Mexican-origin women’s individual and collective strategies to access and share health-promoting resources in the context of exclusionary immigration and immigrant policies – BMC Public Health

We identified three major categories to capture Mexican-origin women’s responses to racialization processes as they sought to access and share health-promoting resources (Table 2). These represented individual and collective strategies including: (1) maintaining access to health-promoting resources; (2) limiting activities or contact with stigmatized others in order to protect one’s own identity; and (3) mitigating adverse effects by leveraging social support. In the following sections, we present our analysis of women’s responses, then discuss implications of these responses for maintaining access to health-promoting resources in the context of political, social, and economic barriers.

Maintaining access to health-promoting resources

Women used multiple strategies to prevent restrictions on access to resources necessary to maintain health. Those restrictions resulted from immigration and immigrant policies and practices that were grounded in, and that simultaneously reinforced, the construction of a devalued identity. Women in the first- and 1.5-generation recounted several experiences of being asked about their legal status in a variety of contexts. Several immigrant women and women with immigrant family members who had an unauthorized legal status recounted their experiences as they sought to renew their driver’s licenses. For example, Susana, a first-generation woman, shared:

We went all over the place, to all the secretaries [Secretary of State] to see [about renewing driver’s license] and no. We went downtown, we went to … Jackson [Michigan], all over and they said that they were still giving [driver’s] licenses, but we didn’t make it. By the time we went they weren’t [issuing driver’s licenses to undocumented residents]. They didn’t give us one.

A driver’s license is a critical resource that facilitates work and other daily activities: Following implementation of Michigan’s restrictive driver’s license policy, access to this critical resource was limited. This policy both made it more difficult for those with undocumented status to get or renew a driver’s license or state ID and intersected with practices that increasingly required a driver’s license or state ID to access health-related resources. Often, women described going outside of Southwest Detroit because they anticipated clerks at their local Secretary of State office would use their Southwest Detroit residence as a racializing marker or symbol of (il)legality [43].

Women reported a variety of results of this strategy at a time when changes in driver’s license access was beginning to have a more widespread effect. Some, like Susana, were unable to renew their driver’s license despite repeated efforts. Others did experience success. For example, Angela, a 1.5-generation woman in her 20’s recalled her mother’s experience:

Before, she [her mother] didn’t have one [a driver’s license] and she went … when they [Secretary of State’s office] had, like, stopped giving them [licenses to undocumented residents], she went and she got it in Taylor, because right here [in Southwest Detroit] they’re more, racist. Like, they know you’re Hispanic so they, right away ask you for your social [Social Security number] and stuff. So, when she went over there and they didn’t ask her for it, she got it [driver’s license] you know, we were like, “Oh, you know, I’m gonna go try it, whatever.” But then after that, I went to go try and I guess, like, they let ‘em know now that you have to have a social [Social Security number], so they didn’t give it to me.

Though she did not have a driver’s license prior to 2008, Angela’s mother’s effort to obtain a driver’s license after the implementation of Michigan’s restrictive driver’s license policy highlights the importance of this resource. While not all first-generation women made use of this strategy, several did so, recognizing the importance of a driver’s license in a context in which immigrant policing was pervasive. These efforts also were an attempt to retain access to critical personal and community resources, such as employment, mobility, remaining in the U.S., family cohesion, identifying documents, services, and goods. Without a driver’s license, women experienced heightened social and economic vulnerabilities that have been linked with health inequities [40, 72].

In addition to facing questions about their legal status, second-generation women also recounted experiences in which they felt denigrated based on the racialized identities. For example, Alice, a second-generation woman in her 50’s, recalled her daughter’s experience with a Latina clerk at the Secretary of State’s Office:

Like, um, the Secretary of State that was … here [in Southwest Detroit] that was real bad too, they [clerks] just rolled their eyes just like, Uhh. You know just they did – like they didn’t want to associate themselves with, you know, I’m Mexican or whatever. Like one instance my daughter, they went up to her and they said, “Are you Mexican?”

