Misinformation, ignorance, difficulties gaining access, fear of maltreatment, and worries over violations of privacy: these are some of the obstacles that keep Latinos from visiting healthcare facilities and/or sex and reproductive health clinics. Beyond that, the reality that they may, in fact, receive poor treatment; interact with indifferent providers and attendants; and may not have access to Spanish-speaking medical professionals are real barriers that keep Latinos from returning to health care facilities after a single visit. In a nation where Latinos represent the largest and fastest growing minority group (16 percent of the country's population in 2011), it's important that this demographics' reproductive, medical, and mental health concerns are met. 

Lina Guzman, senior research scientist for the Latino Children and Families division of Child Trends, and her esteemed colleagues published a report that not only addresses the barriers that Latinos face when seeking information pertaining to reproductive health, but they also designed a comprehensive collection of recommendations that health care providers can realistically implement in order to beckon Latinos clients, and keep them as loyal patrons. The research that Guzman and her team compiled suggests that Latinos tend to seek sexual and reproductive health care from those who are personable and warm, and those who take the time to build trust and rapport with their patients.

Guzman, a Colombia-native who moved to Queens, NY at the age of 3, was one of the first in her family to receive a Ph.D. She attended City University of New York, where she earned her undergraduate degree in Sociology; and she applied for a minority student fellowship that would open doors for her, allowing her to attend graduate school in Wisconsin. Graduate school was an eye-opener for Guzman; it's where she began to see the distinct disadvantages that certain groups face, refining her desire to research that's beneficial to the Latino community.  

Post-graduation, Guzman moved to D.C. to be closer to family. There she also began conducting research for Child Trends, work that she's been doing for the past 11 years. As senior research scientist, she leads investigations on the subject of the largely understudied Latino minority group, exploring a variety of topics, including teen pregnancy, contraception, early childhood development, family formation, positive youth development, child well-being and effective programs. Qualitative research, literature review, survey design, data analysis and evaluation go into contracting the information that's included in their research reports. Guzman's interest in the subject matter, like many of her colleagues', comes from a place of experience and curiosity.

"I choose to focus on Latinos in my research because I don't want to turn my back on my community." Guzman said in her interview with the Latin Post. "Also, there are very few Latinos in the field. It's important to develop a network of opportunities for upcoming generation, which is a focus at Child Trends. [Latinos] are the largest racial/ethnic group, but it's not well-represented."

Latinos' absence from research reports, and a general failure to gravitate toward the research field, suggests that they will continue to be underrepresented. Latinos helping to develop research that's Latino-centric is so important; utilizing insider's perspective, asking relevant questions, and being in tune with the target audiences helps to correctly assess and draw attention to the unique challenges that Latinos face.  

When Guzman was in high school, three out of five of her best friends had a child by age 20 and were forced to leave school or change their future plans in order to care for the kid(s). The experience of having her friends prematurely leave school created an understanding of the needs that needed to be meet and programs that needed to be designed to specifically target Latinos, incorporating Latino culture -- as there are not very many programs of this nature. She also understood that teen pregnancy programs need to be embedded in the education settings, also that abstinence-only education need to be dismissed; instead there needs to be comprehensive information provided to Latino youth, telling them not only how to access contraception, but how to properly use it -- and to always use it. Research suggests that Latino teens don't want to be parents; hence, the congruently high abortion rates for that age bracket. However, while contraception/condom usage is low among Latino teens, more are likely to use the shot/IUD once they're older, have more access to health care information, and have already undergone an abortion or had a child.

That being said, Latino teen pregnancy is a community issue, not just a woman's issue. Parents and teens need to have open and honest dialogue on the matter. Being honest about sex could mean that the negative connotation would be removed, and teenagers may become less likely to engage in risky or unsafe sex practices out of defiance or ignorance. Young Latina women should talk to their partners about sex, contraception and birth control. Young Latino males often want to take part of the conversation, and need to be involved. Many young men would like to take preventative measures in order to decrease the likelihood of pregnancy and STDs, however they're either uninformed or feel obliged to adhere to Latin male stereotypes.

