Amplifying Asian Immigrant Women Voices through a Study on Sexual and Reproductive Health Experiences

April 30, 2024
Group photo of the BRAVE Study team (left to right): Tenzin Khando, Pabitra Rizal, Jessica Gipson, Diana Patton, Annie Ro, Andrea Hwang, May Sudhinaraset, Esther Kim, Brenda Soun, RJ Ronquillo, Rachel Gonzales and Carla Ibarra, and Hye Young Choi, Jung Ha Kim, and Siyue (Lena) Wang on Zoom.

May Sudhinaraset, PhD, Associate Professor and Vice Chair of the Department of Community Health Sciences at University of California Los Angeles’ Jonathan and Karin Fielding School of Public Health, has spent her career researching the experiences of Asian immigrants. And through her work, she saw a gap, and therefore a need to learn more about their sexual and reproductive health experiences. “Asian immigrant women are often invisibilized due to there being a lack of comprehensive data that specifically highlights their distinct experiences.” As such, Dr. Sudhinaraset and her colleagues launched the NIH-funded Bridging communities Raising API Voices for health Equity (BRAVE) Study, the first study to collect national data on the sexual and reproductive healthcare experiences of Asian immigrant women. The diversity of the Asian American and Pacific Islander (AAPI) community in the U.S. is often overlooked in research, so the BRAVE team set out to dive deeper into the unique experiences of this important and diverse group.

“I was getting more interested in Asian American mental health after COVID and the surge in hate crimes,” says BRAVE team member My Hanh (Theresa) Nguyen, PhD, PMHNP. As a psychiatric nurse practitioner, Dr. Nguyen was eager to join the BRAVE team for her post-doctoral work through the UCLA National Clinician Scholars Program and was eager to help shed light on the experiences of Asian immigrant women. The study is novel in that it is the first of its kind to engage participants from multiple cities, Los Angeles, New York, Houston, and Atlanta. “Working across multiple states was critical to the goals of the study given that reproductive rights and immigrant policies are typically made at the state and not federal level,” says Dr. Sudhinaraset. “We purposefully chose states that had a diverse policy context in terms of both restrictive and inclusive policies in order to understand the daily lived experiences of immigrants in navigating these different policies.” Their team found that women who live in states with fewer reproductive rights have lower rates of low birth weight, particularly for Black women. They also found that inclusive immigrant policies were associated with better birth outcomes for all immigrants. As such, they wanted this study to be focused on places where Asian immigrant women needed the most support.

The research study utilizes mixed methods which means using both qualitative interviews and quantitative data gathered from surveys for Asian Immigrant women between ages 18-49 focusing on the four largest undocumented Asian ethnicities (Indian, Chinese, Filipinos, and Koreans). The team has completed a total hour-long interviews with 62 participants that were conducted in the participants’ preferred language. “We asked them about their immigration process, everything from what it was like in their home country and what it was like growing up and what they understood of coming to the States or the receiving country and their adjustment process and then segues into their sexual and reproductive health” says Dr. Nguyen. What they learned in the qualitative studies helped inform the survey that will be going out to 2,000 documented and undocumented Asian women in the participating cities Summer to Fall 2024. The team was mindful to oversample the groups that were most likely to be undocumented given that there is no national data on undocumented Asian women’s sexual and reproductive health. “Undocumented immigrants are the most likely to be excluded from benefits and the target of immigration enforcement activities,” says Dr. Sudhinaraset. “The confluence of both a restrictive reproductive rights and immigrant policy context makes immigrant women particularly vulnerable given the heightened surveillance and potential for criminalization.”

The BRAVE team is currently writing up results for publication and has created a preliminary conceptual framework from their observations. “What the data is telling us is that there's a level of stress that's inherent to any sexual and reproductive health care experience,” says Dr. Nguyen. They find that women’s sense of agency and autonomy is affected by the relationship they have with health professionals and the level of person-centeredness of healthcare interactions. “For example, one participant spoke about having a provider that was very clear about what to expect during the procedure, that certain points might be painful or uncomfortable or didn't minimize their pain or they felt respected,” says Dr. Nguyen. “They would say things like ‘that made me feel happy about getting care,’ or ‘that made me feel like I wanted to get more care’ versus other experiences where a woman felt disrespected or uninformed.” Examples of the disrespect they received came in the form of lack of communication such as not discussing the potential pain from an IUD replacement or having a more extensive conversation about the presence of students in the exam room. These experiences are consistent with the common Western assumption that Asian women are submissive which leads to microaggressions such as these experiences in the exam room. These are uncomfortable situations and forms of disrespect for most people receiving sexual and reproductive care, but the stress is heightened greatly by the cultural, linguistic, and economic circumstances that add barriers to self-advocacy.

