Asian American Women: Issues, Concerns, and

Osteoporosis is primarily a woman’s disease, with women making up approximately 80% of all cases. Asian American women are at higher risk for osteoporosis, most likely because they tend to be lighter in weight and have smaller bones and possibly due to an average calcium intake half that of the general US population. 20% of Asian American women are estimated to have the disease and are at higher risk for hip, spine and wrist fractures. The dangers posed by a hip fracture are particularly serious. Within one year after a hip fracture, up to 30% of the victims will die, 25% of the survivors will be confined to long-term care facilities, and 50% will experience long-term loss of mobility. Yet, only 11% of Asian American women between the ages of 40 and 64 in California have had a bone density test for osteoporosis in the past two years.

Mental Health

Asian American women have the highest suicide rates among women over age 65 and the second highest among women ages 15 to 24 in the United States. Suicide is the eighth leading causes of death for Asian American women. Among all Asian female suicide deaths in California, 56% were Chinese, 22% were Japanese, 11% were Korean, and 8% were Filipina. In addition, 89% of those who committed suicide were immigrants. The suicide death rate for Chinese women is 20 deaths per 100,000 population, the highest of all racial and ethnic groups. A high suicide rate may be a combination of cultural and social factors; cultures in which counseling and psychotherapy are not socially acceptable, such as in many Asian cultures, tend to have higher rates of suicide.

Despite these alarming figures, Asian Americans are only a quarter as likely as whites, and half as likely as African Americans and Hispanic Americans to seek outpatient treatment. Asian Americans are also less likely than whites to be psychiatric inpatients. A constellation of barriers deters Asian Americans from seeking treatment, and when they do seek treatment, it may not meet their needs. Many Asian Americans feel ill at ease with the mental health system in the United States. They may find clinicians who only understand the white middle-class orientation, with its cultural values and beliefs, as well as its biases, misconceptions, and stereotypes of Asian cultures. Other reasons for the underutilization of services include the stigma and loss of face over mental health problems and limited-English proficiency among some Asian immigrants. These obstacles are more pronounced for recent immigrants.

For certain Southeast Asian refugees who have suffered persecution, torture, and starvation during the Vietnam War and after, more than psychiatric treatment is needed. While there are no known longitudinal studies, the few that exist show that survivors of the Cambodian holocaust, the Mahantdorai, are experiencing a health crisis that is a direct result of their extraordinary trauma. Those who lived in Cambodia from 1970-80 suffered major trauma that included starvation, combat conditions, slave labor, imprisonment, witnessing atrocities, torture both physical and psychological, death of family members, physical injury, and loss of home, property, and country. A study of Cambodians living in Massachusetts found that by the mid-1980’s, those who had lived in Cambodia from 1975-79 were suffering high incidence of headache, dizziness, fatigue, muscle and bone pain, palpitations, sweating and fever-symptoms associated with starvation. For those who suffer post traumatic stress disorder (PTSD), their symptoms increase as they age. A California State Department of Mental Health survey found that 16% of Cambodians met the criteria for PTSD and other studies have found that 40 to 50% of Khmer teenagers who lived through the Mahantdorai had PTSD. Many years after their trauma experiences, child survivors are having breakdowns and intrusive memories. For women traumatized as children, they demonstrated an unusual lack of physiologic response to a startle paradigm. Psychosomatic blindness for Cambodian women ages 40 years and older has also been reported.

Researchers are discovering that like survivors of the Nazi concentration camps of World War II, the survivors of the Cambodian holocaust also suffer psychic symptoms such as increased lassitude, failing memory and inability to concentrate, sleeplessness or irritability, and vertigo. The psychic symptoms are the result of starvation-induced organic brain and neurological changes. Studies are beginning to show that a history of torture is associated with hidden or undiagnosed traumatic brain injury that may be interfering with positive responses to psychiatric treatment. This fact raises serious questions as to whether some Manhantdorai survivors will be able to achieve self-sufficiency at a time when the safety net of social protection is being shredded in this country.

Reproductive Health and Maternal-Child Health

1. HIV and STDs

Of all women of all racial groups, in recent years, APIA women have the highest rate of increase in certain sexually transmitted diseases (STDs), such as gonorrhea and chlamydia. APIA women have four times as many reportable STDs as APIA men. Although less than one percent of AIDS cases occur among APIAs, APIA women have the highest rate of increase in new HIV/AIDS infections in recent years. However, because of cultural stereotypes about patients at risk for HIV, doctors often fail to offer Asian women HIV tests or compile sexual history profiles for these women. Many Asian American women only learn of their HIV status through tests during pregnancy, job or insurance change, or after their partner became ill. White and Asian women tend to be infected for the longest time before discovering their HIV status.

2. Early Prenatal Care

Prenatal care provides early detection of mothers at risk of delivering a premature or growth-retarded infant and interventions to reduce the risks of low-birth weight and other adverse pregnancy conditions and outcomes. Some groups of Asian American women have particularly low rates of prenatal care. Laotian women have the lowest percent (56.1%) receiving early prenatal care. Nearly half of Cambodian women do not begin prenatal care during their first trimester and as a result experience higher risk births. Of the five major Southeast Asian groups in Oregon (Khmer, Hmong, Mien, other Lao, and Vietnamese), Hmong American women had the least favorable birth risk profile. Asian Indians (8.3/1,000) and the group classified as “Other Asian” (8.9/1,000) have the highest infant death rates among Asians and Pacific Islanders. Asian Indians (8.4%), Thai (7.5%), Cambodians (7.1%), and Filipinos (7%) have the highest percentages of low-birthweight infants among Asians.

3. Hepatitis B

Hepatitis B rates for Chinese, Koreans, Filipinos, Southeast Asians and Pacific Islanders range up to 15%, as compared to 0.2% among the general US population. Perinatal transmission is the most common mode of transmission among Asian women and their children. Every year, about 19,000 women infected with Hepatitis B Virus deliver infants in the US; nearly half of these women are Asian.

4. Breast-Feeding

The American Academy of Pediatrics recommends that all mothers breastfeed their children. The benefits to breastfeeding for both mother and child include the better health of the infant which translates into time, energy, and money saved due to fewer visits to the doctor and fewer missed days from the job tending to a sick child. Among all women in California, Southeast Asian women have the lowest incidence of breastfeeding. This contrasts with the very high rate of breastfed Southeast Asian babies (93%) born outside of the United States as compared to only 10% of those born in the United States. Possible barriers include lack of information about breastfeeding, limited maternity leave, lack of workplace breastfeeding facilities, and lack of support from peers and family members.

Barriers to Care

As described above, the paucity of research and data and the failure to disaggregate data lead to health care providers failing to provide adequate health care to Asian American women. In addition, the lack of education among Asian American women leaves them with the false belief that they are not at risk for breast or cervical cancer or fatalistic resignation if diagnosed with cancer. Other equally serious barriers to care are outlined below.

1. Uninsured Asian American Women

One reason for the low utilization of preventative services is the lack of health insurance. Approximately 36% of Asian American women under 65 years of age do not have any form of health insurance, a higher proportion than the general US population. Asian American women in California were ranked second only to Latinas (21% and 32% respectively) as most likely to be uninsured. Asian immigrants are concentrated in low-wage jobs that do not provide health insurance, such as garment shops, restaurants, and private households. Korean Americans are the most likely to be uninsured of any racial or ethnic group. In addition to the financial barriers to the working poor purchasing individual health insurance, the 1996 Welfare Reform Act excluded many Asians immigrants living in poverty from federal- and/or state-funded Medicaid programs. Furthermore, as described in Chapter One of this report, those who remain eligible for Medicaid do not apply for fear of adverse immigration consequences. In California, since welfare reform, there has been a 33% decrease in Medicaid coverage among Asian Americans. As a result, selected sub-populations of Asians are more likely to be without health insurance, and this lack of health insurance causes some Asian American women to become frequent users of hospital emergency rooms.

2. Language Barriers to Care

Language barriers impede clear communication that is vital to ensuring the delivery of quality health care. Linguistic accessibility means that service delivery sites must utilize appropriately translated forms, educational materials, signs and posters. Since over 60% of the Asian immigrant population is limited-English proficient, the lack of linguistically accessible services poses a serious impediment. There are far too many anecdotal accounts of immigrant children having to interpret for their mothers at the doctor’s office. Sometimes interpreters are found at random. For example, a 52-year-old Korean-speaking woman had a gynecology appointment at a county hospital. A community-based agency called ahead to request a Korean language interpreter for her. She arrived at her appointment, but the hospital did not provide an interpreter or bilingual worker. Instead, the hospital staff asked a 16-year-old boy sitting in the waiting room–a complete stranger–to be the interpreter for her gynecology appointment.