"They don't want to live up to Latin lover, machismo stereotypes. There's a lot of pressure to do that and they don't necessarily see those as positive roles. We need to shift the paradigm," Guzman said.

The clinics that offer these contraceptive services are also responsible. While they provide a terrific service to the community, they tend to only be open at certain times -- which are usually inconvenient for individuals who work or attend school. The staff members at these facilities aren't always respectful to Latinos, the facilities do not advertise their services well; there tends to be language barriers; and there are confrontations of cultural norms. Also, undocumented individuals tend to stay away from these facilities because they fear that they will be compromising themselves, or they won't have the documentation needed to prove that they are entitled to services that are provided to other low income individuals. Often, women in immigrant communities turn to a "black market in contraception," where birth control and other contraception is dealt behind flea markets and bodegas.

"Reproductive Health Care through the Eyes of Latina Women: Insights for Providers" is the title of a research report published by Lina Guzman and her colleagues at Child Trends, which directly addressed Latinas' access to services, ways for providers to enhance direct services -- including building rapport and trust, and ways that clinics can engage the community that they serve, so that they can deliver better service to Latina women of every age.

The report begins with the facts: young adult Latinas suffer STD infections and unintended pregnancies at a rate that is significantly higher than young adult white women. Thirty percent of Latinas give birth by the age 20, compared with 14 percent of non-Latina white women. And, the pregnancy rate for unmarried Latina women 20-29 years old is more than double that of non-Latina unmarried white women of the same age. This is greatly due to aforementioned lower rates of condom use, and failure to apply consistent contraceptive use. The report clarifies, however, that the unintended pregnancy rate for Latina women below the poverty line is approximately six times higher than the unintended pregnancy rate for Latina women at or above 200 percent of the poverty line -- those women presumably having access to reproductive information at a young age, exposing lack of sex education as a class issue.

The nine major recommendations that are gathered in the "Reproductive Health Care" report reveal effective ways for providers to motivate Latina women to take their personal health as seriously as the needs of their families; and first step is personalismo. Recommendation #1 suggests that providers offer personalized provider-client interaction. Latino cultural norms indicate that sexually explicit conversation is taboo; also, many undocumented Latina women worry that health care workers will "disclose their legal status to immigration authorities." The Latino cultural norm of personalismo is important for this reason. By interacting in a warm friendly way, making eye contact, asking open-ended personal questions and asking brief non-medical questions about life events is "pivotal in Latinas' selection of providers" and their willingness to return for follow-up visits. Women will travel long distances to receive services from preferred providers, avoiding exchanges with rude staff or providers who lack personalismo.

Encouraging Latina women to speak out about needs and concerns pertaining to sexual and reproductive health is Recommendation #2. Many Latina women need providers to clearly communicate the importance of helping the provider to understand their needs, because she may feel uncomfortable discussing sex, or may be withholding due to a sense of respeto for the doctor. While empowering Latinas to voice concerns, providers must also be respectful of cultural values and must be judgment free. The Latina patient is looking for cues from the provider, and would like to be guided with prompting questions.

Being able to comprehend that Spanish heritage can be the only tie between Latina women, and that each individual client deserves an individual assessment is Recommendation #3. Clinics with high Latina patient turnover may need to consider working around the discomfort that Latina patients have when disclosing personal information. Non-physician staff (i.e. medical assistants) should be assigned to talk with Latinas during waiting times; collecting information, encouraging trust, and developing an understanding of the individual. Meanwhile, providers should be able understand that while a woman may not be able to convey what she may want or need in English, it's certainly possible that she could do so in her native language -- so translators or Spanish-speaking associates should be available to assist.

