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When the American dream becomes a public health nightmare

The plight of Asian-Indian women immigrants demonstrates immigration policy’s effect on public health.

America’s culture has assigned gender roles within marriages for centuries. It’s been a simple concept: Men go to work. Women tend to the home. And although this way of thinking is steadily changing—there are fewer assigned gender roles in marriage today—it remains a cultural issue, not a legal one.

The same can’t be said for immigrant spouses of the U.S.’s H1-B visa program that allows companies to employ exceptionally skilled workers in specialty occupations. For years, through the H4 visa program allowing dependents of H1-B visa holders to accompany them, the spouses (often Indian women) of these workers have been restricted by the U.S. government from obtaining employment, and thus legally assigned the role of housewife.

“It’s not particularly a health policy,” says Dr. Mudita Dave, program chair of the Master of Public Health program at The Chicago School, who recently spoke about the impact of these policies on the health of Asian-Indian women at the 2017 APHA conference. “But it does have a tremendous impact on health and well-being of these women.”

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A history of the H4 visa

Widely utilized in the 90s, the H4 visa program provided immigrant couples a way to remain together if one was to find temporary, and often lucrative, work in the U.S. through an H1-B visa. However, it did not authorize the spouse of the H1-B visa holder to gain employment.

Male Indian citizens have traditionally comprised the majority of H1-B visa applicants and recipients, specifically through work in the information technology sector (about 195,000 H-1B visa openings annually for IT). So, naturally, the majority of spouses seeking H4 visas were Indian women. In fact, 90 percent of H4 visa holders are women.

Many of them are trained professionally and academically in various fields or were entrepreneurs back in India. But because they didn’t want to rip apart their family, they decided to come to the U.S. with their husbands. But an inability to gain employment can lead to frustration and isolation, while the stigma of being labeled “dependent” has a negative effect on self-esteem.

“Many more women accompany men on these visas than vice versa,” Dr. Dave says. “It becomes a very gendered pattern of people not being able to use their education skills and training.”

One of the first women interviewed during Dr. Dave’s research is a prime example. She held a master’s degree in chemistry from an Indian university, but upon moving to the U.S. after her husband obtained an H1-B visa she felt her career was put on hold. Even worse, she was forced to move three times within two years, until her husband’s work was complete and they returned to India. This lack of stability is especially challenging for families that arrive with children.

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Upon her second venture to the U.S. (again, because of her husband’s pursuit of work) she decided to further her education; seeking to be productive in some way. Even this became a burden due to restrictions on spouses accepting paid positions as research assistants, forcing them to pay for any education costs out-of-pocket.

“So many of these women don’t feel accepted and wonder why they are trying so hard to contribute to a system that doesn’t seem to want them,” Dr. Dave says.

Progress for immigrant spouses

To address these issues, the U.S. Citizenship and Immigration Services began allowing H-4 visa holders to obtain employment under specific conditions on May 26, 2015, in response to an executive action implemented by the Obama administration. This was estimated to give eligibility to 179,600 H4 visa holders in the first year, and 55,000 annually thereafter.

Additionally, it eased the burden of maintaining a single-income household, increased the incentive for the highly skilled H1-B visa workers to remain with their companies, and, most importantly, empowered thousands of women to begin seeking employment opportunities or continue their education; it gave them a sense of purpose.

Although not all spouses are eligible, this was a step in the right direction, Dr. Dave says. But the future of this progress hangs in the balance.

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The struggles that recipients of the H4 visa face are a perfect example of how public policy impacts public health in unexpected, yet clear, ways. As thousands of immigrants continue to wait on policy decisions that will affect their future, Dr. Dave says a unique determination to succeed has helped many of those affected.

The woman she first interviewed decided to pay for her education out of pocket, spending $50,000 to get her master’s degree from an American university. Her husband applied for permanent residency, and she was authorized a work permit after a nearly 10-year struggle.

But according to Dr. Dave, stories of immigrants overcoming the hardships they face is why people will continue applying for a program they know requires so much sacrifice.

“Even though the U.S. is still widely considered a land of opportunity, lived experiences of my study’s participants throw light on a relationship that is not commonly considered or well understood,” Dr. Dave says.


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Blake C. Pinto

Blake C. Pinto, a military veteran, joined TCS Education System’s marketing department as the Advertising Copywriter in July 2017. He has previously worked for HLR Media and LC Digital Marketing in Southern California.


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