In one of the most extreme examples of a health care breakdown due to lack of language accessible services, a 51-year-old mother of seven was imprisoned for 10 months in Fresno, California because she failed to take all her tuberculosis medication. She had stopped because of severe side effects, and because, after talking to county health interpreters who did not speak Lao, she thought the medicine could kill her. She was arrested by police with guns drawn. At the jail, a translator misunderstood and told officials that she was suicidal. She was held in a cell with no light, water, heat, or food for three days. After she became acutely ill due to this mistreatment, she was taken to a hospital where she was chained by her ankles to the bed. After six months, the doctors diagnosed her as being noncontagious, yet she was held another four months before a judge found that she was being illegally detained.

3. Lack of Culturally Competent Care

Despite growth in and the diversity of the Asian American population, the US health delivery system has not been able to meet the need for culturally competent services. Culturally competent health care requires having knowledge of cultural beliefs and practices, including dietary and health care practices. It requires the ability to introduce Western medical practices to non-Western patients in a way that can be understood within their cultural framework. It also encompasses incorporating traditional treatments in clinical practice and health education. For example, traditional practices such as acupuncture and herbal medicines should be, but often are not, included in the treatment of Asian Americans or covered by insurance. Yet, Asian American women are more likely to use traditional health practices and medicines than Asian men—69% versus 39%. By ethnic group, nearly 96% of Cambodian women, 81% of Laotian women, and 64% of Chinese women use traditional health practices. Their reliance on traditional medicines may explain the high non-compliance with Western prescription medications. Instead of viewing the non-compliance as lack of cooperation, health care providers should be trained on how to incorporate traditional health practices into their western clinical practices.

4. Barriers Faced by Asian American Lesbians

As described in more detail in Chapter Ten, Asian American lesbians face multiple forms of discrimination based on race, gender, and sexual orientation. One can hypothesize that as a result, stress effects may be great for Asian American lesbians. Yet, the author of this report found no health studies specific to Asian American lesbians. Studies relating to the health of lesbians generally have shown that lesbians have overall poorer health than the general population, morbidity is greater among lesbians than among heterosexual women, and lesbians use the health care system less often than heterosexual women. In addition, lesbians who do not disclose their sexual orientation may be at increased risk for melanoma or other cancers due to psychogenic suppression of the immune response. Chapter Ten also describes the difficulties Asian American lesbians experience when they “come out” to their families. However, there is no data to determine how this stress affects the particular health care needs of Asian American lesbians.

With regard to the general lesbian population, it is known that lesbians encounter discrimination by health care providers, such as reluctance or refusal to treat, negative comments during treatment, or rough handling during examinations. As a result, the majority of lesbians, up to 72%, do not disclose their sexual orientation when seeking medical care. Without knowledge about a woman’s sexual orientation, physicians are unable to provide appropriate, sensitive, and individualized health care. For example, when seeing a gynecologist, she/he may assume that the patient is heterosexual and asks questions that are heterosexist, such as “Do you use birth control?” The doctor will not know to ask questions about family history for breast cancer given that women who do not have children may be at a higher risk for this disease. Gathering accurate information about sexual behavior history is an essential component of good medical care. Yet, if a physician is not aware that a woman is lesbian or is uncomfortable eliciting this information on sexual behavior, she/he cannot advise, for example, on safe sex practices or order tests for particular STDs.

The Organizations

Most of the Asian American organizations engaged in health care advocacy are based in California, funded by the California Endowment or California Wellness Foundation, but their advocacy work is national in scope. Asian American health organizations in other parts of the country primarily focus on providing direct services or research.

The Asian Pacific Islander American Health Forum (Health Forum) was founded in 1986 and is based in San Francisco. The Forum conducts public policy advocacy, capacity building for health CBOs, and regional and national conferences on APIA health. It currently has four projects: HIV Capacity-Building Assistance Program, National Cancer Survivors Network, Center for Census Information and Services, and Tobacco Education Network. In its projects, the Health Forum partners with health CBOs and local clinics throughout the country, provides technical assistance (including review of health promotion literature for cultural competency) and trainings, and acts as an intermediary with federal agencies, particularly within Health and Human Services. As the intermediary, it keeps the CBOs informed on policy, legislative, and regulatory changes that affect provisions of health services and acts as the advocacy arm of the CBOs, conveying to the federal agencies the specific health care issues facing Asian Americans and their providers. The Health Forum had a Women’s Information Network (WIN) project that networked with APIA women’s organizations, published a newsletter, and reviewed multi-lingual health outreach and education materials related to Asian women’s health. Funding for WIN ended and the Health Forum folded advocacy on women’s health issues into its overall work. It is the fiscal sponsor for the Asian American Pacific Islander Domestic Violence Institute.

The National Asian Women’s Health Organization (NAWHO) approaches health from a “rights” perspective, with a focus on access to health. It conducts research to assess health disparities among Asian American women and widely disseminates results to policymakers, health care providers, and government health agencies. It conducts train-the-trainers programs on cultural competency, creates curricula, and educates policymakers through media briefings. An example of a successful campaign is the research it conducted on prevalence of smoking among Asian Americans. Through media work publicizing the results, the Center for Disease Control, which initially refused to fund NAWHO based on their belief that “Asians don’t smoke,” released funding for people of color organizations to engage in education and outreach work in their communities. NAWHO’s breast and cervical cancer program has developed cultural competency curriculums for and also provides train-the-trainers programs to state health care officials and personnel and staff of the American Cancer Society and their affiliates from eight states.

Recommendations for Action

The best way to achieve health is through the “public health” model where health providers and their patients work in partnership to move patients from “communities of recovery” to “communities of resistance”, best described by the feminist bell hooks. For the Asian American communities, advocacy is needed to address the specific barriers to women’s empowerment over their own health care, including advocacy for the following:

Culturally competent research and data disaggregated by ethnic group, to assess and understand the particular health needs of Asian American women. The research agenda should take into account the health crisis present in certain specific sub-populations of Asian American women.

Educating health care providers, public and private, of the high-risk diseases present among different ethnic groups in order to overcome stereotypical assumptions that preclude the provision of high-quality and appropriate medical care.

Training health care providers to better understand their patients’ culturally related health beliefs and medical practices in order to incorporate them into treatment plans and/or to better explain western treatments to patients.

Educating Asian American women to understand the health issues specific to them to enable them to be proactive in the prevention, early detection, and treatment of high-risk diseases.

Providing linguistically accessible services, including hiring of interpreters and bilingual health care workers, so that women can communicate with their health care providers.

Researching and studying the health status and needs of Asian American lesbians.

Footnotes

1 Asian Pacific American Islander Health Forum, Women’s Health Watch Newsletter, Summer 1997.

References

American Heart Association, Biostatistical Fact Sheets, Leading Causes of Death for Asian/Pacific Islander Females United States: 1998

Asian Pacific Islander American Health Forum, Making Managed Care Work for Asian and Pacific Islanders, an Action Agenda for Asian Pacific Islander American Communities, Nov. 21, 1997

Brown, E.R., Ojeda, V.D., Wyn, R., and Levan. R, Racial and Ethnic Disparities in Access to Health Insurance and Health Care. UCLA Center for Health Policy Research and Kaiser Family Foundation, April 2000

Gonen, Julianna S., Ph.D, Managed Care and Unintended Pregnancy: Testing the Limits of Prevention, Insights, Jacobs’s Institute of Women’s Health, July 1997 – No. 3

Kuoch, Theanvy, Khmer Health Advocates, Inc., Health Crisis in the Cambodian-American Community (a working paper), date unknown

Luluquisen , E.M,. Groessl, K.M, and Puttkammer, N.H., The Health and Well-Being of Asian and Pacific Islander Women. Oakland, CA: Asian and Pacific Islanders for Reproductive Health, 1995

National Women’s Law Center, et al., Making the Grade on Women’s Heath, A National and State-By-State Report Card, August 2000

Nowrojee, Sia, and Silliman, Jael, “Asian Women’s Health: Organizing a Movement” from Dragon Ladies: Asian American Feminists Breathe Fire, Sonia Shah, Ed. (Boston: South End Press, 1997), p. xii-xxi

Penserga, Luella , “Health Profile of Asian and Pacific Islander Women: Legislative Briefing on Women’s Health,” Asian and Pacific Islander American Health Forum, March 12, 1997

Srinivasan, Shobha , Asian and Pacific Islander Women’s Health: A Review of the Literature, Annotated Bibliography on Asian and Pacific Islander Women’s Health, Asian and Pacific Islander American Health Forum, 1998