"I think the challenge is that we don't have a homogeneous group, we have such a continuum, and we have the generational issues. And there is always that desire to sort of cubby [hole] them," a provider from the West Coast stated to the Child Trend researchers. "So you can't just say I'm in a Latino community. Well, are you in the undocumented, recently immigrant community? Are you with the second and third generation...? I mean if you don't know that level, it can really make a big difference as to what your approach is going to be."

Latinos understanding the information in relative terms directly correlates with Recommendation #4. Materials at the facility should address Latinas at every level of English language comprehension and every level of literacy. The pamphlets should be easy-to-understand, and the information should be comprehensively accessible to anyone who wishes access it. Also, fotonovelas and videos should be made available -preferably depicting images of Latina clients. The use of illustrated information, charts, pictures, simplistic terms, and neutral information, particularly in women's preferred language, guarantees understanding. Also, providers should be proactive about relaying information, asking open-ended questions and assessing patient comprehension.   

Recommendation #5 requests that providers counsel and educate their Latina clients in order to retire misinformation and misconceptions. Half of Latino young adults reported that they had little-to-no knowledge about condoms, while only a quarter of white young adults said the same. Proper information regarding contraceptive tools would greatly change the trajectory of young Latinos. Teaching clients to use the pill, informing them about potential side effects of medication and the causes of various diseases and illnesses is important because if they aren't informed by professionals, they will be undoubtedly misinformed by peers.

Privacy and confidentially being made top priority for clients is Recommendation #6. Being that immigrant women fear disclosing their documentation status, they need to be reassured that their privacy will be upheld. The same can be said of young Latina women who fear that family members will learn about their receiving sexual and reproductive health care services. Clinics should reiterate that clients' private information will not make leave the facility. And, there will be no formal or informal breaches of confidentiality -- in accordance to clinic policies and laws.

An up-to-date portrait of the Latino population in target service areas is Recommendation #7. The Latino population is diverse and ever-changing, so it's important for service providers to identify the needs of the community they serve, so that they're servicing rather than generalizing. Offering appropriate services and addressing relevant concerns, such as STD testing and contraception for younger clients, and annual exams and mammograms for older clients -and providing a full understanding of services -- is essential. The Latino population needs prenatal care, pediatric services and health services, indicated by the STD and pregnancy statistics.

Recommendation #8 instructs that health clinics use multiple strategies to retain their patients. Heightening the clinic's visibility; practicing personalismo; utilizing promotras (community members with specialized training in health education); and employing trusted community members to vouch for the facility will make it more attractive to clients, and it will keep them coming back. Young Latina women are drawn to visual aids, and attracted by word-of-mouth recruitments. Spanish-speaking staff, transportation assistance, child care and creative outreach are also beneficial tools for building loyalty among Latina clients.

"I know that most of our clients come from word-of-mouth. You know, they bring their sisters. They meet someone at the bus stop," said the provider from the West Coast.

Connecting with other providers in order to extend complete support is Recommendation #9. Beyond reproductive assistance, Latinas also require medical and mental health care, domestic violence support, and other kinds of services. If Latina clients feel that a provider is concerned with her general well-being, she will be more inclined to keep the provider in mind when she needs future assistance. Also, providers should allocate funds for child care and pediatricians during Latina clients' visits, and grant free or low-cost services to Latina clients in need -- decreasing barriers for those who wish to obtain quality health care.

The report recognizes that some of their recommendations may be pricey to coordinate, while others are inexpensive and can be easily implemented. The piecemeal approach is beneficial, but tackling the recommendations jointly is the most effective for improving quality and access to service for Latina women. Clinics that offer warmth and personable service; build trust and rapport; create patient profiles of women's health; encourage Latinas to voice their needs and concerns; provide tailored written and visual reproductive information; and guard private information are the most helpful clinics, and will boast more devoted Latino clients. Providers efforts would eventually lead to a general decrease in teen pregnancy, STDs, and dropout rates.