"This is what labels you": Examining the structural context of how limited English proficiency and experiences with interpretation services interact to shape health and health access for im/migrant women in Metro Vancouver, British Columbia

Considerable research has documented negative health outcomes of 'language barriers' for im/migrants in destination countries. There is a crucial need for research underpinned by structural and intersectional frameworks that center im/migrant women's lived experiences to inform interventions that move beyond the individual-level towards systemic, equity-oriented change. This study analyzed qualitative data from focus groups (4, N=29) and individual interviews with im/migrant women (N=49) and providers (N=10) conducted from July 2018 – February 2020 in Metro Vancouver, British Columbia. Moving beyond conceptualizations of language as a 'barrier', narratives revealed how unmet communication needs for im/migrant women operated as a form of systemic discrimination. Responsibility for communication often rested on im/migrant women, relegating them to a second tier of care. Best practices for interpretation included a holistic approach that went beyond availability of language-concordant options towards im/migrant-sensitive models that accommodate converging effects of language, im/migration status, systemic racism, and gender.