Mary McKay: Understanding the Female Refugee Experience with Healthcare in Central Ohio

 

The United States is going through a difficult period today. The divisions that exist seem to be deepening and the way we are addressing policy seems to be going backwards and less inclusive. The national discourse surrounding immigration is one example of our increasingly hostile environment and discourse. Particularly when it comes to refugee populations, policy is moving toward a restrictive program, which is alarming considering the many atrocities and conflict these populations are experiencing. There is still hope, however, as pushback begins to grow and the truths about refugees and their beneficial contributions to society continue to be highlighted across the country.

According to the United Nations, a refugee is “someone who has been forced to flee his or her country because of persecution, war, or violence[1]”. Refugees experience unimaginable trauma throughout their lives. Many have seen family members die, war rage on, and are subject to persecution and discrimination because of who they are or what group they identify with. When they are finally granted the opportunity to seek refugee status and find refuge in a new country, they still face new versions of adversity, especially in the US. Since 1980, 3 million refugees from across the world have resettled in the United States[2]. Other developed countries that are home to the world’s refugees experience their own respective pressures and influences; however, in the United States, a unique set of conditions exist, a product of the complex and racist history that still impact and perpetuate many of the social problems present today. One such distinct feature is that of racism and the particular discrimination it creates.

For some refugees, being labeled a ‘minority’ in the United States is a new experience. The uniquely American racism, borne from the legacy of slavery, Jim Crow, and modern day implicit biases, can be particularly harmful to myriad outcomes. For example, research shows that the mental health of refugees can be harmed due to discrimination based on race, ethnicity, limited English proficiency, among others[3]. Although the research is growing within refugee studies, there are still many questions that go unanswered. As a student pursuing Sociology, I started to realize there is much work to be done.

Here in Central Ohio, 16,000 refugees have called our region home since 1983. We are lucky to be host to many cultures within this general population– from Somalia to Bhutan to Iraq to Burma to many other countries throughout the world. Many have wondered, “why Central Ohio?” While the mechanisms initially designating Central Ohio as a location for refugee resettlement are related to federal government and past immigration policies, our region remains a strong hub for many refugees because of the cost of living, reunification with family members, employment opportunities, and the community’s capacity to work with certain ethnic groups[4]. The support networks that exist throughout the region have been strengthened through the many refugees who work with each other and other key community members to establish organizations, opportunities, and help for those who would come in the future. These networks support a diverse group of refugees today and are key to the adaptation process. Although there are strong supports, discrimination and bias nevertheless impact our refugee population.

As mentioned earlier, Central Ohio hosts a large Somalian population, many of whom are the product of civil war and chaos in Somalia. As of 2017, 35% of the 2.4 million displaced individuals from Somalia are refugees[5].  The Somali government collapsed in 1991, which led to a civil war, producing many thousands of refugees[6].  Those who were fortunate enough to survive and leave found themselves in refugee camps in surrounding countries, such as Dadaab Refugee Camp in Kenya or Ethiopia. As time continued, those who qualified were able to be selected to resettle in the United States. The second highest population of Somali refugees in the United States is right here in Central Ohio. 53.5% of all refugees since 2002 in Columbus are from Somalia[7]. The networks that exist among the Somali population in Columbus are strong and supportive, enabling many newcomers to adjust quickly and access valuable resources they need to succeed.

Research demonstrates the power these networks and resources have on outcomes, including positive influences for educational, economic, and health outcomes, among others. In addition to this, immigrants overall are shown to have better than expected outcomes when looking at health. First discovered in 1986 among immigrants in the Southwest, the immigrant health paradox is a critical component in the research on immigrants in the U.S. This theory states that despite the strong relationship between socioeconomic status and health outcomes, immigrants have better than expected mortality, morbidity, heart disease, and other outcomes. Myriad studies find this trend among numerous immigrant populations from around the world throughout the country. What is interesting is that over time, this health advantage diminishes and the health of immigrants tends to converge with that of their native-born counterparts.

Because refugees are a type of immigration, it may be reasonable to expect they would follow similar patterns in health outcomes as other immigrant groups. However, there are several conditions connected to the refugee status itself that could lead to different outcomes, influences, and trends. For example, although refugees experience a new type of minority status when entering the U.S., they also have access to strong networks and numerous resources when placed in areas with high concentrations of similar refugee populations which may serve as a “protective buffer” against newly-encountered racial discrimination.  Unfortunately little research has unpacked the complex interplay between refugee status and health outcomes. Why? Well, data is very limited. We just do not have the data sets and tracking available to test certain relationships between context and outcomes. In such a situation, where quantitative data is lacking, we can turn to qualitative to fill in some gaps.

