, and were guided in their work.  


In phase two, female interpreters and CHW’s recruited participants through their social networks, recruiting women who both live in the area year-round and those who migrate annually. Women were given the option of taking the survey in their native language or in Spanish.  Non-Indigenous researcher conducted all the qualitative interviews with clinicians who have regular contact with indigenous prenatal patients, the majority were licensed staff and four were indigenous. The third phase is analysis and dissemination.





Total Sample (N=82)








Average: 36 years

Range: 19-65 years

Average: 36 years

Range: 19 -65 years

Average: 35 years

Range: 20-55 years

Average: 36 years

Range: 19-64 years

Length of Time in US

Average:13 years

Range: 0-28 years

Average:15 years

Range= 2-28 years

Average: 15 years

Range: 0-28 years

Average: 7 years

Range: 0-16 years

Completed Survey in Spanish (%)





Read/Write English or Spanish (%)






Average: 5 years

Range: 0-14 years

Average: 5 years

Range: 0-12 years

Average: 5 years

Range: 0-14 years

Average: 5 years

Range: 0-13 years

% Migrants







35% (10k-25k)


27% (10k-25k)

42% <$10,000

47% (10k-25k)

53% <$10,000

36% (10k-25k)


46% rent

46% rent

42% Employer provided

53% rent


Preliminary findings from the quantitative surveys and qualitative interviews find structural and non-structural barriers to prenatal care utilization. Some are uniform across communities such as lack of money or transportation, and others unique to certain communities such as difficulty making appointments over the phone, or not knowing where to seek prenatal care which illuminates limitations with language and not being tied in to a local social network. Based on this preliminary data, we can conclude that many attitudes, perceptions and practices are uniform across demographics, but others vary based on their community, age, language, and length of time in the US.



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