Suh, Dong, and Penserga, Luella J., Riding the Waves of Change, Improving the Health of Asian and Pacific Islander Women under Medi-Cal Managed Care Expansion, Policy Report of the Asian Pacific Islander American Health Forum, December 1996

Women of Color Health Data Book: Adolescents to Seniors, Office of Research on Women’s Health, National Institutes of Health, US Department of Health and Human Services, Date unknown, http://www.4woman.gov/owh/pub/woc/toc.htm

Wong, Doreena, Testimony Before the President’s Advisory Commission on Asian Americans and Pacific Islanders at the AAPI Lesbian, Bisexual Women, and Transgender Community Forum Health and Well-Being Panel, Health Access and Physical Health Issues, San Francisco, CA, November 13, 2000

Part 2, Chapter 6

Sexual and Reproductive Freedom for
Asian American Women

Introduction

For women, sexual freedom is the right to be a sexual being, free from both the patriarchal constraints of uncontrolled pregnancy or the mandate to be heterosexual.1 Control over sexuality and reproduction are inextricably interrelated.2 Society’s deep-seated antagonism toward women’s sexual freedom has limited the discussion regarding women’s reproductive health and rights to a narrow focus centered on control over women’s procreative functions. But, to deny a woman control over reproduction and force her to remain pregnant against her will is, in essence, to force her into a form of slavery. She becomes the involuntary vessel for someone else’s desire for procreation.

The choice of whether or not to have an abortion is fundamental to women attaining full status as persons. In Roe v. Wade, the Supreme Court provided the right to abortion and as well as a constitutional basis for women’s liberation, gender equality, and the capacity to participate equally in society as full persons. However, in the United States powerful social forces attack this constitutional right; their objective goes beyond assuring that motherhood is the primary occupation of women. The core of the attack is antagonism to women’s sexual freedom. Women’s sexual freedom, well-being, needs, and rights have only recently been recognized and incorporated into public debate. Women have been disadvantaged in making sexual choices, exercising their rights with partners, and negotiating safer practices in personal relationships.

Reproductive freedom and the notion of “choice” for Asian American women encompasses more than the decision of whether or not to have an abortion. It also includes a broader framework of racial, gender, and economic justice. Reproductive freedom includes the struggle for the very existence of Asian women in America, their right to establish families and communities, having and making reproductive “choices” freely, having control over the gender and number of children born, the right to culturally relevant sexuality education, and freedom from environmental exposures that affect women’s overall and reproductive health.

Silence about Sex and Sexuality

How do Asian Americans view sexual freedom and other matters related to sexual health and well-being? Questions about attitudes on these topics have not been asked explicitly. However, there is evidence that suggests that, by and large, Asian Americans are “pro-choice.” In a 1991 survey by the Asians and Pacific Islanders for Reproductive Health, 77% identified themselves as “pro-choice” and an overwhelming majority of the over 1,000 respondents were supportive of a woman’s right to choose abortion under varying conditions. The survey did not inquire as to the basis for their pro-choice feelings and it remains unclear whether the beliefs expressed are based on a woman’s right to sexual freedom or on other grounds. In certain Asian American communities, sex is as much a taboo topic, if not more so, as in the general American population. Asian American lesbians have explained that one of the reasons it is so difficult to come out to their parents is that sex is not a topic that is usually or openly discussed in their families, especially outside the family, i.e., publicly. In some Asian cultures, women are not seen as sexual beings; they have sex for the purposes of reproduction or as a marital obligation, not for pleasure. To be a lesbian is to choose to be a sexual person and some Asian American parents are shocked and have a difficult time accepting this. Sexism allows male children greater freedom to express their sexuality and independence than female children.

The dialogue around sexuality is very new. Perhaps the first time that people of color convened nationally to discuss sexuality in their communities was in February 2001 when the Ford Foundation invited experts and activists from around the country to engage in a dialogue. Given that these issues have only recently moved from behind closed doors, there are no specific studies on Asian American women’s sexual rights and well-being. Hence, this report can only note the importance of this emerging issue for Asian American community and the need for resources to examine and investigate how sexuality is defined and the patterns of sexual behavior in different Asian American communities. This is critical for determining how views of sex and sexuality contribute to reproductive health and social problems discussed in this and the following chapter on domestic violence.

Obstacles to Reproductive Freedom for Asian American Women

Government Policies to Control the Asian American Population

Ever since there have been Asians in the United States, the government has created laws and policies to control the size and existence of Asian American populations. When Asians first arrived on US shores, Asian male indentured servants were prohibited from having families. The Page Law of 1875 was the first federal anti-Asian Exclusion Act aimed specifically at barring Chinese women from joining Chinese men working in the US. Anti-miscegenation laws and the Chinese Exclusion Act further prevented family formation and reproduction among Asians in the US. Similar policies were also applied to Filipinos. (See Chapter Nine on Hawai’i.)

Today, anti-immigrant sentiments play out differently, but nonetheless aim to control the population of Asian and other immigrant communities of color. Groups such as the Carrying Capacity Network and the Federation of Americans for Immigration Reform, and segments of groups like Zero Population Growth and the Sierra Club, now use overpopulation and environmental reasons to argue for drastically reduced immigration quotas from countries that have been utilizing the “family reunification” application process. The 1986 Immigration Marriage Fraud Amendments (IMFA) (described more fully in Chapter Seven on domestic violence) made it more difficult for immigrant women to obtain lawful permanent residence status which is a prerequisite to citizenship. The IMFA is a legacy of the Page Law of 1875; its passage was in large part based on testimony in Congressional hearings about women from Asia allegedly entering into fraudulent marriages with US citizens in order to enter the US.3

Lingering Traditions of Male Preference

First-generation Asian American women often experience reproductive oppression when their husbands and extended families put both overt and subtle pressure on them to bear a male child. It is widely known that unwanted girl babies are abandoned all over Asia every day and that women who bear only girl children are accorded less respect. In many cases, women are pressured into having more children than the family can economically support until a male heir is born.

The devaluation of girls and adult women until they bear male children has led to the practice of aborting female fetuses in certain Asian countries. In China, because of its one-child policy, women use ultrasound or amniocentesis to determine the gender of the fetus in order to abort female fetuses. Similar attitudes and practices can be found among some Asians who migrate. In an example from Canada, South Asian women activists waged a huge and successful fight to shut down private prenatal testing clinics that were set up to assist South Asian families in determining the sex of the fetus in order to abort female fetuses. In the US, a study of prenatal testing done at the University of California, San Francisco, found that Asian and white women undergo prenatal diagnosis for chromosomal disorders at a significantly higher rate than Latinas and African Americans. Experts speculate that the low use of prenatal testing by Latinas may be due to Catholic religious beliefs. African American women may avoid such tests due to historical experiences with sterilization abuse, eugenics politics, and the infamous Tuskegee Institute study that allowed African American men affected with venereal diseases to go untreated. In contrast, Chinese women had high utilization rates for prenatal testing, including amniocentesis. Experts speculate that the practices resulting from China’s one-child policy influence the acceptance and use of prenatal testing. The use of such reproductive technologies begs the following questions:

Should sex selection and abortion of female fetuses be a woman’s choice?

Is sex selection a form of reproductive repression rather than freedom of choice when women internalize sexist and patriarchal beliefs about the lesser value of girls or pressures are put on them to abort their less valued female fetuses?

These issues are not addressed by mainstream reproductive rights activists and are only beginning to be addressed by Asian American women’s groups.

Limited Choice of and Access to Reproductive and Sexual Health Care

1. Contraceptive Abuse

True reproductive “choice” means that Asian women are able to utilize family planning, fertility and abortion services in their languages, and have their needs met without fear of being denied access to or coerced into using one form of reproductive technology over another. There is anecdotal evidence that Asian women may be victims of contraceptive abuse. For example, it is widely known within the Asian community and Planned Parenthood clinics that Depo-Provera, a contraceptive injection given every three months, is the most popular contraception for Asian women. However, it is also a form of birth control that has many potential side effects. Each of these following questions about why the use of Depo-Provera is so widespread suggests an underlying injustice around the limited reproductive rights and choices low-income Asian women experience when they “choose” this form of birth control.

Is Depo-Provera popular because of the wide promotion and use of this form of family planning in Southeast Asian refugee camps and in those countries where it first appeared in the market?

Is there a greater need among Asian women for an invisible form of birth control to hide from one’s spouse/extended family?; or

Is Depo-Provera’s popularity because it is a convenient, low-maintenance method which requires less time and health education effort from overburdened health providers?

