Table 2.

Heightened Barriers to Quality Prenatal Care Experienced by Direct Service Providers' Immigrant Clients During the Early Months of the COVID-19 Pandemic

Barriers to making and attending appointments
Heightened fears of deportation due to concurrent widely publicized federal policy changesa	“She didn't really want to have any contact with any [medical] professionals because she was worried about her [legal] status and being questioned or getting any authorities involved or anyone knowing too much information that could draw attention to her.”
Increased financial stress due to the pandemic	“Because we do have a lot of clients that are struggling with bills right now and are struggling with rent because of the pandemic, losing jobs, not being able to move around, that's the limitation that we're having.”
Decreased ability to make appointments using previously employed strategies	“It has been challenging even to get an appointment for the client. Most of the issues start from the first step, when we call because the clients cannot walk in already, their working hours were changed during that time, the client could not walk in to do the pregnancy test.”
Heightened childcare barriers to attending prenatal visits	“La única parte que no le gustaba a ella, como tenían hijos a veces pequeños, que tenían que buscar quién les cuidara a los niños porque no podían llevar a nadie más que ella a la cita médica. Y cuando fue momento de ver el género del bebé tampoco podía ir su pareja porque nomás podía ir la embarazada.” (English translation of above quote) The only part that she didn't like, [because] they had children, sometimes little ones, that they had to find someone that could take care of the kids because they couldn't take anyone besides herself to the medical appointments. And when the moment came to see the gender of the baby, her partner was not able to go because only the pregnant person was allowed to go.

Barriers to quality care during appointments
Challenges with prenatal care delivered solely through telemedicine	“To tell you the truth, when COVID started, she missed out on a lot of visits because of the virtual, the telemedicine.” “Telemedicine was difficult for the one client that I'm thinking because she didn't have a good phone. So she wasn't able to do the video calls. She could do a phone call, but that was sometimes tricky because maybe her phone was off because of lack of income at the time. So thinking about if we're to go back to, even the quarantine status or anything it was just very difficult for her to access services without me there to use my phone. So internet, phones, that was just very difficult when it came to getting services in that way.”
Care that was not language concordant or culturally sensitive	“When she would go to try to make an appointment to speak with someone at the front desk, unless she brought a translator with her, there was no one there to communicate back and forth with her.” I'm going to give you a really silly example, right? In my husband's culture, he's from [country], it's very typical when a newborn is born to put a bracelet on them. To keep away from the evil eye or things like that. In the United States, you go and you get reprimanded for having a bracelet on them because it's a choking hazard, et cetera, right? So, just explaining those things about having cultural sensitivity around it right now, not being aggressive with when our patients, when we talk to them about those things, taking culture into perspective.
Discriminatory encounters with health care staff when attending visits alone	Yo creo que no importa dónde ellas vayan, que hayan personas empáticas porque hay veces que las enfermeras son rudas o el personal que esté en el “service desk” a veces no son empáticos, no le ayudan a las mamás cuando son primerizas y no saben qué necesitan hacer. (English translation of above quote) I think that it doesn't matter where they go, as long as there are empathetic people [staff] because there are times when the nurses are rude or the personnel that are at the service desk are not empathetic. They don't help the first-time mothers who don't know what they need to do.

^a For example, the Trump administration's proposed changes to the Public Charge Rule for Inadmissibility went into effect in February of 2020.