Copyright 2009 Ranjana Chakrabarti

CONSTRAINED SPACES OF PRENATAL CARE: SOUTH ASIAN IMMIGRANT WOMEN IN

BY

RANJANA CHAKRABARTI

DISSERTATION

Submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Geography in the Graduate College of the University of Illinois at Urbana-Champaign, 2009

Urbana, Illinois

Doctoral Committee:

Professor Sara McLafferty, Chair Professor David Wilson Associate Professor Ezekiel Kalipeni Associate Professor Zsuzsa Gille Abstract

The aim of this research is to examine use of prenatal care by South Asian

immigrant women in New York City, focusing not only on barriers to care but also

women’s reliance on multi-scalar, place-based social networks and resources. Recently,

public health analysts have raised concern about low utilization of prenatal care by South

Asian women who are much less likely than US-born women to receive early and adequate prenatal care.

I use a mix of quantitative and qualitative methods to examine spatial variation in use of prenatal care for South Asian women in New York City and to understand experiences of pregnancy care for a specific sub-group of South Asian immigrant women. In the quantitative section, GIS and statistical methods are employed to identify risk factors and areas where use of prenatal care is especially low. The qualitative section comprises in-depth interviews with women from Bangladesh and Bengali women from

India to understand their formal as well as informal pregnancy care experiences. I seek to examine the social, cultural and geographical barriers these women face in gaining access to prenatal care and explore how women create and draw upon resources at different geographical scales to maintain health and well-being during pregnancy.

Results from the quantitative section show that Bangladeshi and Pakistani women are at higher risk of receiving less than adequate prenatal care especially in specific areas

such as in South Central Brooklyn. Education and employment emerges as significant

risk factor for Pakistani and Bangladeshi women’s low use of prenatal care. Results from

the qualitative section highlight South Asian women’s situatedness in local and

ii transnational networks and the role of such networks in enabling women to use both

formal and informal pregnancy care.

Situated within the theoretical framework of a ‘new’ medical geography this

research makes several contributions to the emerging body of work untying the linkages

between health and place. Home emerged as important as a space for care as well as

strenuous labor for pregnant South Asian women. Everyday places such as neighborhood

parks, temples emerged as important spaces with physical as well as social therapeutic

qualities. Social therapeutic networks, operating at multiple geographical scales were

important in shaping women’s place-based experiences of pregnancy care. As these

networks unfolded, places were recreated and/or transformed making them therapeutic

and healthy places. Therapeutic qualities of informal conversations and of sights and

sounds surfaced in women’s narratives, further enriching the notion of therapeutic

landscapes. Identifications of everyday locales as therapeutic as well as use of social

therapeutic networks differed based on differences in class, religion and country of

origin.

The research has several policy implications. Issues raised by the women, such as

long waiting times and too many tests, need to be addressed. By highlighting within

group diversity amongst South Asian women, this research emphasizes the need to fine-

tune prenatal care policies to cater to the needs of diverse sub-groups of women masked

under a broad label. By highlighting the impo