Contributors to Health Inequities in Rural Latinas of Childbearing Age: An Integrative Review Using an Ecological Framework

Abstract

This integrative review uses an ecological framework to examine research describing multilevel contributors to health inequities among Latina childbearing women in rural U.S. communities. Rurality exacerbates existing structural issues and makes the accumulation of both social capital and cultural competence in accessing and utilizing the health care system difficult. Four electronic databases were searched—Ovid/Medline, Web of Science, Google Scholar, and CINAHL—over the period of 2006 to 2018. Twenty-nine full-text articles met inclusion criteria. Findings were that a convoluted immigration policy, health care delivery and payment systems, geographic and economic barriers, discrimination, gender roles, and reproductive coercion all contribute to decreased utilization of health care, which in turn contributes to health inequities. More attention is required to situate Latina health inequities in rural communities within the context of other health-relevant aspects of discrimination and reproductive coercion, and to understand the contribution that the health care system itself has on these health inequities. Use of the ecological framework for this integrative review integrates well with inclusive vulnerable population research approaches such as community-based participatory research, because of its multilevel focus.