Despite this experience of having a racialized identity made salient, Alice’s daughter was able to renew her license. Like many other second-generation women in this study, despite discriminatory treatment, she was able to mitigate the effects of racialization through her legal ability to access resources denied to unauthorized immigrants.

Repeated experiences of discrimination, such as those described by women in this study, have been linked to adverse health outcomes among Latinas [73], as well as other racially minoritized groups [74]. Active coping responses, such as those described here related to efforts to obtain driver’s licenses, have been hypothesized to exacerbate those adverse health impacts when they are conducted in particularly restrictive contexts [75, 76] and there is some evidence to support this hypothesis [77].

Limiting labeling and stigmatization

Women described vigilant efforts to limit labeling and stigmatization by circumscribing their activities in order to prevent surveillance related to immigrant policing. This theme includes strategies to minimize visibility, activities, and mobility in public spaces. For many women, this involved particular care related to driving. As Consuelo, a first-generation woman in her 30’s with an unauthorized legal status, explained:

I always drive with care. To avoid them [police] stopping me. For example, usually every time they [police] call immigration it’s because you um, don’t speak English and you are driving, or you’re speeding or maybe in an accident or you didn’t stop at a stop. So, I try to always drive at the speed limit and always follow the laws that are there so you don’t have any contact with the police.

Consuelo’s accounting illustrated vigilance in a context in which police surveillance was prevalent, reflecting her concern that racial profiling from police and/or minor traffic violations could lead to contact with immigration officials. Consuelo identified her limited English use and, in further conversation, her expired driver’s license, as racializing markers that were leveraged as symbols of (il)legality that heightened her vulnerability to immigrant policing.

Consuelo’s concerns illustrate that vulnerability to immigrant policing derives from immigrant policies that target those who have been racially minoritized. For example, Clara, a second-generation woman in her 40’s whose husband recently became a permanent resident, shares her concern about her husband’s driving experiences:

Even though my husband’s okay, but you still fear. Like he’s gonna be picked up or spotted real easy, like is a cop gonna stop him just for racial profile and just take away his papers? […] That’s why I tell my husband, “Be careful, you know, who you’re with. Just make sure you don’t bring people in the truck, because you don’t know … Because you are a target.” … And um, a couple of times when he’s driving, we’ll have cops behind us. It’s my truck. Has my plates. It says my name on it too. And, it’s like, wait a minute. But, when I drive, nobody bothers me. It’s – it’s because of who’s driving.

Clara’s vigilance centered on her husband’s vulnerability to immigrant policing when driving, whether or not she accompanied him. She was attentive to the possibility that police would “target” her husband, resulting in an encounter with immigration officials, regardless of whether the traffic stop occurred as a result of a traffic violation. Clara’s high level of mistrust in officials was apparent in her narrative, despite her husband’s authorized legal status.

The extent to which women were vigilant depended upon their own vulnerabilities and those of others within their social networks. For women in the first- and 1.5-generations, having an unauthorized legal status or a close relationship with someone with a more vulnerable legal status heightened their vigilance. Among second-generation women, having family members who had an unauthorized legal status contributed to greater intensity and chronicity of vigilance. Driving was the most common – but not the only – context in which women described being vigilant. Women described engaging other vigilant strategies, such as limiting their activities outside of their home such as in public spaces or ceasing to work. For example, Lily, a first-generation woman in her 40’s who has lived in the US for 28 years described restricting when she would leave her house to prevent interactions with immigration enforcement officials: “You have to think about what can happen outside … The house is surrounded by immigration. This house they are watching me, watching me […] but if I go out when they are outside they are going to grab me.”