2. Abortion

Financially strapped nonprofit and public hospitals that provided abortion services are being merged into or bought by Catholic hospitals. Because of their religious doctrines, Catholic hospitals are eliminating access to abortions, to emergency contraception, and sterilization at their newly acquired hospitals.4 Sterilization is the most commonly used form of birth control for American women–28% of all women undergo contraceptive tubal ligation. This number leaps to 41% among poor women. Large numbers of low-income Asian American women without insurance who relied on the nonprofit or public hospitals are losing access to abortion and family planning services. There is also a growing strategy of anti-choice groups such as the Christian Coalition to recruit Asian community churches, especially those with immigrant or refugee memberships, to take on anti-gay and anti-choice political causes.

Language and cultural access is an issue for Asian American women. According to clinic providers, for the most part the Planned Parenthood clinics and other public family planning providers are aware of the need to provide language access for limited-English speaking women. However, such clinics are only equipped to handle early-term/first trimester abortions. Given the overall lack of providers that perform late-term abortions, it is usually the most isolated limited-English speaking women with the least access to family planning services or prenatal services who, in their third trimester, end up seeking but having even narrower opportunities to end unwanted pregnancies.

3. Medicaid Managed Care

The shift by Medicaid to managed care plans has interfered with the ability of low-income women to receive time sensitive services such as prenatal care, abortion, and contraception. Under managed care, services may be delayed when a primary care provider is required to give prior authorization for visits to obstetricians and gynecologists. Allowing women to choose obstetricians and gynecologists for primary care is one solution but these doctors often cannot treat a woman for other illnesses. Many states allow self-referrals to obstetric and gynecological services but place limitations on the number or types of visits. The emphasis on care coordination between providers may conflict with the confidentiality concerns of women who go to a family planning provider (FPP) instead of their regular doctors because they may not want other family members to know. Basic information such as the right to go to an out-of-plan provider or even which FPPs are part of the plan is not being distributed.

For low-income women, many reproductive care services are not covered by Medicaid managed care (MMC) plans even though the state has authorized these services as a covered benefit. FPPs have had difficulties obtaining reimbursement for most costly contraceptives such as Depo-Provera and Norplant and sterilization. In one state, the managed care plans routinely ignore claims for reimbursement for STD diagnosis and treatment. FPPs, including community-based providers in Asian American communities, are experiencing growing financial difficulties when they treat women enrolled in managed care but are at best partially reimbursed. In addition, multilingual translation services are not being fully reimbursed.

4. Domination of Western Medical Practices

Many traditional maternal health practices that empower Asian women throughout the birth process are being denied Asian American women because they conflict with predominant Western medical practices. For instance, Hmong women will search far and wide for doctors who do not “cut” during the birthing process and allow them to squat during birth. The custom of saving the placenta after a birth for burial in a special site is not honored in today’s hospitals; they consider the placenta a “biohazard.” The common practice of offering ice chips and ice water during labor is antithetical to widespread Asian beliefs about the harm from exposure to coldness. For women who believe in these practices, the lack of support by the medical establishment means their birth experience and reproductive freedom are compromised.

5. Sexual Health Care

Health must also include sexual well-being, that is, the right to a satisfying and safe sex life, with healthy and pleasurable sex for both men and women. There needs to be a construction of sexuality that portrays women as equal sexual partners responsible for their well-being and health, and provision of information and services that enhance women’s capacities to safely negotiate their sexual encounters. The taboo in many societies and people’s association of shame, guilt, and secrecy in discussing sex hinders the development of this more healthy view of sexuality. Taboos around sexuality also create barriers to improving reproductive health by hindering discussion about the extent of HIV/AIDS transmission and by extension, the development of prevention strategies.

Cultural Acceptance of Teen Pregnancy

According to a recent California Wellness Foundation study, teen pregnancy in some Asian American sub-populations is on the rise. The highest teen birth rates in California are among Laotian girls (8.7%). According to the Women’s Association of Hmong and Lao in Minnesota, among Hmong girls between ages 15 to 19 in Twin Cities high schools, 50% have had children or become pregnant before they graduate. These pieces of data do not square with the August 2000 Centers for Disease Control (CDC) report that announced the lowest teen birth rates in 60 years for women ages 15 to 19: 4.96 percent for women of all ages and 2.28 percent for Asian women. The data was not disaggregated by ethnic group and as a result, the CDC report gives the public health community the impression that teen birth rates are very low among Asian girls. These misleading statistics have made it difficult to finance teen pregnancy prevention programs in the Southeast Asian communities where teen pregnancy rates are high.

Mainstream pregnancy prevention programs are based on the premise that teen pregnancy is a pathology. But counselors who work with girls in Southeast Asian communities with high teen birth rates find that it is not financial barriers, ignorance of birth control, lack of access to family planning services, or peer or boyfriend pressure to have sex that cause teen births. Rather, the high birth rates among certain Southeast Asian girls is the result of cultural traditions, such as among the Hmong and Mien, that encourage or pressure girls to marry at a young age and to have children in their teens. This is often seen as a rite of passage and a woman is not given respect and authority within her family and community until becoming a mother. For Cambodian teens, the primary reason for becoming a mother was to gain respect and authority within their families. However, some teenage girls are fighting against early marriages that often condemn them to a life of poverty and cut off their dreams to full personhood.5

For example, programs such as the San Francisco-based Asian Women’s Shelter and Oakland-based Narika have assisted teenagers who have resisted forced arranged marriages by escaping from their families. Narika has an outreach program on forced arranged marriages, conducting workshops for teens as well as with community members and leaders to raise awareness about the impact of forced arranged marriages on teens. The Women’s Association of Hmong and Lao (WAHL) also has a teen pregnancy prevention program, which is described in Chapter Eight, Hmong Women in the US.

Environmental Toxins’ Impact on Healthy Birth Outcomes

Freedom to have healthy births also is linked to living and working in environments free of toxins. An emerging body of literature supports claims that past exposure to military bombs, Agent Orange (a powerful herbicide), and DDT (a long-banned pesticide in the US but used widely in Southeast Asia and in refugee camps during and after the Vietnam War) causes poor reproductive health outcomes among Southeast Asian women. Ironically, after escaping the war, because of their need to resettle in low-cost housing areas, many of these same women and their families now live in the shadows of the refineries and chemical manufacturing plants that once produced these toxins. Moreover, large numbers of Asian women work in high-tech manufacturing where they are more vulnerable than the general population to chemical and heavy metal exposures that lead to miscarriages or birth defects. (See Chapter Four: Other Low-Wage Workers.) There are disproportionate levels of pollutants in these communities and little research has been conducted regarding the effect of these toxins. In part because of a fear of entering into discussions that require acknowledging that a fetus be given legal standing, mainstream reproductive rights activists have shied away from taking on issues relating to unhealthy workplaces and the links to women’s reproductive health.

An additional challenge in attaining environmental and reproductive justice for Asian women is the fact that scientific research is inconclusive as to causation, that is, whether the illnesses that Asian women are having today are a result of exposures that happened many years ago in their countries of origin. Their health status is also intertwined with the effects of the overall lack of health care and poverty in the US. In addition, most primary care providers are not trained in screening for environmental or occupational health diseases. Thus, many of the effects of these exposures are undetected and go untreated for many years and across generations.

The Organizations

Grass Roots Organizing

California-based Asians and Pacific Islanders for Reproductive Health (APIRH) believes that if women are to have true reproductive freedom, they must have the economic, social, and political power to make healthy decisions for themselves and their families at work, home and all other areas of their lives. Key strategies that APIRH employs include community organizing, leadership development, popular education, community building and participatory action research. Two campaigns waged by APIRH to protect the safety and reproductive health of API girls and women exemplify these strategies. For instance, in 1998, after an incident with a male teacher who sexually harassed several girls, Cambodian teenage girls in APIRH’s Health, Opportunities, Problem-Solving & Empowerment (HOPE) project in Long Beach successfully waged a two-year research and action campaign that resulted in a citywide taskforce on school safety and stronger anti-harassment policies that are now enforced throughout the Long Beach School District. In early 2001, APIRH played a leadership role in stopping toxic dioxin emissions from a medical waste incinerator located in Oakland between Interstate 880 and Alameda. In this campaign, HOPE members increased the visibility of reproductive health issues related to the toxic emissions and within the grassroots environmental justice movement. APIRH members also recently published the first Reproductive Freedom Tour Guide which identifies toxic sites in Oakland that pose concern to the reproductive health of low-income API young women. Currently, APIRH is working with other organizations to increase the base of API women and girls involved in the reproductive rights movement.

Coalition Work

The Asian Pacific Environmental Network (APEN) has also worked with environmental groups and environmental justice organizations to counter the policy, public relations, and editorial campaigns that were being waged by anti-immigration population control groups posing as environmentalists. Whenever these groups lobbied or paid their way into speaker slots at environmental law and student conferences, APEN along with other immigrant rights and friends in the environmental movement worked to provide a counter perspective. These strategies successfully helped to expose the anti-immigrant, racist agenda behind these organizations.

