Juan M. Pedroza
Immigrant families, immigration policy, and infant health
Updated: Aug 31, 2022
On Sunday (11/22/2020), the New York Times (11/22/2020) published "Undocumented and Pregnant: Why Women Are Afraid to Get Prenatal Care."
Caitlin Dickerson reports first-hand accounts of barriers to prenatal care among immigrant women in Texas. Citing academic research -- including a paper "Policies of Exclusion" by Krista Perreira and me -- Dickerson notes:
"The disparities [in access to prenatal care] were linked to the stress of living on the margins of society, as well as the fact that undocumented immigrants are eligible for fewer public benefits than American citizens, and are often wary of using government help out of concern that they could face repercussions."
Because we undermine our own future when we fail to invest in prenatal care, I want to highlight studies on infant health among immigrant families.
Seven published studies have examined whether changes in state laws or immigrant apprehensions are related to infant health (and if so, who appears to have been affected). Work to date has examined:
Postville, Iowa and the rest of the state following a 2008 worksite raid;
California between 2008 and 2015 as immigrant apprehensions set new records;
An Immigration Climate Index (ICI) across 47 states between 2005 and 2016;
States with an E-Verify mandate across US states between 2007 and 2014;
287(g) programs in North Carolina between 2004 and 2006;
Arizona in 2010 following the passage of SB 1070; and
Nationwide study examining birth weight and immigration enforcement (2003-2016).
Each found immigration restrictions (whether a raid, laws, or apprehensions) predicted worse infant health, either on: (a) Latina immigrant mothers; (b) all Latina mothers; (c) US-born Latinas (but not as much for immigrants); (d) all immigrant mothers, especially those with lower levels of educational attainment, but not US-born Latina mothers or (e) likely affected mothers such as immigrants or unauthorized as well as non-Hispanic, US-born mothers. In alphabetical order, they found:
Low birth weight was more common after the Bush-era May 2008 Postville, IA raid among both US-born and immigrant Hispanic/Latina mothers, and the relationship was "stronger among term than preterm births." Novak, Nicole L., Arline T. Geronimus, and Aresha M. Martinez-Cardoso. "Change in birth outcomes among infants born to Latina mothers after a major immigration raid." International Journal of Epidemiology 46, no. 3 (2017): 839-849. Also available as a PubMed publication.
Hispanic/Latina mothers living in locations with most immigrant apprehensions under the Obama Administration (2008-2015) had higher odds of preterm births (though not low birth weight), and the relationship was more pronounced among US-born Latina mothers. Ro, Annie, Tim A. Bruckner, and Lauren Duquette-Rury. "Immigrant apprehensions and birth outcomes: Evidence from California birth records 2008–2015." Social Science & Medicine 249 (2020) 112849.
Higher odds of very preterm births among Hispanic/Latina women (both foreign-born & US-born) in restrictive states as measured by an Immigration Climate Index (ICI) between 2005 and 2016. Stanhope, Kaitlyn K., Carol R. Hogue, Shakira F. Suglia, Juan S. Leon, and Michael R. Kramer. "Restrictive sub-federal immigration policy climates and very preterm birth risk among US-born and foreign-born Hispanic mothers in the United States, 2005–2016." Health & Place 60 (2019): 102209.
E-Verify mandates passed at the state level predicted worse infant health (between 2007 and 2014) for all moms: immigrant, US-born, and non-Hispanic/Latinas alike. Strully, Kate W., Robert Bozick, Ying Huang, and Lane F. Burgette. "Employer Verification Mandates and Infant Health." Population Research and Policy Review (2019): 1-42.
Decreased infant birth weight (among newborns with immigrant parents) in North Carolina when comparing counties with and without the voluntary 287(g) deportations program: Tome, Romina, Marcos A. Rangel, Christina M. Gibson-Davis, and Laura Bellows. "Heightened immigration enforcement impacts US citizens’ birth outcomes: Evidence from early ICE interventions in North Carolina." PLOS ONE 16, no. 2 (2021): e0245020.
Lower birth weight among Latina immigrant women after the passage of Arizona SB1070, but not mothers born in the U.S. (either White, Black, or Latina) and only during the time period after the law was signed (and not during its stunted implementation). Torche, Florencia and Catherine Sirois. “Restrictive Immigration Law and Birth Outcomes of Immigrant Women.” American Journal of Epidemiology (2018). Also available as a SocArxiv working paper.
Lower birthweight (especially during the third trimester) among first-born births of likely unauthorized mothers (from Mexico and Central America) in locations with intensified immigration enforcement across the country -- and effects are not significant for US-born, college-educated, white non-Hispanic mothers and non-Hispanic fathers: Amuedo-Dorantes, Catalina, Brandyn Churchill, and Yang Song. "Immigration Enforcement and Infant Health." (2021). American Journal of Health Economics
New work published recently:
Sudhinaraset, May, Rebecca Woofter, Maria-Elena De Trinidad Young, Amanda Landrian, Dovile Vilda, and Steven P. Wallace. "Analysis of State-Level Immigrant Policies and Preterm Births by Race/Ethnicity Among Women Born in the US and Women Born Outside the US." JAMA network open 4, no. 4 (2021): e214482-e214482.