Women described restricting their driving by limiting the frequency, distance, or boundaries in which they drove, and in some cases, ceasing to drive altogether, in response to the heightened surveillance and stigmatization they experienced around driving. For example, Ava, a 1.5-generation woman in her 30’s, described how she stopped driving after her license expired and her sister was deported after a traffic stop:

When I saw that they stopped her [sister] and she didn’t have a license and they took her to immigration – well I said, then I won’t drive […] what would happen with the children? Where would we leave them? And my parents aren’t here, they are in California and they, well no, they have more children and I don’t think they could take care of more children. So yes, you could say I am here alone and I can’t be taking advantage and driving like it’s nothing if you don’t have a license too.

Ava chose to stop driving to mitigate the threat of immigrant policing. Weighing her more limited mobility against the lack of options to care for her children if she were detained or deported, she concluded that a decision not to drive was central to protecting and fulfilling her role as a caregiver.

The decisions women made with regard to driving were contingent and negotiated within particular social relationships. Like Ava, above, Dalilia, a 1.5-generation woman in her 20’s also described her decisions about driving as linked to her role as a caregiver. However, her particular circumstances led to a different decision, albeit one that she described in conflicted terms:

They [immigration officials] told me not to drive and I lasted a while … [I was] really scared and I didn’t drive. I lasted like … one or two months and I couldn’t do it anymore because it’s really difficult not driving. You know here how it is for a mother you have to take your kids to the doctor, you have to – I was working and, and you need transportation you can’t, you can’t be asking people for help all the time because people aren’t going to help you. So I had to – that order I did have to disobey and I had to drive. […] And now every time I see a police in the street I get scared. This didn’t use to happen; now I do get nervous and… it’s difficult….

Dalilia’s decision to stop driving and then to begin driving again reflects the dynamic nature of these decisions, and the ways in which individual decisions are contingent upon the social resources that she could call upon and her caregiving and employment responsibilities. She linked her ability to stop driving to the burdens imposed on network members for rides. Her description highlights the social relationship costs involved in such decisions and balancing the potential strain on those relationships. As she noted, her decision to resume driving simultaneously eased the strain on her social relationships, while increasing her risk of encountering immigration officials. She clearly articulates the costs, in terms of heightened vigilance and stress. The time and energy that women dedicated to frequenting multiple Secretary of State’s offices in order to obtain or renew a driver’s license, as described earlier, highlights the critical role of the driver’s license in accessing health-related resources, such as caregiving and employment as illustrated in women’s experiences noted above.

The health impacts of the strategies women used in response to heightened policing are complex, and deeply intertwined with their social, economic and legal circumstances. Women with more limited social and economic resources and greater vulnerability to immigrant policing (due to either their own status or that of family members) may be more likely to circumscribe their activities in a context of heightened surveillance. While this strategy may reduce the likelihood of encounters with immigration officials, it was clearly balanced against its impacts on broader social networks. Given substantial literature documenting that access to and receipt of social support is health protective [58, 78], women’s concerns about overburdening or fraying those social ties by too great a dependency on them are reasonable. The excerpts above clearly illustrate the negotiated and contingent nature of the decisions women made as they sought to retain access to critical social and material resources (e.g. driving children to school, accessing health care). While constraining, women recognized that their need to rely on others to drive them and their children can simultaneously undermine the social relationships necessary to protect health. In the following section, we examine in greater depth the importance of those social relationships as resources that can be leveraged within racializing contexts.

Mitigating adverse effects of immigrant policing by leveraging social support

Women described using or providing social support to reduce the effects of racialization and provide resources for identity support. Women who had an unauthorized legal status, lacked a valid driver’s license, experienced family separation through deportation, managed caregiving and/or employment responsibilities, and/or experienced economic hardship were more likely to describe using this strategy. This theme emerged in two categories: emotional and instrumental social support.