Recommendations for Action

Ensure that the voices of the vast majority of Asian Americans who are pro-choice are heard in order to counter inroads being made by social conservatives and Asian churches. The communities’ widespread support for a woman’s right to choose is important to provide an alternative message to young Asian American girls that motherhood is not their only path to respect.

Break down the taboos to discussing sex in Asian American communities so that a more healthy view of sexuality can develop. Begin dialogues regarding Asian American women’s sexuality, rights, and needs. Examine how sexuality is defined and how patterns of sexual behavior hinder the ability of women to be equal sexual partners.

End the abusive practices of sex selection and pressuring women to have more children than they want through work on transforming cultural norms. (For examples see descriptions in Chapter Seven: Domestic Violence and Chapter Eight: Hmong Women in the US.)

Provide language services that allow women access to safe and legal abortions. Address issues in the Medicaid managed care system that delay or make it difficult for service providers to get reimbursed for using translators when providing care.

Develop teen pregnancy prevention programs that address the specific community and cultural values Asian American girls encounter, i.e., by addressing the root causes that lead to teen births in low-income South Asian and Southeast Asian sub-populations.

Integrate traditional Asian and Western sexual and reproductive health practices.

Conduct research on the effects of toxins on the reproductive health of Asian American women.

Footnotes

1 Same-sex relationships also threaten the traditional hegemony of men in the sexual pecking order. The potential for women to have sexual pleasure and to construct relationships and communities without men changes the balance of sexual power in familial relations, precisely the arena most resistant to egalitarian intervention.

2 In the early abortion cases, some advocates pressed this argument and emphasized the differential punishment women suffered as a consequence of sexual activity enjoyed at least as much by men. But antagonism by the courts toward sexual freedom is very deep. Thus, in Roe v. Wade, advocates relied primarily on and the Supreme Court chose the right of privacy as the constitutional basis to protect a woman’s right to abortion, and not the 13th Amendment prohibition against servitude and slavery.

3 The 1996 welfare reform package also contained provisions affecting the reproductive rights of Asian American women. These lesser-known provisions of the welfare reform package are conservatives’ efforts to control the fertility of poor women of color. For example, the “family caps” or “child exclusion” policy allows states to withhold cash benefits to discourage women from having more children while on assistance. In addition, by providing monetary incentives, states are encouraged to reduce out-of-wedlock births.

4 In June 2001, the National Conference of Catholic Bishops declared that sterilization (tubal ligation and vasectomy) is “intrinsically evil” and voted 207 to 7 to prohibit sterilization from being performed in any Catholic-run hospital. The new policy affects all of the nation’s 1,140 Catholic health-care facilities, which treat 85 million patients annually. In California, Catholic hospitals are a major source of health care. Catholic Healthcare West is the single largest hospital operator in California, with over 12% of the state’s general care hospitals.

5 Teenage mothers face awesome challenges and poor life prospects. Children of teenage mothers are more likely than children of later child-bearers to have health and cognitive disadvantages and to be neglected or abused. Census data from the 1995 special tabulation indicates that 33% of single female heads of households are living in poverty, compared to 11% of single male heads of household and 7% of married households. Particularly with the elimination of welfare as an entitlement for single mothers with children, funding for teen pregnancy prevention programs is needed more than ever.

References

Asians and Pacific Islanders for Choice, 1992, The Asian/Pacific Islander Reproductive Health Survey 1991-1992

Banzhaf, Marian, “Welfare Reform and Reproductive Rights: Talking about Connections” presented to the National Network of Abortion Funds, June 11, 1999

Barron, Sandy, “Sick and dying in Cambodia: Postwar public health system sinks into decay, pestilence,” San Francisco Chronicle, Oct. 19, 1998

Copelon, Rhonda, From Privacy to Autonomy: The Conditions for Sexual and Reproductive Freedom, printed in From Abortion to Reproduction Freedom, Transforming a Movement (Marlene Gerber Fried, ed., Boston, MA, South End Press 1990)

The Ford Foundation, Sexuality and Reproductive Health: Strategies for Programming, January 2001

Gay, Jill, Workshop Report for Ford Foundation’s Roundtable on Sexuality Issues in Communities of Color, unpublished draft, March 14, 2001

Gonen, Julianna S., Ph. D, Managed Care and Unintended Pregnancy: Testing the Limits of Prevention, Insights, Jacobs’s Institute of Women’s Health, July 1997 – No. 3

Ikemoto, Lisa C., Lessons from the Titanic: Start with the People in Steerage, Women and Children First, in Mother Troubles: Rethinking Contemporary Maternal Dilemmas (Julia E. Hanigsberg & Sara Ruddick eds., Beacon Press 1999)

Jaffe, Robert, Benjamin, Elizabeth and Hickley, Elizabeth, “Reshaping Reproductive Health, A State-by-State Examination of Family Planning Under Medicaid Managed Care,” The Institute for Reproductive Health Access, A Program of the NARAL/NY Foundation, 2000

Kuppermann M., Gates E., and Washington, A.E., Racial/ethnic differences in prenatal diagnostic test use and outcomes: Preferences, socioeconomics or patient knowledge? Obstetrics and Gynecology 1996; 87:675-682

Lattin, Don, Vatican pushes birth control edit despite court ruling, San Francisco Chronicle, July 8, 2001

National Academy Press and Veterans and Agent Orange: Health Effects of Herbicides Used in Vietnam, Institute of Medicine, National Academy of Sciences, National Academy Press, Washington DC 1994

Peffer, George Anthony, If They Don’t Bring Their Women Here: Chinese Female Immigration Before Exclusion, University of Illinois Press 1999

Roberts, Dorothy, “Punishing Drug Addicts Who Have Babies: Women of Color, Equality, and the Right of Privacy,” Harvard Law Review, Vol. 104: 1991

Ross, Loretta, “African-American Women and Abortion” in Rickie Solinger (ed.), Abortion Wars: A Half Century of Struggle, 1950-2000. (Berkeley: University of California Press 1998)

San Francisco Chronicle, “The Vietnamese Victims of Agent Orange,” January 14, 1996

Veterans and Agent Orange, Update 1996, Committee to Review the Health Effects in Vietnam Veterans of Exposure to Herbicides, Institute of Medicine

Part 2, Chapter 7

Domestic Violence and

Asian American Women

Prevalence of Domestic Violence Against Asian American Women

A woman is physically battered every nine seconds in the United States. One out of three women reports physical abuse at the hands of an intimate partner at least once in their lives. Every year, an estimated 1.5 to 3.9 million women are physically abused by their partners. In all intimate relationships, both heterosexual and lesbian, domestic violence occurs 20 to 25% of the time. Domestic violence occurs in every community regardless of race, ethnicity, class, or sexual orientation. Yet, domestic violence is an underreported crime.

For Asian American communities, the paucity of data makes it even more difficult to estimate the prevalence of partner abuse. This report extrapolates from the few specific studies that do exist. The studies indicate that domestic violence is at least as prevalent in the Asian American population as the general American population1 and may be higher in certain Asian subgroups.2 For example, in Chicago, a survey of 150 Korean women found that 60% reported physical abuse. The data also suggests that Asian American women may be at higher risk for fatalities related to domestic violence than women in the general population. For example, Santa Clara County in California is comprised of 17.5% Asians. However, between 1994 and 1997, almost one-third of the 51 deaths related to domestic violence occurred among Asian women, the highest of any ethnic group. In Massachusetts, Asians constituted three percent of the population. However, in 1997, 18% of Massachusetts residents killed as a result of domestic violence were Asian.

Safety Needs Neglected

What accounts for the higher fatality rates related to domestic violence for Asian American women? Why are the safety needs of Asian American women not being met by the systems that exist? To date, there has been no research to answer these questions. We do know that Asian American women in abusive relationships face different challenges than white women who speak English and are American citizens, for whom most shelter and outreach programs are designed. Asian American women, the majority of whom are foreign-born immigrants with different languages and cultures, experience numerous institutional barriers to seeking safety. The categories of safety-related challenges particular to Asian American women–ill-equipped shelter programs, language barriers, laws that discriminate against immigrants, cultural values that lead to violent behavior, and barriers to safety for Asian American lesbians-are described below.

