Skip to main content

Advertisement

SpringerLink
Log in

Immigration Policy and the Health of Latina Mothers and Their Infants

  • Original Paper
  • Published:
Journal of Immigrant and Minority Health Aims and scope Submit manuscript

Abstract

Restrictive immigration policies may adversely affect the health of Latina mothers and their infants. We hypothesized that undocumented Latina mothers and their US born children would have worse birth outcomes and healthcare utilization following the November 2016 election. We used a controlled interrupted time series to estimate the impact of the 2016 presidential election on low birth weight (LBW), preterm birth, maternal depression, well child visit attendance, cancelled visits, and emergency department (ED) visits among infants born to Latina mothers on emergency Medicaid, a proxy for undocumented immigration status. There was a 5.8% (95% CI: −0.99%, 12.5%) increase in LBW and 4.6% (95% CI: −1.8%, 10.9%) increase in preterm births immediately after the 2016 election compared to controls. While these findings were not statistically significant at p < 0.05, the majority of our data suggest worsened birth outcomes among undocumented Latina mothers after the election, consistent with larger prior studies. There was no difference in well child or ED visits. While restrictive policies may have contributed to worse birth outcomes among undocumented Latina mothers, our findings suggest that Latino families still attend infants’ scheduled visits.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Sarah P JB. Dismantling and Reconstructing the U.S. Immigration System A Catalog of Changes under the Trump Presidency. Migration Policy Institute; 2020 July 2020.

  2. Eskenazi B ea. Association of Perceived Immigration Policy Vulnerability With Mental and Physical Health Among US-Born Latino Adolescents in California. JAMA Pediatr. 2019.

  3. Perreira K, Pedroza JM. Policies of exclusion: implications for the health of immigrants and their children. Annu Rev Public Health. 2019;40:147–66.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Masciale M, et al. Public Benefit Use and Social Needs in Hospitalized Children With Undocumented Parents. Pediatrics. 2021;148(1):e2020021113.

    Article  PubMed  Google Scholar 

  5. Abby Budiman CT, Lauren Mora, et al. Facts on U.S. immigrants, 2018: Pew Research Center; 2020 [Available from: https://www.pewresearch.org/hispanic/2020/08/20/facts-on-u-s-immigrants/.

  6. Clarke W et al. One Quarter of Hispanic Children in the United States Have an Unauthorized Immigrant Parent. National Research Center on Hispanic Children and Families; 2017.

  7. Gemmill A, et al. Association of preterm births among US Latina women with the 2016 presidential election. JAMA Netw Open. 2019;2(7):e197084.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Cholera R, et al. Health Care Use Among Latinx Children After 2017 Executive Actions on Immigration. Pediatrics. 2021;147(2):e20200272.

    Article  PubMed  Google Scholar 

  9. Nwadiuko J, et al. Changes in health care use among undocumented patients, 2014–2018. JAMA Netw Open. 2021;4(3):e210763.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Chu D, et al. Cohort analysis of immigrant rhetoric on timely and regular access of prenatal care. Obstet Gynecol. 2019;133(1):117–28.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Hate Crime Analysis & Forecast for 2016/2017 Center for the Study of Hate and Extremism, California State University, San Bernadino.

  12. Fortunato O, Dierenfeldt R, Basham S, McGuffee K. Examining the impact of the obama and trump candidacies on right-wing domestic terrorism in the united states: a time-series analysis. J Interpers Violence. 2022;37: 23–24.

  13. Morrison CN, Ukert B, Palumbo A, Dong B, Jacoby SF, Wiebe DJ. Assaults on days of campaign rallies during the 2016 US presidential election. Epidemiology. 2018;29(4):490–3.

    Article  PubMed  Google Scholar 

  14. Bolter JI, Emma; Pierce, Sarah. Four Years of Profound Change, Immigration Policy during the Trump Presidency. Migration Policy Institute; 2022 February 2022.

  15. President EOot. Protecting the Nation From Foreign Terrorist Entry Into the United States: Federal Register; 2017 [Executive Order 13769 ]. Available from: https://www.federalregister.gov/documents/2017/02/01/2017-02281/protecting-the-nation-from-foreign-terrorist-entry-into-the-united-states.

  16. President EOot. Border Security and Immigration Enforcement Improvements: Federal Regist er; 2017 [Executive Order 13767 ]. Available from: https://www.federalregister.gov/documents/2017/01/30/2017-02095/border-security-and-immigration-enforcement-improvements.

  17. President EOot. Enhancing Public Safety in the Interior of the United States: Federal Register; 2017 [Executive Order 13768 ]. Available from: https://www.federalregister.gov/documents/2017/01/30/2017-02102/enhancing-public-safety-in-the-interior-of-the-united-states.

