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C h a p t e r 8 The Health and Well-Being of Immigrant Women in Urban Areas DeAnne K. Hilfinger Messias Human migration and the growth of cities are interconnected local and global phenomena affected by social, economic, and political forces in the sending, transit, and receiving countries that play out in the lives of individuals, families, and communities. For some women, migration provides opportunities to lead productive and fulfilling lives in welcoming , safe, and healthy urban environments and therefore is worth the sacrifices and the difficulties of separation from family, language, culture, and country of origin. For other women, the migration experience is fraught with risk, fear, abuse, exploitation, and significant damage to their physical, mental, and social health and well-being. For most immigrant women, migration and settlement—and in some cases, return migration—occur within fluid, in-between spaces of transition and ongoing social, cultural, economic, and identity adaptations and adjustments (Donnelly 2006; Messias 2010). Immigrant women’s health is intimately connected to the context of these in-between, intercultural spaces as well as to the physical and social environments in which they live. To be effective, health promotion efforts, health and social services, and related policies in urban areas must take into account the diversity and complexity of immigrant women’s lives and migration experiences. This chapter provides a broad overview of the intersections of migration , gender, and health in urban contexts, drawing on evidence and examples from the international literature. The chapter begins with a brief presentation of commonly used migration terms and classifications followed by an examination of migration flows and the growth of urban areas. The discussion then turns to the interactions of gender, migration, health, and urban environments, with emphasis on salient immigrant women’s health issues, and concludes with recommenda- The Health and Well-Being of Immigrant Women in Urban Areas 145 tions for health-care providers, systems, and researchers, as well as policymakers , urban planners, and administrators. Classifications of Migration and Migrants Human migration is the process of leaving one place, moving to another , and settling there. Migration occurs both within and across national borders. Transnational migrants, defined as persons living outside their country of birth, constituted 3 percent of the world population in 2005 (UNFPA 2006). Migrants are commonly classified into several basic types (e.g., voluntary migrants, refugees and asylum seekers , and irregular migrants). Although these terms and classifications are important and useful, they are not universally adopted or accepted and may not adequately reflect the diversity of contexts and conditions involved in women’s migration decisions and experiences. (See the Global Migration Group [2008] for detailed definitions and descriptions of the migrant classifications.) The distinction between voluntary and forced migration implies the presence or lack of free choice in the migration process. In theory, voluntary migrants move of their own free will, often seeking better employment , educational opportunities, and improved access to resources and health and social services for themselves and their families. Economic and labor migrants are generally considered voluntary migrants, a very broad category that ranges from rural peasants fleeing deteriorating economic, environmental, and social conditions to highly educated professionals seeking better-paying jobs outside their country of origin. Forced migration includes the cross-border movement of refugees and asylum seekers, who leave their homes fleeing war and persecution due to race, religion, national or tribal membership, or political positions. In the past thirty-five years, 2.6 million refugees from Central and South America, Europe, Africa, and the Middle East have been resettled in the United States (US DHHS 2009b). Forced migration also includes human trafficking for forced labor and the sex trade, often involving women and girls. Internally displaced persons are forced migrants who migrate within a region or country but do not cross national borders. Irregular migrants, often referred to as undocumented, clandestine, or illegal immigrants, are individuals who lack legal status in a transit or host country as a result of either undocumented entry or visa expiration (Global Migration Group 2008). Irregular migrants may have left their country of origin as either voluntary or forced migrants. Their irregular status contributes to heightened vulnerability and exposure to abusive conditions. Irregular migrants often live in substandard housing 146 DeAnne K. Hilfinger Messias and work without any type of labor or health protections and undocumented female immigrants are particularly at risk for sexual and physical abuse (UNFPA 2006). Overall, women face more barriers to regular migration than men, increasing...


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