Lack of Culturally and Linguistically Accessible Services

1. Limited and Inadequate Shelter Space

Shelter space in general is limited, but those with the capacity to serve Asian women’s language needs and who make their facilities culturally supportive for an immigrant women are in extremely short supply. In Massachusetts, out of 35 women’s shelters, only two have Asians on staff. Some shelters do not accept non-English speaking women at all. The Asian Women’s Shelter (AWS) in San Francisco has the capacity to help non-English-speakers but is forced to turn away 600 individuals each year. This number represents 75% of the women who contact the clinic. Moreover, mainstream women’s shelters are not designed for women with more than one or two kids.3 Hmong women in the St. Paul/Minneapolis area who have larger than average families were not able to make use of most shelters until Asian Women United designed a shelter to accommodate larger families. Asian Health Services, an Oakland community health clinic, believes that these institutional barriers are so formidable that only two out of 10 Asian American women patients who experience abuse actually find refuge in a shelter. This ratio is low compared to the mainstream population.

2. Lack of Accurate Interpretation

Police who respond to domestic violence calls are seldom bilingual and often do not bring interpreters with them. They seek to communicate with someone who speaks English and that is often the husband. As a result, in many cases the Asian woman’s story goes unheard. In some instances, children, family, and friends have inappropriately been asked to interpret. When those close to the situation have judgmental attitudes and/or fear retaliation by the abuser, they often engage in victim-blaming and are unable to accurately or completely convey the women’s perspective. An example of the tragic results of inadequate translation occurred in the state of Washington. A battered woman’s estranged husband threatened her with a gun, with the intention to kill her. Because of the lack of adequate translation, the abuser was never prosecuted because the police did not obtain statements from the victim and two witnesses with sufficient detail for the prosecutor to proceed. A year after the incident, the abuser killed his wife.

In addition, many Asian women come from countries where police and other institutions do not respond to domestic disputes, which contributes to the lack of reporting. Moreover, the US criminal justice system is viewed as discriminatory toward immigrants, people of color, and other minorities and this also creates negative perceptions that prevent women from seeking police protection when necessary.

3. Lack of Services for Batterers

In most parts of the US, linguistically and culturally accessible intervention programs for batterers from the Asian community do not exist. Court sentences for batterers that require mandatory participation in such programs are rendered meaningless if no such program exists in the batterers native tongue.4

Laws That Traps Asian Women in Violent Domestic Situations

1. Anti-Immigrant Legislation

Anti-immigration legislation poses the most difficult barrier to Asian immigrant women seeking safety. Prior to 1986, a US citizen husband could petition for and obtain lawful permanent residence status (a green card) for his immigrant wife immediately after marriage. However, in 1986 Congress enacted the Immigration Marriage Fraud Amendments (IMFA) that created a new conditional residence status requiring that an immigrant spouse must stay married to a citizen spouse for two years. At the end of two years, the partners must file a joint application to adjust the conditional status to permanent status. As a result, some immigrant women were trapped in violent domestic situations, unable to leave out of fear that their husbands would become unwilling to cooperate in jointly filing the application, thereby rendering them undocumented and thus subject to deportation at the end of the two years.

In 1990, Congress enacted the Battered Spouse Waiver to remedy the unintended consequences of the 1986 law after powerful documentation of the physical, emotional, and economic abuses suffered by battered immigrant women was brought to light. The Battered Spouse Waver allowed a battered immigrant woman to leave her US citizen husband and “self-petition” for lawful permanent residence without the cooperation of her husband. In 1994, Congress enacted the Violence Against Women Act (VAWA) to provide broader protections to immigrant women, allowing any woman, documented or undocumented, married to a citizen or green card holder to self-petition if she is a victim of domestic violence. When VAWA was reauthorized by Congress in 2000, other barriers to the self-petition process were removed. These included allowing divorced spouses to self-petition, allowing abused wives living abroad to self-petition if married to employees of the government or US military, and eliminating the requirement to show extreme hardship to her or her children if deported to her home country.5

2. Limitations of the Battered Spouse Waiver and VAWA

The Battered Spouse Waver and VAWA have been on the books for twelve to eight years respectively. However, because of lack of education and outreach, many monolingual women are unaware of these legal protections. Many women are under the impression that their batterers have complete control over their immigration status and continue to live in dangerous and violent domestic situations. In addition, there are not enough attorneys trained in immigration law, family law, and domestic violence law to deal with the most complicated VAWA cases, especially those involving undocumented women. Even when a woman self-petitions, she may not get the relief she seeks.

An attorney from the Asian Law Caucus in San Francisco found that Asian immigrant women have difficulty meeting the documentation requirements for self-petitioning. For example, in order to self-petition for permanent residence status after leaving an abusive husband, immigrant woman must document the abuse through either police reports or protective orders, record of time spent at a shelter, or affidavits from friends. The extreme isolation of many Asian immigrant women, their lack of awareness of the availability of shelter programs or police protection, and the language barriers to obtaining assistance from them, make it difficult for them to use these channels to document the abuse. In addition, because the crime of domestic violence is a deportable offense, some Asian immigrant women hesitate to report their batterers to law enforcement. These women often must use only their own declarations and rely on the discretion of INS officers. But an advocate who tracks VAWA cases nationally notes that the INS has a great deal of discretion in hearing a case, and even if the woman’s declaration is legally sufficient, many INS officers in local district offices are not sympathetic to the plight of battered immigrant women.

3. Restrictions Created by Welfare Reform

Welfare reform has resulted in serious financial barriers to Asian immigrant women seeking safety. Recognizing that welfare programs serve as an essential bridge to safety for women fleeing domestic abuse, Congress created exceptions for battered immigrant women. For example, a battered immigrant woman, even if she is undocumented, is eligible for public benefits when she has a pending VAWA or family sponsored petition. Battered women are also exempted from the “sponsor deeming” requirements. Congress also created the Family Violence Option (FVO), which allows states to exempt a battered woman from TANF work requirements if meeting these requirements would make it more difficult for the woman to escape an abusive situation. FVO also permits the clock on the five-year lifetime cap to stop running until the woman is safe. Under FVO, a state can waive the paternity establishment and child support requirements. However, the widespread, erroneous impressions among both caseworkers and battered women themselves that “immigrants aren’t entitled to any benefits anymore” have kept battered women from applying and caseworkers from accepting applications. There is anecdotal evidence that caseworkers ignorant of FVO provisions have sanctioned battered women for not complying with job search and work requirements, and thus reducing or terminating their benefits. In addition and as described in Chapter One of this report, fear of mandatory reporting to INS and fear of becoming a deportable public charge6 has also kept eligible Asian immigrants from applying for public benefits.

Without a safety net to keep them from falling into dire circumstances if they leave the batterer, women remain in dangerous and violent situations. In a report by the Family Violence Prevention Fund that chronicles the effects of welfare reform, an advocate from Massachusetts relays:

“Many women are afraid to apply for benefits because of the public charge issue. We’ve heard of cases where someone received benefits only briefly-just for the time it took to leave a dangerous relationship-and was denied legal permanent residency by the INS and put into deportation proceedings. To many women, it just doesn’t seem worth it.”7

Welfare reform has also resulted in shelters mistakenly believing that it is unlawful to provide services to undocumented women and thus increasingly denying services to battered immigrant women. In fact, emergency medical care and shelters continue to be available to everyone, regardless of immigration status. Some shelters also believe that their funding streams preclude them from serving immigrant women when in fact federal domestic violence funding carries no such restrictions. Given the limited number of beds, some shelters have chosen to provide services only where there is a guarantee of public benefits reimbursement and to deny these services to immigrant women whose eligibility for public benefits are in doubt. One Asian women’s shelter director suspects that instead of fund-raising to increase language capacity and transitional programs specifically needed by immigrant women, these shelters justify discriminating against Asian immigrant women by simply stating that their programs cannot serve their needs.

Cultural Norms and Values That Lead to Violent Behavior

1. Acceptance of Violence Against Women

A survey conducted by the Boston Asian Task Force revealed that 20-25% of the respondents from the Cambodian, Chinese, Korean, South Asian, and Vietnamese communities surveyed thought that violence against a woman was justifiable in certain domestic disputes. The report also found that a higher number of Asian men than women condone family violence. Among Korean respondents, 29% (the highest percentage among the five ethnic groups surveyed) felt that a battered woman should not tell anyone. In general, Cambodian and Vietnamese respondents believe that a battered woman should not leave or divorce her husband. South Asian respondents felt that the woman in marriage becomes her husband’s property and thus she cannot turn to her family and/or parents to ask them to intervene. Older Chinese respondents were more tolerant of the use of violence in certain situations, and younger Chinese were less likely to see leaving and divorce as viable options for battered women. Response patterns were similar between the foreign-born and US-born. Moreover, these attitudes permeate all sectors of a community, including those who are supposed to protect battered women. One legal advocate who represents battered women in Hawai’i was dismayed to hear female interpreters at an immigrant social service agency siding with a particularly violent batterer on the grounds that his estranged wife was pregnant by another man.