Emotional social support

Actions in the category of emotional social support included talking with or listening to family or friends about stressors that women were experiencing. Women who had an unauthorized legal status or who had family members who had an unauthorized legal status used this strategy to alleviate the consequences of racialization. Some women discussed these stressors with trusted others. For example, Alicia, a 1.5-generation woman whose husband had an unauthorized legal status, shared, “I have about two people in my life that I like to vent with and they can advise me very, very wisely. […] I think it takes a load off your shoulders because you’re not stuck with that in you.” For Alicia, talking with trusted others (e.g., friends, family members) provided an opportunity to discuss stressors related to her husband’s legal status, and her concerns about family separation if he were to be deported. Women also discussed efforts to protect their family and manage their identities. Alicia’s metaphor that talking with others took “a load off of [her] shoulders” suggests the physical relief of sharing her experiences and concerns with trusted others. Receiving emotional support may be health enhancing as she and her family contend with racialization processes and their implications. Women’s experiences of drawing support from co-ethnics illuminate the nuances of responses to racialization processes. Specifically, these experiences highlight ways in which co-ethnics may offer unique elements of emotional support, particularly when discussing identities and racializing markers that have been highly stigmatized and/or topics that are highly sensitive and may need to be held in confidence, for which other co-ethnics may have keen understanding through their own lived experiences. Though several women limited their contact with peers to prevent othering and immigrant policing, others discussed their experiences with racialization with trusted members of their social networks, and – like Alicia – described experiencing affirmation and a sense of reprieve in doing so. That relief may be health enhancing.

Accounts of drawing on or providing emotional support were less common than descriptions of providing or receiving instrumental support (described below). The limited discussion of emotional support may reflect several factors. Emotional support may be less visible (and therefore discussed less), although embedded in instrumental forms of support – such that the support women described provided not only critical instrumental support, but also emotional support (e.g., discussing difficult topics during car rides). It is also plausible that other strategies women used to mitigate the adverse effects of racialization, such as limiting mobility and contact with peers, may reduce contact with those to whom women could provide or from whom they might receive emotional support.

Instrumental social support

The category of instrumental social support included examples in which women described giving or receiving tangible forms of assistance or support, generally with family or network members. Examples included: giving rides to persons who may lack a driver’s license, receiving rides from someone with a driver’s license, registering cars in the name of a person with a more protected legal status, translating or assisting others with navigating confusing immigrant policies and systems, and providing or receiving housing. Assistance with driving-related concerns (e.g., offering a ride, registering cars) was the most common form of instrumental support received or offered. For example, Bella, a 1.5-generation woman in her 20s, explained that before she received Deferred Action for Childhood Arrivals (DACA) status, she relied on her mother and others to drive her to fulfill her employment responsibilities:

It was very hard. Well … my mom didn’t work at that time so she’d be able to take me here and somebody would have to pick me up or I’d get a ride home from somebody, so I was more home than I was out because I didn’t have a driver’s license. And now it’s different. Now, it’s like you don’t see me at home, I’m always working and so I’m out. …. Before that [getting a driver’s license through DACA] I never drove or nothing because I was like paranoid, and it goes from the cops getting you to asking for your license and it just goes bad from there … I didn’t want to risk it so I was just like, I’ll just stick to getting rides you know – ‘cause I worked around the area.

These forms of assistance helped reduce Bella’s concerns about encountering police or immigration officials while driving to or from work. The family members and friend who provided those rides illustrated their willingness to extend the benefits of their more protected statuses (e.g., driver’s license) to members of their networks who were more vulnerable to adverse consequences of interactions with police or immigration officials. Importantly, those benefits included offering rides for women as they sought to fulfill caregiving and employment responsibilities in a region with a historically underinvested public transit system and limited walkability [79].

Support in the form of rides also enabled engagement in social settings for women who limited their mobility because they lacked a driver’s license. For example, as Susana, a first-generation woman, explained:

When I am [riding] with someone that is good, that is legal, that has their papers, it’s like then I do feel safe, as I say, “Well, I am with her, they won’t do anything to me, they won’t say anything to me.” [laughs] And it’s the same though either way they [police or immigration officials] won’t say anything to us. [laughs] No they won’t do anything! But yes, I do feel safe.

