Prenatal care among immigrant and racial-ethnic minority women in a new immigrant destination: Exploring the impact of immigrant legal status

Despite the rising share of undocumented immigrants in the US population, research has been quite limited regarding immigrant legal status and how it may limit healthcare access, especially research involving direct identification of undocumented populations. Drawing upon the Utah Population Database, a unique, comprehensive linked system of vital, medical, and administrative records, we analyze the prenatal care utilization in a large and recent cohort of births to mothers residing in the pre-emerging immigrant gateway state of Utah. Our analyses focus on the racial-ethnic, nativity and legal status of mothers as factors that influence prenatal care utilization. State administrative records are used to assess legal status among foreign-born mothers, specifically driver privilege cards made available to undocumented migrants. Our results indicate the importance of disaggregating the expansive categories of Hispanics and the foreign born to better understand health outcomes and healthcare utilization among immigrants. In particular, we find that the legal status of immigrant mothers is one of several important factors influencing prenatal care utilization. Undocumented women are among the least likely to obtain adequate levels of prenatal care. However, undocumented women's prenatal care utilization is enhanced among those using the state's integrative driver privilege program, and among those residing in neighborhoods with high concentrations of immigrants. Results are discussed in light of theory on immigrant integration and healthcare access, and in terms of public policies, such as those extending driver privileges to unauthorized immigrants, which aim to facilitate immigrants' access to institutions within destination communities. (C) 2011 Elsevier Ltd. All rights reserved.