In the home countries of many Asian women, extended families often exert collective pressure to prevent abuse of wives. However, migration to the US broke up extended families and changed social practices to the detriment of women who often rank lowest in the family structure. In some communities this has resulted in the perversion of extended families from protector to perpetrator. NARIKA, a South Asian domestic violence resource center in Berkeley, has reported that there are cases where entire families, extended and joint, get involved in abusing a woman, with some members holding her down while others do the hitting. Therefore, conventional legal restraints, such as protective orders against the lone male abuser, are of limited use-when there are multiple perpetrators-including in-laws and other women in the family.

2. Cultural Emphasis on Preserving Family

The notion of having to preserve the family and “save face” often makes Asian women more hesitant to leave and break up the family. Women in abusive marriages are frequently blamed for not behaving or told to tolerate the abuse in order to save face for the entire family or clan. Because certain Asian communities are small and close-knit, victim advocates from the communities often face harassment and threats from the abuser and the family for helping women leave the relationship and upsetting the social order. Also, this pronounced belief in the sanctity of the family even in the face of violent victimization, combined with a cultural antipathy toward divorce, makes it more difficult for white shelter workers and advocates to provide support and understanding to Asian women. As the Boston-based Asian Task Force against Domestic Violence notes, “One of the biggest and most important challenges to addressing family violence within Asian communities is reconciling the differences between Western ideals of independence and individualism with Asian ideals of interdependence and group harmony.”

In addition, the traditional Asian gender roles of male providers and female homemakers are often disrupted by the American economy that requires both partners to work outside the home. As described in Chapter Eight, while this has been liberating for some Asian women, women’s economic independence is seen as a threat to social orders that privilege men and has, in some communities, contributed to a rise in domestic violence.

3. Transforming Culture

Culture is not static, fixed, and unchangeable. Norms, values, and beliefs are constructed in the interchanges between and among people within cultural groups and are constantly evolving. As Asian immigrants, it can be threatening in light of changes forced by relocating to the United States, to think that cultures must also be changed from within. Who will we be then? Will we disappear as a distinct social group? There are aspects of Asian cultures that are worthy of saving and passing on. There are others that must be transformed in order to honor basic human rights-in this case, the right of women to be free from domestic violence.8 In Asian American communities for example, the emphasis on preservation of the family is worthy but must be transformed so that it is achieved not by pressuring women into staying in violent situations, but by changing the cultural and social cues that sanction men’s use of violence to control women. Thus, a number of Asian women shelters and outreach groups frame their organizing work as “work to perpetuate the core values of each Asian community that are positive and to eliminate those parts that are no longer useful or healthy.”

Battered Queer Asian American Women9

Domestic violence is equally prevalent in queer Asian women’s relationships. However, there is little research and data on same-gender relationship violence10 and what does exist tends to underreport the incidents involving queer Asian women.11 There are several causes for this underreporting. In 1998 national and local focus groups held by the Family Violence Prevention Fund and the San Francisco-based Asian Women’s Shelter, queer Asian women divulged that they did not feel safe reporting relationship violence to the police or authorities. They feared that disclosing oneself as a lesbian being abused by another lesbian may subject them to further abuse at hands of the police. Many were hesitant to access service providers due to sexism, racism, homophobia, language and cultural barriers, and fear of disbelief among service providers. Queer Asian women often do not feel safe even speaking to friends. They may also hesitate to report their abusive partner because they do not want to further isolate a woman who is already marginalized by society or subject her to a homophobic, racist legal system and its consequences.

Even when abused queer Asian women seek help, they find that the vast majority of domestic violence agencies are not able to meet their needs. One factor is that the domestic violence movement does not acknowledge same gender relationship violence. The mainstream domestic violence movement understands violence as a patriarchal phenomenon, deriving from sexism, with men using violence to control women. Within the queer women’s community, it is not always the more masculine, or butch, woman that is the abuser. Women can be survivors and batterers. The typical response of mainstream domestic violence agencies’ is to ostracize the batterer. But banishing the abuser from a small, marginalized queer Asian community is akin to cutting her off from her only family members. Agencies do not have programs that assist both the batterer and survivor. The San Francisco shelter is the only program with a Queer Asian Women Services project.

The Organizations

The Shelter Programs

Since the first shelter program for Asian American women and children started in Los Angeles in 1981, six other Asian women’s shelters have emerged across the country12 along with over a dozen outreach, education and hotline programs for Asian women. The majority of these were started by and for South Asian women. These include organizations such as Apna Gar (“our home” in Hindi-Urdu), Manavi (“primal woman” in Sanskrit), the Nav Nirmaan Foundation, Inc., the New York Asian Women’s Center, Raksha (“protection” in several languages), Pragati (“progress”) and Sakhi (“women’s friend”).

The handful of shelters that are available cannot meet the needs of Asian American women, especially limited-English speaking women, in their regions, let alone the country. All these groups and shelters conduct some form of community education and outreach as part of their prevention activities to address the root causes of domestic violence. Shelters have conducted local advocacy, such as pressuring police departments to hire interpreters or working with them on protocols on handling domestic violence calls in Asian communities. Not until 1997 was the first large national pan-Asian conference convened in California that brought together 400 service providers and activists from across the country. Since then, other conferences have been held, such as one for Koreans in Los Angeles, South Asians in New York, and a pan-Asian conference in Ohio. With such limited capacity, locally based shelters and programs have relied on coalitions such as the National Network on Behalf of Battered Immigrant Women to conduct the statewide and nationally advocacy needed to address the unique challenges Asian women face, when and if those challenges dovetail with the agenda of these broader coalitions.13

Coalition Work

In 2000, as a means to address the lack of a national Asian American battered women’s advocacy organization, the San Francisco-based Asian Women’s Shelter, the Asian & Pacific Islander American Health Forum, the Family Violence Prevention Fund, and the National Resource Center on Domestic Violence, launched the Asian and Pacific Islander Domestic Violence Institute (APIDVI). The mission of APIDVI is to advocate for policy changes and increased ethnicity specific data collection, facilitate the sharing of service models for battered Asian women and children, and promote national discussions on differing Asian community perceptions of domestic violence, community responses to the problem and the intersecting cultural values. Since the formation of APIDVI, all the various Asian women’s shelters and domestic violence programs have become members. Based on evidence of higher fatality rates among battered Asian women, its first research project is a fatality review of deaths of Asian and Pacific Islander women in major urban centers like Chicago, Santa Clara, San Francisco, and Boston. Its first advocacy project will focus on getting police departments to disaggregate fatality data by ethnicity because most departments simply put Asians under the “Other” category after “White”, “Black” and “Hispanic.” The APIDVI advocacy will focus on two areas: Welfare Reform and Cultural Competency as they relate to domestic violence. This work will be conducted by working groups consisting of its member organizations and coordinated by APIDVI staff. Initial funding came from the US Department of Health and Human Services.

Transformative Initiatives

An example of work to transform local community attitudes on domestic violence in the Korean community is the SHIMTUH project-a joint project between the Asian Women’s Shelter in San Francisco and the Korean Community Center of the East Bay. SHIMTUH has direct service, outreach, and organizing components. It reaches out to the social networks, structures, and institutions in the Korean community to transform cultural norms. Through cultural events, drumming, singing, working with the Korean press, and outreach to indigenous Korean religious institutions, SHIMTUH engages in public dialogue with religious leaders and others to influence more and more spheres in the community. Another example is the Family Violence Prevention Fund’s reframing of the concept of “hiya” or shame in the Filipino community. In a poster campaign, the FVPF introduced the concept of “nakakahiya”-a woman should not feel ashamed for having bruises and being beaten, and the community should be ashamed for not helping her.

One example of work among immigrant men is the Tapestri Men’s Group, a project of the Refugee’s Women’s Network, Inc. in Atlanta, Georgia. Tapestri’s philosophy is twofold. First, it believes that cultural norms are not immutable and can evolve. Second, it views the violence of men not as an individual pathology amenable to counseling or therapeutic intervention in one-on-one sessions, but rather as a social malaise where a man has learned through modeling at home and in society that the use of violence against women is an accepted way of resolving differences. Thus, Tapestri does not provide anger management because it views men’s violence against women not as an angry man out of control, but as a man who chooses to be violent to control his partner.

