Asian women in the U.S. have long faced “othering” due to xenophobic stereotypes while also bearing a legacy of deep-rooted shame around women’s health.
For some who come from conservative countries with fewer family planning options, biases collide with internal stigma, including the pressure to live up to “model minority” expectations. As a result, reproductive health is pushed into the shadows.
Katrina Heyrana, MD, PhD
Asian American women, as a whole, have the lowest rate of breast and cervical cancer screening of any ethnic group. Also, Filipinas are more likely to experience preterm birth, teen pregnancy and serious maternal illnesses, such as preeclampsia. Yet, even as the community doubled in size over the past two decades, there have been few scientific efforts to unravel the underpinnings of such inequalities.
Between 1992 and 2018, just 0.17% of National Institutes of Health research grants went to projects directly targeting Asian American, Native Hawaiian and Pacific Islander people, according to JAMA Network. Cedars-Sinai OB-GYN Katrina Heyrana, MD, PhD, is determined to correct this neglect.
“If we go on like this, our patients will continue to suffer from a system that declines to fully consider their identities when providing reproductive healthcare,” said Heyrana, who recently authored an Obstetrics & Gynecology paper on the subject. “Leaving Asian American, Native Hawaiian and Pacific Islander people out of health research is lazy science that provides an incomplete picture at best, incorrect at worst.”
What drives your personal passion to study Asian American women’s health?
One of my mentors used to say that the best kind of research is “me-search”—where you can see yourself, the community you come from or the people you care about in the research that you do. I was raised in a big Filipino Catholic family that never talked about sexual or reproductive health. As I became older, I felt unprepared for every developmental milestone—getting my period, starting to have sex, choosing contraception—and found that many of my Filipino peers dealt with similar challenges.
I also saw friends and family face unplanned pregnancies, severe pregnancy complications and other gynecological problems either in silence or with significant social consequences when they spoke out. During medical training, I realized a familiar, deafening silence pervaded other Asian American, Native Hawaiian and Pacific Islander people’s experiences, not just Filipinos. This drove me to think about where we fit into the bigger picture, what our needs were, and how to develop interventions to improve our relationship with sexual and reproductive health.
What do you see as the main barriers to research inclusion and representation?
Asian American, Native Hawaiian and Pacific Islander people still comprise a smaller share of the U.S. population than other racial and ethnic groups, which can lead to statistical complexities in large population-based studies. There are also language barriers: Given the linguistic diversity of the more than 50 cultural subgroups in our community, researchers have often failed to provide recruitment and study materials in preferred languages. It’s hard to study demographic groups you aren’t recruiting effectively. Some cultures also have social taboos around open discussion of sexual health, which may lead to less healthcare use or reduced research participation. Finally, the model-minority myth—which views all Asian American people as high-achieving and well-off—overlooks marginalization, creating a perception of few health risks.
What do we know about Asian American, Native Hawaiian and Pacific Islander gynecological health disparities and how the lack of data perpetuates them?
We don’t truly know the scope; not only is there a dearth of serious studies of these communities’ sexual and reproductive health needs, but also their aggregation into one umbrella group oversimplifies their situations. For example, Laotian refugees may have very different practices than Samoan people due to cultural, linguistic or religious differences.
We know that Asian American, Native Hawaiian and Pacific Islander people do not access gynecological healthcare as frequently as their peers. A National Partnership for Women & Families survey found that those who are pregnant in California receive inadequate support for anxiety and depression during pregnancy and perceive biases from their care teams. Startlingly, the community also has the highest rates of stroke among pregnant women with chronic hypertension. But these are selected studies out of the mountain of health data. Disparities persist because they can while they are unobserved.
How can the medical field challenge ongoing stigma around sexual health and family planning in these communities?
True community partnerships are essential. Knowing a community well requires acknowledging that each prioritizes different needs and care and will only welcome solutions that align with their priorities. I believe most of the big questions in sexual health, including how to fight stigma and misconceptions, can be found in bringing community members meaningfully into the building and execution of research.
While maternal and reproductive medicine is becoming more inclusive, the tides often shift. Moving forward, where do you see access for Asian Americans, Native Hawaiians and Pacific Islanders?
In the wake of the landmark 2022 Supreme Court reversal of Roe v. Wade, reproductive health providers and researchers are still grappling with how misleading narratives, when left unchallenged, can shift public health policy in reactionary ways. Some older family planning literature mischaracterized Asian people as obtaining abortions mainly for sex selection or genetic reasons, which is inaccurate in my professional experience and has always rankled me as a Filipino American abortion provider. Now is the time to get the story straight, to conduct the necessary research, and to identify and address disparities instead of propagating tired narratives about what Asian American, Native Hawaiian and Pacific Islander communities do or do not need.
