Recently, Planned Parenthood of New York City released a study entitled "Un Pie En Dos Islas," which delved into the reproductive health of Dominican women in both Santo Domingo and New York City. Among other things, the qualitative study revealed a deep seeded mistrust of the health care system, leading women to more often than not take their health care, including diagnosis, medication and even abortion, into their own hands.
The study has generated a lot of press coverage -- the New York Times published an article on January 5, and outlets ranging from Forbes to Univision to Feministing to Jezebel to RH Reality Check have responded. Reactions have varied greatly, but the main point still holds true: the immigrant women in our study, both those who have moved here and those who were born here, articulated that because of racism, inaccessibility and language barriers, they feel alienated from what should in theory be some of the best medical care in the world. They described being chastised for not speaking English, and found the health care system in New York City intimidating, difficult to navigate and disrespectful.
This study also speaks to the power of cultural norms and traditions. Women relying on each other for advice is never a bad thing, yet somewhere along the way, the New York City health care system is failing to connect with these immigrant populations. And the only way to fix this is by approaching health care for these communities from the inside out.
The Dominican population in New York City is unusual in that they're coming from a country where abortion is illegal, without exception even in the case of the health of the mother. Yet, the Dominican women in our study reported that they still consider abortion a part of the reality of their lives. This has led to a culture of women taking their care into their own hands -- through various over-the-counter medications and home remedies.
Yet, for the women in our study, these norms are holding true even when they've left the Dominican Republic. And it's not just when it comes to abortion: regarding condom use, birth control, attitudes towards sexual health and a culture of male domination remained constant in both places. Women described condom use as problematic with their partners -- with the introduction of a prophylactic standing in as either an accusation of infidelity or a confession of one.
In fact, it was only when it came to domestic violence that there were marked differences between the attitudes of women in both places. Although domestic violence is still a problem in both communities, women in the Dominican Republic reported often feeling as if they had to resign themselves to a situation of violence due to their economic dependence on their partners. Women in the U.S., however, reported being aware of their rights and options in a violent situation, and felt more empowered to get themselves out of a dangerous situation.
The importance of community and conversation cannot be overestimated -- and is ultimately one of the best tools that we have when approaching public health. In some senses this study confirms a long-held belief in the reproductive rights movement: that regardless of what procedures, medications, etc. are legal or not, when women feel they have no other options, they will take matters into their own hands.
And when this is the case we should be grateful that women do have a community to turn to. Yet the next step is making sure that this community, which will always serve as the first line of information for sexual and reproductive health, has the correct and best information available. This means investing in more community outreach, education and communication, as well as making sure we understand women's realities well enough to provide them with sensible and realistic options. This also means working through the community, by reaching out to and empowering key thought leaders to help reach the larger population.
Women will always turn to those they trust the most first -- for some that may mean doctors with degrees from the most respected institutions, for others that may mean the women they've known all their lives, that understand their experiences and current situation. Whichever may be the case, our most important job as health care providers is to work with that community, making sure that we reach them, on their terms, with the information and resources that are best for their health.