In the men’s groups where Asian, Latino, Caribbean, African, and East European men have participated, the transformative and re-education work takes place not by experts imparting information top down to batterers, but through a process where men themselves critically explore, in an atmosphere of mutual respect and horizontal relationships, the antecedents, dynamics, and effects of their violent behaviors, values, and expectations. In the process, men’s views of themselves and their roles as partners and fathers are transformed, gender identities are de-constructed and re-constructed, and the men become agents of change in their communities. The Tapestri Men’s Group and others like it were created when domestic violence survivors, who did not want to leave their marriages, requested intervention programs for their husbands. As the men participate in the 24-week program, women advocates from Tapestri work with their wives to provide support, ensure that they are not in danger, and monitor the progress being made by the men.

Recommendations for Action

Address racism, homophobia, and xenophobia within social service and law enforcement agencies that deal with battered Asian American women.

Increase language access to all services needed by battered women through hiring of interpreters and bilingual staff and creating culturally competent services in police departments, shelters, and counseling and court intervention programs for men.

Eliminate barriers to public benefits such as the chilling effects of mandatory reporting to the INS, fear of being designated a public charge, and hostile caseworkers.

Train eligibility caseworkers on the exceptions for battered women, the Family Violence Option in TANF, and the myriad categories of immigrants to correct the widespread erroneous perception that immigrants are no longer eligible for benefits.

Educate both government agencies and social service providers and immigrant women to understand and utilize the protective provisions in VAWA

Repeal the conditional residence status that has trapped women in violent homes and which the passage of VAWA simply will not fix.

Address and transform cultural norms that accept violence against women as a means of discipline or control. This includes creating programs for both female and male Asian American batterers.

Conduct studies on relationship violence in queer Asian women commun-ities. Redefine domestic violence theories to include same gender relationship violence.

Footnotes

1 In Boston, a survey of men and women from the Cambodian, Chinese, Korean, South Asian, and Vietnamese communities found that 38% of respondents reported knowing a woman who had been physically abused or injured by her partner. A focus group with Southeast Asian Chinese estimated that 20-30% of Chinese husbands hit their wives. A Northern California survey found that 25% of Filipinas had experienced domestic violence in the Philippines, the US, or both.

2 Research indicates a higher incidence of domestic violence among military families. Advocates in Hawai’i, which has a large military base population, have noticed that Asian immigrant women married to US servicemen have fewer financial and social resources, suffer from prejudices against interracial marriages, and are especially vulnerable to abuse. As described in Chapter Two of this report, domestic violence against women in servile marriages may be higher than in the general population.

3 Mainstream shelters are designed in dormitory styles with congregated dining that is alienating to Asian women used to cooking their own foods, feeding their own children, and keeping their children with them most of the time. Additionally, Asian women have a difficult time following mainstream shelters’ programs and procedures, such as participating in shelter chores selection, because of their inability to communicate with staff and other residents. They also report feeling very lost when they were forbidden to have any contacts with their mothers who have traditionally been their source of support.

4 Court sentences that involve serving time and mandatory participation in intervention programs are often insufficient to convey the gravity of the crime to the batterer. In addition, there needs to be culturally relevant sentencing. For example, in the Hmong community, when clan elders resolve domestic violence cases through the mediation process, they may order the husband to hire a shaman for a soul-calling ceremony to heal the wife. When a wife has been abused, the soul leaves her body because it has been mistreated. When the soul is not well, the body is not well. In a soul-calling ceremony, a shaman calls the soul back to the body.

5 VAWA 2000’s other provisions allow self-petitioning by women whose abuser husbands die or lose their immigration status or whose husbands have committed bigamy. In addition, VAWA 2000 also created a new visa, the U visa, for women not covered by VAWA, such as battered wives of men holding temporary worker visas or student visas and victims of sexual and other crimes, such as rape and torture. However, it is more difficult to obtain relief through the U visa than through VAWA’s self-petitioning process because the woman must show substantial physical or emotional abuse.

6 INS’s May 1999 guidelines state that use of non-cash benefits such as Medicaid and food stamps does not make one a public charge. VAWA 2000 barred the INS from finding a woman a public charge based on her use of non-cash benefits that she is legally qualified to use.

7 Family Violence Prevention Fund, “Caught at the Public Policy Crossroads: The Impact of Welfare Reform on Battered Immigrant Women,” January 1999.

8 See Julia L. Perilla, “Domestic Violence as a Human Rights Issue: The Case of Immigrant Latinos,” reprinted from Hispanic Journal of Behavioral Sciences, Vol. 21, No. 2, May 1999, pp. 107-133.

9 The term queer is controversial within the lesbian/gay/bisexual/transgender (LGBT) community. However, many LGBTs have reclaimed “queer” as a positive term. This report uses it to encompass the diversity of the LGBT community.

10 In both national and local focus groups of queer Asian women held by the Family Violence Prevention Fund and the San Francisco based Asian Women’s Shelter, survivors expressed discomfort with the label of domestic violence and preferred the term relationship violence to describe violence in queer relationships.

11 In October 2000, the National Coalition of Anti-Violence Programs issued a report that there were over 3,000 cases of LGBT domestic violence (47% female, 50% male survivors) throughout the US, with 1,356 cases in Los Angeles, 741 in San Francisco, and 510 in New York. For San Francisco, 75% of the cases involved whites and 25% people of color, including Asian Americans.

12 The seven shelters are the Asian Women’s Home in San Jose, the Asian Women’s Shelter in San Francisco, the Asian Women United in Minneapolis/St.Paul, the Center for Pacific Asian Families in Los Angeles, the New Moon Shelter in Boston, Apna Ghar in Chicago, and the New York Asian Women’s Center. There are also programs within larger shelter programs like the Asian Unit of Interval House in Long Beach/Orange County, CA. In Atlanta, Georgia, the International Women’s House serves women who do not speak English, including Asian immigrant women.

13 The National Network is made up of three groups, the Family Violence Prevention Fund, the Immigrant Women Program of NOW Legal Defense Fund (formerly housed at AYUDA, Inc.), and the National Immigration Project of the National Lawyer’s Guild.

References

Chan, Sue, M.D., “Domestic Violence in Asian and Pacific Islander (API) Communities,” compilation of studies, statistics, and data on domestic violence and API’s, Asian Health Services.

Family Violence Prevention Fund, January 1999, “Caught at the Public Policy Crossroads: The Impact of Welfare Reform on Battered Immigrant Women”

Perilla, Julia L., “Domestic Violence as a Human Rights Issue: The Case of Immigrant Latinos,” reprinted from Hispanic Journal of Behavioral Sciences, Vol. 21, No. 2, May 1999, pp. 107-133

Santa Clara County Death Review Sub-Committee for the Domestic Violence Council, Final Report, 1997

Warrier, Sujata, Ph.D, “(Un)heard Voices: Domestic Violence in the Asian American Community,” Family Violence Prevention Fund, produced with a grant from the Violence Against Women Office, Office of Justice Programs, US Department of Justice

Yoshioka, Marianne, Ph.D., M.S.W., “Asian Family Violence Report: A Study of the Cambodian, Chinese, Korean, South Asian and Vietnamese Communities in Massachusetts,” Nov. 2000, Boston, MA

Part 3

Special Focus

Part 3, Chapter 8

Hmong Women in the US:

Changing a Patriarchal Culture

Introduction

The story of Hmong women in America is a story of both crushing burden and an indefatigable will to survive and overcome barriers. Many Hmong women marry and have children at young ages, work full-time jobs, and cope with raising 10 to 14 kids. Sometimes they are the sole breadwinners of the family. It is the strength of Hmong culture and the women themselves that have made survival possible. Many of the older women who grew up in Laos worked beside their men in the fields harvesting crops, clearing brush, feeding the pigs, cooking, and raising the children. A 56-year-old Hmong grandmother says proudly, “I delivered all 12 of my babies by myself and never let their heads touch the ground.”

In America, Hmong women quickly realized they had freedoms that didn’t exist back in Laos. They were free to marry whomever they choose, free to pursue jobs or an education, and free to get out of a bad or loveless marriage. Denied educational opportunities in Laos, Hmong women of all socioeconomic classes have seized educational opportunities and are often more likely to get and hold a job than their male counterparts. The first Hmong Ph.D. in anthropology in the US was a woman. The majority of Hmong lawyers in Minnesota are women and collectively they started the first and only Hmong Bar Association in the country.

However, some women found themselves in situations where the burdens were too much to bear. In June 1998, a 13-year-old Hmong girl, Lee Vang of Wisconsin, killed the infant she had just given birth to; this infant was the product of rape by her even younger male cousin. Lee Vang’s mother was single and relied on the assailant’s family for financial support. The assailant came and went from their house all the while sexually assaulting Lee Vang. Mother and daughter could not defend themselves and had no one to protect them. In the aftermath of Lee Vang’s arrest and release, Hmong elders shunned and isolated her for bringing shame onto the community. In Septembe