This provision of a ride enhanced Susana’s mobility, facilitated interactions with friends, and avoided the isolation that otherwise would have come with the decision to not drive without a license. Thus, instrumental support enabled social participation and offered one gateway to the social relationships essential to both emotional and instrumental support. Several women who had driver’s licenses recounted providing rides to family members, friends, or neighbors, illustrating the mutual social relationships that enabled women to support each other as they sought to respond to discrimination associated with racialized immigration status.

Women with protected statuses (e.g., having a driver’s license, DACA status, or another authorized status) also described sometimes registering cars for others in their own name, and ensuring that insurance payments were up-to-date on vehicles used by those without a license. Alicia, a woman in the 1.5-generation, explains the strategic actions she took to protect her husband during the time that he lacked authorized legal status:

I always make sure the taillights work on my car. I always make sure that things are so perfect. I have insurance … And there are times I wanna give up on that $400 payment for all three vehicles. But the fact that I know that that might [emphasis] reduce the risk of him [emphasis] getting in trouble is worth those $400 a month.

Indeed, several women provided similar support for their family, registering or insuring vehicles for them, despite the economic hardship that entailed.

Some first- and second-generation women extended their home to family or friends who experienced a deportation and/or a financial hardship related to legal status, immigrant policing, and exclusionary immigrant policies. For example, Margarita, a woman in the first-generation took in a friend’s daughters after her friend was deported. She explained: “Because from the moment [they asked if they could stay with her] I said: where one eats, two can eat. Where three eat, four can eat.” Despite their own economic struggles, women sought to protect and support their network members by adopting economic and family responsibilities once borne by those who were deported and/or who struggled to make ends meet.

Women in the first- and 1.5-generations also expressed concerns that asking for emotional or instrumental support would burden their networks. Ava, a 1.5-generation woman, describes trying not to bother anyone:

Since [my license] expired I hardly ever drove because it was hanging over me and sometimes I needed to drive, like, the child to the doctor or things like that where I needed to leave to buy things … I felt bad because well I don’t like bothering anyone and well I had to keep bothering people. […] many times I didn’t want to ask anyone because I felt bad bothering people or sometimes they tell you no and I feel bad when they say no to me. So sometimes to avoid them telling me “no” I wouldn’t ask anyone ….

Several other women echoed Ava’s fears of possible rejection when requesting support from others. Of note, women who had an unauthorized legal status, family members with a less protected legal status, and/or limited networks (e.g., single parents, no extended family in the area) were most likely to express this concern. This hesitation may be because they are least able to reciprocate or may need to make more requests for assistance and thus are particularly sensitive to not overburdening their networks.

These worries suggest that the forms of social support available may depend on the number and strength (e.g., time invested, intensity, and intimacy) of the relationships or social ties between those giving and receiving support [80]. Granovetter [80] theorized that weak social ties are important for expanding social networks and accessing informational support that may not be embedded within the networks of stronger social ties. In the present study, although some 1.5- and second-generation women who had a valid driver’s license registered other people’s cars in their name and insured those cars, none did so for non-family members. Ava’s inability to find someone to register her car may reflect the structure of her local social network. For example, earlier in the interview Ava explained that her decision to stop driving after her driver’s license expired was motivated by her concern that she had no local family to care for her children if she were detained or deported. Thus, because this form of support is potentially expensive and risks the registrant’s personal insurance record, women with local family members may be better able to draw on such support. Separately, registration of a car for a family member enabled that family member to be more mobile, independent, and to fulfill caregiving and employment responsibilities, some of which may be mutually beneficial within the family. Relatedly, women described giving rides to, or receiving them from, members of their social networks with whom they had strong ties or weaker though trusted relationships (e.g., neighbors). Based on this example, it is plausible that women may find it easier to ask for, or provide, instrumental support that entails substantial financial commitment with members of their family, or others who are highly trusted. Women who needed to draw upon such instrumental support frequently, particularly if they are not in a position to reciprocate, may experience strains in their social ties. Given the chronicity with which women needed support with driving, women may need to tap multiple weak ties so as not to stretch any one relationship too thin.