At Portland State University, partnerships are central to fulfilling our mission to let knowledge serve the city. Partnerships enable students and faculty to work within the community developing collaborative solutions to society's pressing challenges. Lynne Messer, a social, environmental, and reproductive epidemiologist and faculty member of the OHSU-PSU School of Public Health, conducts research that connects the university's mission to the region's underserved communities' needs.
While the relationship between Portland State University and the Multnomah County Health Department (MCHD) goes back decades, Messer recently partnered with MCHD on an NIH-funded study that will provide health practitioners and policy-makers critical information on how factors like nativity, documentation status, and residential context influence pregnancy outcomes for the county's Latina population. This data could shed new light on what's knows as the "Latina paradox"—a well-documented phenomenon that suggests pregnancy outcomes for Latinas are nearly as good as those of non-Hispanic white women despite low socioeconomic status and other potential disadvantages. By disaggregating where women were born from their documentation status, from where they live once they arrive in Multnomah County. From the blanket category "Latina," the study could identify nuances in the paradox and provide a more granular level of detail to Latinas' pregnancy health profile. For the MCHD, the study will help community health providers develop interventions that address specific traumas related to country of origin, documentation status, discrimination, and security, and promote all Multnomah County's Latina's reproductive health women and the health of their children over the life-course.
To disentangle data related to nativity and documentation status, Messer is working with state birth certificate data. To incorporate the influence of residential context on pregnancy outcomes, Messer will also review data from the US Census and the USDA's Food Access Atlas. An analysis of all the data could identify relationships among a woman's country of origin, documentation status, residential environment, and pregnancy outcomes, including prenatal weight gain, pregnancy-induced hypertension/eclampsia, preterm birth, and term birth weight within the county's Latina population.
"The CAWEM-Plus data is the real linchpin in this study," Messer said. "Oregon is one of the few states in the nation that supports a program that provides insurance and access to affordable health care to undocumented community members, those whose immigration status precludes them from enrolling in Medicaid, and who are otherwise unable to purchase private insurance. And because Oregon supports this program, we have an incredible source of data that enables us to link information contained in birth records with a mother's documentation status and neighborhood profile and thereby get a more distinctive picture of the Latina women giving birth in the county."
Available to qualifying pregnant women statewide through the Oregon Health Authority, the CAWEM-Plus benefits package covers all Oregon Health Plan benefits, including labor and delivery, though benefits end at delivery. According to Aileen Duldulao, MCHD's Maternal and Child Health Epidemiologist, what makes the data from CAWEM-Plus so valuable is that it's only available to individuals ineligible to receive Medicaid, which means enrollment can be used as a proxy for documentation status.
"For us at the county health department, there is an urgent need to get more and better information about undocumented Latinas who are pregnant," Duldulao said. "At this moment, that data doesn't exist in the literature. Getting down to that level of detail is why the partnership with PSU is such a great opportunity. In the health department, and in public health generally, we want to develop preventative programs based on evidence. And right now, we lack the evidence we need to create programs for undocumented pregnant Latinas. That's why we're working with PSU and Messer. Partnerships like this help us better serve the community. They bring the people and resources we need to achieve the kind of evidence base required to improve public health services and address health disparities faced by many in the community."
"Data is a tool for action, and we hope the findings of this study will shed more light on the health disparities we seen in our immigrant communities," said Olivia Quiroz, Senior Policy Analyst and Community Liaison at MCHD's Equity, Planning and Strategy Division.
According to Messer, some of the most exciting work that will emerge from this partnership will come after the data has been analyzed, and the findings published. Backed with data that suggests if and how a woman's country of origin, documentation status, and residential context influence pregnancy outcomes, MCHD will be able to develop culturally-informed interventions that promote prenatal health, pregnancy outcomes, and support a healthy start to life for the newest members of our community.