Project Summary/Abstract There are over 20 million Asians in the US, 60% of whom are immigrants. By 2055, this demographic is expected to surpass Hispanics to become the largest immigrant group in the country. This includes 1.5 million undocumented Asians, who experience greater barriers to access than their documented peers. Despite these trends, national health statistics often lump Asians into an “other” category or exclude them entirely. For Asian immigrant women, who report greater odds of unintended pregnancies and are less likely to use sexual and reproductive health (SRH) care compared to their US-born counterparts, detailed SRH data accounting for their diversity of social, economic, and political experiences is critical to addressing SRH inequities in their growing community. Moreover, past studies treat immigration status as a binary (documented/undocumented) and static variable; however, there is increasing recognition that there is a hierarchy of statuses and that status can change across the life of an immigrant. Building on the PI’s past work with Asian immigrants, the goal of this study is to provide critical SRH data among the most diverse sample of Asian immigrant women to date. We propose to establish the first multi-city, sequential mixed-methods study of the SRH of Asian women across multiple ethnicities and immigration statuses, including naturalized citizens, lawful permanent residents, temporary workers and students, DACA recipients, and undocumented immigrants. Guided by the social ecological model and life course perspective, this study will assess multilevel factors that mediate and moderate associations between immigration status and SRH care use. We first conduct 48 qualitative life history interviews to examine how sociopolitical experiences of immigration statuses act as barriers to SRH care use over time (Aim 1). Next, using a novel starfish sampling method used to recruit hidden populations, we will recruit 2,000 Asian immigrant women aged 18-49 years, including an oversampling of the four largest undocumented Asian ethnicities (Indian, Chinese, Filipinos, and Koreans) in cities with the highest numbers of Asian immigrants (Los Angeles, New York City, Houston, and Atlanta). Using quantitative survey data, we will 1) examine how immigration status is associated with use of recent SRH services; 2) explore histories of immigration statuses and assess cumulative risks on SRH care use during sensitive periods (e.g. childhood, adolescence, adulthood) (Aim 2); 3) and examine mediators and moderators (Aim 3). In order to improve the quality, relevance, and accessibility of our research, we will partner with the National Asian Pacific American Women’s Forum (NAPAWF), the first national Asian reproductive justice organization, and its chapters located in each of our cities of interest. In addition, we will closely engage the knowledge, expertise, and sensitivities of local community-based organizations throughout California...