Beyond the interpersonal environment in healthcare, there are also large structural barriers to sexual reproductive health services for study participants. These barriers include the language barrier, lack of knowledge about where to get appropriate care, the stress of navigating the insurance system and medical bills, fear among undocumented participants that seeking healthcare could compromise their immigration status, and worrying about taking time off work for appointments.

The study team has engaged closely with their Community Advisory Board (CAB) who represent local and national immigrant and reproductive justice organizations. This conceptual framework about both the interpersonal and structural barriers for Asian immigrant women’s experiences with sexual and reproductive health sets the foundation for the BRAVE team to learn more from the survey that can inform policy and practices within sexual and reproductive healthcare for Asian immigrant women. “It is my hope that our study will contribute to policy-level changes by amplifying the voices of our community--that includes highlighting the needs but also the incredible strength and resilience of our shared experiences,” says Dr. Sudhinaraset. “I am hopeful that shedding light on sexual reproductive health experiences that may be taboo in certain families will also decrease the shame and stigma associated with accessing care for Asian women.”

Group photo from the BRAVE Study Community Advisory Board meeting: (left to right, top to bottom) Lisa Parvin, Kelly Song, May Sudhinaraset, Ahyeon Cho, Xumeng Yan, Isra Pananon Weeks, Maria-Elena Young, Sun Cotter, Regem Corpuz, Michelle Wong, Amy Chen, Amanda Mosner, Priscilla Huang, Theresa Nguyen, Jessica Gipson, Jinkyung Park, Tenzin Khando, Farima Caruso, Drishti Pallai, Berenice Rodriguez, Amy Hsin

As we recognize AAPI Heritage Month and Mental Health Awareness Month this May, there is a lot that the BRAVE study touches upon that adds gravity to the celebrations. “The thing that’s stuck out to me the most in reading these transcripts is that these women feel that they don’t have a voice,” says Dr. Nguyen. “That they’re not heard and that they don’t feel understood or seen is a big theme.” These study participants are also part of a larger community–the AAPI community–whose voices are often overlooked and minimized. UCGHI deputy director, Sun Yu Cotter, MPH has touched upon this topic in past UCGHI stories about her own work where she strives to take up more space as an Asian American woman in public health and also serves as a member of the BRAVE Community Advisory Board. While the experiences of Asian American women are vastly different than Asian immigrant women where there may not necessarily be same degree of language and cultural barriers, the theme of invisibility is persistent. If the diverse lived experiences of people in the AAPI community are overlooked, the lived experiences of Asian immigrant women are dismissed and perpetuate invisibility. In a landscape where Asian immigrant women often do not have the agency or autonomy to take up space and advocate for themselves, the BRAVE Study team is working to make policy and practice changes to help tear down those barriers between sexual reproductive healthcare–and the healthcare system–for Asian immigrant women and all immigrants.

Read more about the BRAVE Study’s research findings related to mental health:

Sudhinaraset, M., Ling, I., To, T. M., Melo, J., & Quach, T. (2017). Dreams deferred: Contextualizing the health and psychosocial needs of undocumented Asian and Pacific Islander young adults in Northern California. Social Science & Medicine, 184, 144-152.

Sudhinaraset, M., Ling, I., Gao, L., Chavarin, J., & Gee, G. C. (2020). The association between Deferred Action for Childhood Arrivals, health access, and mental health: the role of discrimination, medical mistrust, and stigma. Ethnicity & Health, 1-13.

Ro, A., Nakphong, M. K., Choi, H. Y., Nguyen, A., & Sudhinaraset, M. (2021). The association between social ties and depression among Asian and Pacific Islander undocumented young adults. BMC public health, 21(1), 1-10.

Sudhinaraset, M., Landrian A., Choi, H. Y., Ling, I. (2021). Redefining communities: The association between deferred action, online and offline social capital and depressive symptoms among undocumented young adultsPreventive Medicine Reports, doi:

Manalo-Pedro, E., Sudhinaraset, M. (2022). Deferred depression? Mediation analysis of Deferred Action for Childhood Arrivals and immigration enforcement among Undocumented Asian and Pacific Islander students. Social Science & Medicine - Population Health,