Doctoral Dissertation Research: Bolduc: Socio-Spatial Factors Influencing Prenatal Care Availability, Access, and Utilization by Pregnant Haitian Immigrant Women in Immokalee, FL

This ongoing project investigates the socio-spatial relations influencing Haitian immigrant women's prenatal health care access and utilization in lmmokalee--a rural migrant farmworker community in Collier County, Florida. The research has four specific aims investigated through a combination of archival research, qualitative data, and critical/feminist GIS. First, archival research and discourse analysis, it explores how the changing politics of immigrant health care in the United States affects the availability of services for immigrant women in lmmokalee. Second, it uses interview data from health care providers in lmmokalee to explain how the changing politics of immigrant health care affects the provision of health services for immigrant women. Third, using mapping and in-depth interviewing, the project investigates Haitian women?s experiences of the resulting health care system in lmmokalee, as well as how these experiences influence where and how they utilize health care services. Finally, it identifies the socio-spatial barriers that Haitian immigrant women face in accessing prenatal care. This study was prompted by conversations with health care providers in Collier County that indicated that they ?have no idea what to do with [Haitians]? in terms of health care, despite the large number of Haitians (at least 10,000) in the county. In addition, politicians and community members in South Florida often portray Haitian immigrants as undeserving of health care and/or government spending. Intellectual Merit : The intellectual merit of this project lies in its relevance to a range of contemporary scholarly interests. Within geography, there has been a surprisingly small body of work produced on immigrant health( care) in the United States despite the timeliness and relevance of the topic, even though scholars outside of geography have shown significant interest in the spatial factors that contribute to inequities in health and health care in the United States since the enactment of the Affordable Care Act in January 2014. This research directly addresses this gap in understanding by contributing new theoretical insights into the socio-spatial factors influencing the health of a target population in a target area within the context of a rapidly changing immigrant health landscape. In addition, this research explores the methodological possibilities offered by qualitative GIS to health researchers and planners. This project will uniquely analyze information on health and health care in lmmokalee with a critical/feminist lens to produce rich and dynamic maps that show the complex relationship between women, politics, economics, and health care, pushing the boundaries on several subfields of geography. Finally, as a highly interdisciplinary project, this research seeks to ensure that geographers sensitive to issues of space and place are part of the conversations taking place on health and health care through a broad dissemination of results inside and outside of the discipline. Broader Impacts : The broader impacts of this timely study can be seen in its applicability to health care practice and planning in lmmokalee and beyond. The project draws connections to other immigrant groups in the U.S. through an understanding of how the politics of immigrant health care?and the notion of ?deservingness??impact the availability, delivery, accessibility, and utilization of health care by immigrants. As such, this project offers an early view into how changes associated with the ACA might affect the health and healthcare accessibility of immigrant groups across the United States. Second, preliminary research conducted by the co-Pl has indicated that the health care community in Collier County has difficulty connecting with Haitian immigrants at the same time that Haitians desire more and better services. This project potentially brings academics, health care providers, and immigrant women into conversation with each other to address prenatal health disparities and inequities. The researchers are committed to a wide public dissemination of the results of the study. As a result, this research has the potential to improve the quality, efficiency, and effectiveness of prenatal care (and potentially health outcomes as well) in lmmokalee, while also serving as a model for similar studies with other immigrant groups and/or in other locations. Page A