Qualitative research is a valuable tool to gain an in-depth look at the reality of people’s lives. Through direct engagement with the Somali refugee population, we can gain insights into the way refugees navigate networks and resources, and how they feel that these assets have affected their lives. Particularly within Central Ohio, because these networks are strong and well-traveled, the trajectory refugees experience when they arrive here may be unique and could be used to inform other cities with growing refugee population sizes.

This is what my research sets out to do. In an effort to understand the complexities refugees experience, I am conducting an in-depth, qualitative research project in Central Ohio. My main focus is on the Somali population, where I will be interviewing Somali women. Previous research suggests that there are unique experiences for refugee women because of the new level of freedoms they experience upon resettlement in the United States. Because little is still known about how the immigrant health paradox applies to refugees, my questions focus on health, healthcare use, and how stress impacts how they feel. Another focus of my study involves the intersection of neighborhood and health, with questions focused on how they perceive their neighborhood in terms of resources and ability to access things that will maintain or improve their health (i.e. doctor’s clinics, grocery stores with selection, parks). Not only do I want to know if their neighborhood has these things, but also if these women choose to use these resources.

A study by Jennifer Carroll and colleagues looked at Somali women specifically, focusing on their health (2007). Findings from that study show that there are several factors this population considers that though not necessarily health-related, nevertheless impacts their health and wellbeing, such as their dependence on religion and cultural practices (Carroll, et al. 2007)[8]. This study, as well as others about refugee populations and women, helped formed the foundation of my interviews. I also seek to understand how the uniquely American racial discrimination that these women may be experiencing for the first time may impact their health and wellbeing.

I began interviewing women at the beginning of 2018 and will conclude over the summer of 2018. The women in my sample are part of a low-income neighborhood, therefore insight will be revealed into how poverty plays a critical role in health. According the 2016 American Community Survey 5-year estimates, the census tract where these women reside has a median household income of $21,336. Further, about 32% of households earn less than $10,000 and 1/3rd of households are headed by a female with no husband present. These contextual aspects are critical to understanding the pressures and conditions these women face on a daily basis. The interviews are semi-structured to help keep dialogue open and allow for unique individual forces to be highlighted.

Through these interviews, I am hoping to illuminate more the nature of the unique features within the refugee population that influences their health. I want to know how these women navigate the new systems in the United States and how these processes impact their health. For many, while we think these systems are new and hard to figure out, these systems are being guided by organizations and individuals who can help support the adaption process. Because there are supports in place, the resettlement experience may be different for Somali women in Central Ohio compared to other refugee populations across the country. Through the interviews, I want to understand the strength of networks, and how far they reach. How does the low-income refugee population navigate getting a job? Sending their kids to schools? Attending religious services? How do these things change when they get sick? How do these experiences play out here in Central Ohio? It is my hope that this research can advance our understanding of the immigrant health paradox as it applies to refugees and how American society and processes, such as racial discrimination, impacts refugees.

Examining the unique and diverse experiences of the refugee women in Central Ohio is critical for myriad reasons. Knowing how important existing structures and resources are for these women can help inform policy put forth by local government to better serve their needs. Furthermore, research is needed to critically evaluate the impacts of structural factors present in American society, such as discrimination and racism on refugee populations. By looking at the perceived effects, we can begin to unpack how certain processes impact health and ultimately wellbeing.

 

Note: I would like to thank The Ohio State University Global Mobility Project for grant funds to help with interview compensation for participants as well as The Ohio State University Department of Sociology’s Silverman Grant to assist with translation funding.

 

 

[1]https://www.unrefugees.org/refugee-facts/what-is-a-refugee/

[2]http://www.pewresearch.org/fact-tank/2017/05/25/fewer-refugees-arrive-in-u-s-with-declines-in-46-states/

[3]Kim, Isok. 2016. “Beyond Trauma: Post-Resettlement Factors and Mental Health Outcomes Among Latino and Asian Refugees in the United States.” Journal of Immigrant and Minority Health 18(4):740–48

[4]* List from CRIS http://www.crisohio.org/learn-more

[5]For a full report on the Somali Refugee Situation, refer to http://www.unhcr.org/591ae0e17.pdf

[6]https://www.refugeecouncilusa.org/tag/somalia-refugee-crisis/

[7]From the report by Us Together: http://ustogether.us/wp-content/uploads/2016/12/IMPACT-OF-REFUGEES-ON-CENTRAL-OHIO_2015SP.pdf

[8]Carroll, Jennifer et al. 2007. “Knowledge and Beliefs About Health Promotion and Preventive Health Care Among Somali Women in the United States.” Health Care for Women International 28(4):360–80.

 

The Kirwan Institute for the Study of Race and Ethnicity was established in 2003 as a center for interdisciplinary research at The Ohio State University. The Kirwan Institute works to create a just and inclusive society where all people and communities have opportunity to succeed.