Whether undocumented or not, pregnant immigrants in the US are struggling to get care

Thousands of pregnant immigrants are locked out of the U.S. healthcare system, unable to afford or access prenatal or postpartum care because they’re excluded from health insurance.

The lack of medical care before and after birth endangers the lives of pregnant people and their babies. Immigrant pregnant people, regardless of citizenship status, are more likely than U.S.-born people to have inadequate or delayed prenatal care, resulting in undetected health complications and poorer birth outcomes.

Noncitizen immigrants – both those who are undocumented and those lawfully present, such as green card and visa holders – are more likely than citizens to be uninsured. Among nonelderly population, nearly half of undocumented immigrants and about a quarter of lawfully present immigrants are uninsured.

There are several reasons for this:

Immigrants are more likely to work in jobs that don’t offer private health insurance.

They’re also likely to encounter barriers to participating in low-cost public health insurance, like Medicaid or the Children’s Health Insurance Program (CHIP). Noncitizens can’t get publicly-funded health insurance like Medicaid unless they’ve been in the United States for at least five years, according to Federal law, and are lawfully present.

Language and literacy challenges can be barriers, too. And some immigrants avoid enrolling in public health insurance for fear of exposing undocumented relatives to immigration enforcement.

States can opt to cover pregnant people through their public Medicaid and CHIP programs regardless of immigration status – but most don’t.

Better access, better outcomes

When California expanded Medicaid pregnancy coverage to undocumented immigrants a few years ago, researchers found pregnant immigrants were more likely to receive prenatal care, according to a study from the National Bureau of Economic Research.

Not only that: Immigrant pregnant people were also less likely to give birth prematurely and their babies had higher birth weights – both indicators associated with better birth outcomes.

With immigrant kids, states have been more generous. About 35 states have opted to extend coverage to lawfully present children, and research shows it makes a difference: Kids who live in states that offer health insurance to children regardless of immigration status are more likely to get preventative medical and dental care, and more likely to be insured.

But when it comes to pregnant immigrants, regardless of immigration status, states are less interested in granting access to health insurance.

Eligibility requirements gets a little convoluted (check out this report from Kaiser Family Foundation for the full rundown), but about 18 states cover pregnant people by giving CHIP coverage to their unborn child, though that coverage runs out for the pregnant person after they give birth.

Seven states extend postpartum coverage regardless of immigration status, including California and Illinois, and a couple more have similar plans in the works.

One of those is Colorado. Beginning this year, Colorado residents who have low incomes and don’t qualify for health insurance because of their immigration status will be eligible for subsidies to help them buy individual coverage.

Criminalization and safety

Even when states make health insurance accessible for immigrant communities, advocates say people need to feel safe and respected when they’re seeking healthcare.

Enhanced immigration enforcement can have a chilling effect even on pregnant immigrants who are eligible for health insurance. And a growing body of research has found criminalizing immigrant policies – those that bar immigrants from social protections or criminalize their presence in the country – have negative effects on birth outcomes themselves.

State-level policies criminalizing immigrants were associated with higher rates of preterm birth – a pregnancy complication that can negatively impact a baby’s health – for Black women born outside the U.S, according to a recent study of more than 3 million births.

Conversely, inclusive immigrant policies – like extending access to public health insurance – were associated with lower preterm birth for all immigrant women.

For more information

Elephant Circle

National Immigration Law Center’s list of medical assistance programs for immigrants in various states

Maternity Care Coalition

Immigrant Parents Network Association

Puentes de Salud

Justice For Migrant Women

The Immigrant Learning Center