Recently, Planned Parenthood of New York City
released a study (link to PDF) 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 even this web site 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.