Using 2012 from North Carolina, an earlier study (published in 2014 and cited below) focused on the implementation of 287(g) programs found that Hispanic mothers delayed prenatal care and had "inadequate" prenatal care when compared to non-Hispanic mothers. However, overall prenatal utilization rates before/after 287(g) implementation were similar:
Rhodes, Scott D., Lilli Mann, Florence M. Simán, Eunyoung Song, Jorge Alonzo, Mario Downs, Emma Lawlor et. al. "The impact of local immigration enforcement policies on the health of immigrant Hispanics/Latinos in the United States." American Journal of Public Health 105, no. 2 (2015): 329-337.
Several new papers update our evidence through the Trump era by focusing on infant health before and after the 2016 Presidential election (or otherwise comparing time periods that stretch into the Trump era). In alphabetical order:
Chu, Derrick M., Joshua Aagaard, Ryan Levitt, Megan Whitham, Joan Mastrobattista, Martha Rac, Catherine Eppes, Manisha Gandhi, Michael A. Belfort, and Kjersti M. Aagaard. "Cohort analysis of immigrant rhetoric on timely and regular access of prenatal care." Obstetrics and Gynecology 133, no. 1 (2019): 117.
Gemmill, Alison, Ralph Catalano, Joan A. Casey, Deborah Karasek, Héctor E. Alcalá, Holly Elser, and Jacqueline M. Torres. "Association of preterm births among US latina women with the 2016 presidential election." JAMA Network open 2, no. 7 (2019): e197084-e197084.
Gemmill, Alison, Ralph Catalano, Héctor Alcalá, Deborah Karasek, Joan A. Casey, and Tim A. Bruckner. "The 2016 presidential election and periviable births among Latina women." Early Human Development 151 (2020): 105203.
Krieger, Nancy, Mary Huynh, Wenhui Li, Pamela D. Waterman, and Gretchen Van Wye. "Severe sociopolitical stressors and preterm births in New York City: 1 September 2015 to 31 August 2017." Journal of Epidemiology & Community Health 72, no. 12 (2018): 1147-1152.
Riley, Alicia R., Daniel Collin, Jacob M. Grumbach, Jacqueline M. Torres, and Rita Hamad. "Association of US state policy orientation with adverse birth outcomes: a longitudinal analysis." Journal of Epidemiology & Community Health (2021).
Samari, Goleen, Ralph Catalano, Héctor E. Alcalá, and Alison Gemmill. "The Muslim Ban and Preterm Birth: Analysis of US Vital Statistics Data from 2009 to 2018." Social Science & Medicine (2020): 113544.
We have limited evidence on what mitigates harm, although a paper forthcoming in Demography will help answer this issue by examining the effects of DACA, and an Oregon study finds expansion of prenatal care helped immigrant women:
Erin R. Hamilton, Paola Langer, and Caitlin C. Patler. "DACA's association with birth outcomes among Mexican-origin mothers in the United States." Demography.
Swartz, Jonas J., Jens Hainmueller, Duncan Lawrence, and Maria I. Rodriguez. "Oregon’s expansion of prenatal care improved utilization among immigrant women." Maternal and Child Health Journal 23, no. 2 (2019): 173-182.
Also, stay tuned for emerging work on infant health and immigration enforcement. In alphabetical order:
Vu, Hoa. "I Wish I Were Born in Another Time: Unintended Consequences of Immigration Enforcement on Birth Outcomes." See a project description presented at the APPAM 2020 Fall Research Conference.
Ybarra, Marci, Angela García, and Youngjin Stephanie Hong. "Deportation Threat and Infant Birth Weight: Evidence from California." See a project description presented at the APPAM 2020 Fall Research Conference.
For context, the following paper examines three infant health outcomes among babies born to Hispanic/Latina mothers midway through the Obama era:
DeSisto, Carla L., and Jill A. McDonald. "Variation in birth outcomes by mother’s country of birth among Hispanic women in the United States, 2013." Public Health Reports 133, no. 3 (2018): 318-328. Also available as a PubMed publication.
The following papers analyze Utah (birth data between 2000 and 2007), Colorado (birth data in 1998-1999), and two California counties:
Utah: Korinek, Kim, and Ken R. Smith. "Prenatal care among immigrant and racial-ethnic minority women in a new immigrant destination: Exploring the impact of immigrant legal status." Social Science & Medicine 72, no. 10 (2011): 1695-1703. Also available as a PubMed publication.
Colorado: Reed, Mary M., John M. Westfall, Caroline Bublitz, Catherine Battaglia, and Alexandra Fickenscher. "Birth outcomes in Colorado's undocumented immigrant population." BMC Public Health 5, no. 1 (2005): 100. Also available as a PubMed publication.
California: Guendelman, Sylvia, and Paul B. English. "Effect of United States residence on birth outcomes among Mexican immigrants: an exploratory study." American Journal of Epidemiology 142, no. Supplement_9 (1995): S30-S38.
A nationwide study found a curvilinear relationship between birthweight and years in the US; where low birthweight initially declines but then increases after immigrants (including but not limited to Hispanic immigrants) have been in the US longer than a few years: Teitler, Julien O., Nathan Hutto, and Nancy E. Reichman. "Birthweight of children of immigrants by maternal duration of residence in the United States." Social Science & Medicine 75, no. 3 (2012): 459-468.
Another recent paper examines birth weight by race/ethnicity across counties: Douds, Kiara Wyndham, and Ethan J. Raker. "The geography of ethnoracial low birth weight inequalities in the United States." SSM-Population Health 15 (2021): 100906.