UCLA

BackgroundImmigrant women in the United States experience persistent sexual and reproductive health (SRH) disparities due to barriers, including immigration-related policies, insurance exclusions, and limited access to language and cultural concordant healthcare. Women navigate these barriers through transnational healthcare, obtaining care in their countries of origin while residing in the United States. Existing research has focused on general healthcare among Latino populations. Little is known about transnational SRH care among Asian immigrant women, including healthcare decisions across borders, patterns of transnational SRH utilization, services obtained, and reasons for transnational care-seeking.AimsThis dissertation examined transnational SRH care among Asian immigrant women in the United States by exploring: (1) decision-making processes surrounding transnational SRH care, (2) patterns and correlates of transnational SRH utilization, and (3) the types of services obtained, reasons for seeking care abroad, and contextual factors influencing transnational healthcare use.MethodsThis mixed-methods dissertation used data from the Building Communities Raising API Voices for health Equity (BRAVE) Study. Guided by the transnationalism framework and Andersen's Behavioral Model of Health Services use, three complementary studies were conducted: qualitative life-history interviews (Study 1; n=62), quantitative survey analyses (Study 2; n=1,972), and analyses among women reporting transnational SRH care (Study 3; n=731; reasons n=705).FindingsStudy 1: Women strategically navigated SRH care across the United States and their countries of origin, balancing affordability, accessibility, cultural familiarity, provider trust, and healthcare quality.Study 2: More than one-third of participants (36.3%) reported transnational SRH care. Immigration status, years of U.S. residence, and state policy context were significantly associated with transnational healthcare utilization patterns.Study 3: Preventive and gynecologic services were the most obtained transnational SRH services. Affordability, cultural competence, language concordance, and perceived quality of care were the leading motivations for seeking care abroad.Significance:This dissertation is among the first to examine transnational SRH care among Asian immigrant women in the United States. Integrating qualitative and quantitative evidence, it demonstrates that transnational healthcare is an adaptive strategy through which immigrant women navigate structural barriers across multiple healthcare systems. The findings inform equitable, culturally tailored, and accessible SRH policies and services for immigrant population.