Structural constraints and migrant agency as intersecting influences on pregnant and parenting asylum-seeking women's sexual, reproductive, and mental health during forced migration: A qualitative study at the Mexico-US border.

BACKGROUND Driven by structural violence experienced during forced migration, including asylum-deterrence policies, asylum-seeking women face health and social inequities related to experiences of pregnancy and motherhood. Little is known about the intersecting relationships between forced migration and motherhood and their respective health consequences.

OBJECTIVES This study examined the interplay between the structural constraints and the individual agency on pregnant and parenting asylum-seeking women's sexual, reproductive, and mental health and migration experiences.

DESIGN Qualitative.

METHODS As part of a community-academic partnership, we thematically analyzed 38 qualitative, semi-structured interviews conducted in Spanish or Haitian Creole with pregnant and parenting asylum-seeking women at the Mexico-US border (July 2022 to April 2023).

RESULTS Structural violence and agency intersected to affect migrant women's experiences of pregnancy and motherhood. The structural violence experienced during forced migration, including political, legal, and economic violence, constrained women's sexual, reproductive, and mental health during pregnancy and motherhood via barriers to family planning; reduced/delayed access to perinatal care; food, housing, and economic insecurity; and psychosocial stressors (e.g., anxiety around family separation). Concomitantly, women's identity as mothers was a source of agency and resilience amidst forced migration, leading to shifts in migration trajectories and strengthened resolve to build a safer life for their children.

CONCLUSION Asylum-seeking women faced barriers to healthy pregnancy and motherhood during migration, influenced by structural constraints during forced migration and tempered by their strength and resilience as mothers. There is a need for removal of restrictive immigration policies to address the harmful socio-structural contexts that perpetuate adverse health outcomes among women and their families during forced migration, alongside humanitarian and health services for asylum-seeking women that acknowledge the impacts of structural violence amid current migration policies.