title: Access and utilisation of social and health services as a social determinant of health: the case of undocumented Latin American immigrant women working in Lleida (Catalonia, Spain).
abstract: Although Spain has social and healthcare systems based on universal coverage, little is known about how undocumented immigrant women access and utilise them. This is particularly true in the case of Latin Americans who are overrepresented in the informal labour market, taking on traditionally female roles of caregivers and cleaners in private homes. This study describes access and utilisation of social and healthcare services by undocumented Latin American women working and living in rural and urban areas, and the barriers these women may face. An exploratory qualitative study was designed with 12 in-depth interviews with Latin American women living and working in three different settings: an urban city, a rural city and rural villages in the Pyrenees. Interviews were recorded, transcribed and analysed, yielding four key themes: health is a tool for work which worsens due to precarious working conditions; lack of legal status traps Latin American women in precarious jobs; lack of access to and use of social services; and limited access to and use of healthcare services. While residing and working in different areas of the province impacted the utilisation of services, working conditions was the main barrier experienced by the participants. In conclusion, decent working conditions are the key to ensuring undocumented immigrant women's right to social and healthcare. To create a pathway to immigrant women's health promotion, the 'trap of illegality' should be challenged and the impact of being considered 'illegal' should be considered as a social determinant of health, even where the right to access services is legal.
authors.affiliation: Nursing Department, GESEC, Lleida University, Spain.|Health Care Research Group (GRECS), IRB Lleida, Spain.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Gea-Sánchez
authors.affiliation: Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Canada.
authors.forename: Denise
authors.initials: D
authors.lastname: Gastaldo
authors.affiliation: Geography and Sociology Department, GESEC, Lleida University, Spain.
authors.forename: Fidel
authors.initials: F
authors.lastname: Molina-Luque
authors.affiliation: Nursing Department, GESEC, Lleida University, Spain.|National School of Public Health, Institute of Health Carlos III, Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Otero-García
mesh_terms: D000328:Adult; D054242:Emigrants and Immigrants / Q000331:legislation & jurisprudence*; D005260:Female; D006297:Health Services Accessibility / Q000331:legislation & jurisprudence*; D006801:Humans; D007407:Interviews as Topic; D007843:Latin America / Q000208:ethnology; D008875:Middle Aged; D036301:Qualitative Research; D064890:Social Determinants of Health; D013030:Spain; D016387:Women's Health / Q000208:ethnology*
keywords: access to healthcare; employment; gender and inequality; inequalities in health and healthcare; migrants; utilisation