Honors Theses and Capstones

Date of Award

Spring 2024

Project Type

Senior Honors Thesis

College or School




Program or Major

Health Sciences

Degree Name


First Advisor

Hyun Ju KIm


Over 69 million people older than the age of 5 in the U.S. speak a language other than English at home (U.S. Census, 2022). Of this population, around 38% report speaking English less than "very well" or limited English proficiency, “LEP”. Research has shown patient-provider communication quality in healthcare settings to be directly linked to the provider's ability to deliver safe and suitable care for LEP patients (Au et al., 2009). Executive Order (EO) 13166, signed into law in 2000, requires all federal agencies to implement and document language interpretation services in their establishments (Basu et al., 2017). LEP mothers face heightened risks of poor maternal and fetal health in the absence of adequate language services (Togioka et al., 2022). We performed a regression analysis using the Pregnancy Risk Assessment Monitoring System surveillance from 1996-2021to explore changes in maternal (primary cesarean section, vacuum delivery, forceps delivery, gestational diabetes) and fetal outcomes (SGA, preterm, NICU admission) following the enactment of EO 13166 with a focus on Spanish-speaking patients using Medicaid. While some trends, such as forceps delivery and NICU admission, displayed a reduction in rates after EO 13166, other patterns did not correspond with our initial hypothesis. Despite efforts to improve access and utilization of interpretation services, additional research and implementation efforts are required to further address the ongoing disparities among non-English speaking patients in obstetrical care.