  18. Gemmill A, et al. The 2016 presidential election and periviable births among Latina women. Early Hum Dev. 2020;151: 105203.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Krieger N et al. Severe sociopolitical stressors and preterm births in New York City: 1 September 2015 to 31 August 2017. Journal of Epidemiology and Community Health. 2018;72(12):1147–52.

  20. Mersky JP et al. Impacts of adverse childhood experiences on health, mental health, and substance use in early adulthood: A cohort study of an urban, minority sample in the U.S. Child Abuse & Neglect. 2013;37(11):917–25.

  21. Brumariu LEKK. Parent–child attachment and internalizing symptoms in childhood and adolescence: A review of empirical findings and future directions. Dev Psychopathol. 2010;22(1):177–203.

    Article  PubMed  Google Scholar 

  22. Calkins SD et al. A biopsychosocial perspective on parenting and developmental psychopathology. Development and Psychopathology. 2013;25(4pt2):1399–414.

  23. DuBard CA, Massing MW. Trends in emergency Medicaid expenditures for recent and undocumented immigrants. JAMA. 2007;297(10):1085–92.

    Article  CAS  PubMed  Google Scholar 

  24. Fabi RTH. Publicly funded health care for pregnant undocumented immigrants: achieving moral progress through overlapping consensus. Kennedy Inst Ethics J. 2021;31(1):77–99.

    Article  PubMed  Google Scholar 

  25. Bright Futures. Recommendations for Preventive Pediatric Health Care: American Academy of Pediatrics; 2021 [updated 2021. Available from: https://downloads.aap.org/AAP/PDF/periodicity_schedule.pdf.

  26. Cox JL. Detection of postnatal depression. Br J Psychiatry. 1987;150(6):782–6.

    Article  CAS  PubMed  Google Scholar 

  27. Levis B et al. Accuracy of the Edinburgh Postnatal Depression Scale (EPDS) for screening to detect major depression among pregnant and postpartum women: systematic review and meta-analysis of individual participant data. BMJ. 2020:m4022.

  28. Gibson J, McKenzie-McHarg K, Shakespeare J, Price J, Gray R. A systematic review of studies validating the Edinburgh Postnatal Depression Scale in antepartum and postpartum women. Acta Psychiatr Scand. 2009;119(5):350–64.

    Article  CAS  PubMed  Google Scholar 

  29. El-Hachem C, Rohayem J, Bou Khalil R, Richa S, Kesrouani A, Gemayel R, et al. Early identification of women at risk of postpartum depression using the Edinburgh Postnatal Depression Scale (EPDS) in a sample of Lebanese women. BMC Psychiatry. 2014;14(1):242.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Lopez Bernal J, Cummins S, Gasparrini A. Interrupted time series regression for the evaluation of public health interventions: a tutorial. International Journal of Epidemiology. 2016:dyw098.

  31. Lopez Bernal J, Cummins S, Gasparrini A. The use of controls in interrupted time series studies of public health interventions. Int J Epidemiol. 2018;47(6):2082–93.

    Article  PubMed  Google Scholar 

  32. Ranapurwala SI, Ringwalt CL, Pence BW, Schiro S, Fulcher N, McCort A, et al. State medical board policy and opioid prescribing: a controlled interrupted time series. Am J Prev Med. 2021;60(3):343–51.

    Article  PubMed  Google Scholar 

  33. Maierhofer CN, Ranapurwala SI, DiPrete BL, Fulcher N, Ringwalt CL, Chelminski PR, et al. Association between statewide opioid prescribing interventions and opioid prescribing patterns in North Carolina, 2006–2018. Pain Med. 2021;22(12):2931–40.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Amrhein V et al. Scientists rise up against statistical significance. Nature. 2019;567(7748):305–7.

  35. Wasserstein RLLN. The ASA statement on p-values: context, process, and purpose. Am Stat. 2016;70(2):129–33.

    Article  Google Scholar 

  36. Greenland S, Senn SJ, Rothman KJ, Carlin JB, Poole C, Goodman SN, et al. Statistical tests, P values, confidence intervals, and power: a guide to misinterpretations. Eur J Epidemiol. 2016;31(4):337–50.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Novak NL, et al. Change in birth outcomes among infants born to Latina mothers after a major immigration raid. Int J Epidemiol. 2017;46:839–49.

    PubMed  PubMed Central  Google Scholar 

  38. Potochnick S et al. Local-level immigration enforcement and food insecurity risk among hispanic immigrant families with children: national-level evidence. Journal of Immigrant and Minority Health. 2017;19(5):1042–9.

  39. Vargas ED, et al. Fear by association: perceptions of anti-immigrant policy and health outcomes. J Health Polit Policy Law. 2017;42(3):459–83.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Shapiro GD et al. Psychosocial stress in pregnancy and preterm birth: associations and mechanisms. Journal of Perinatal Medicine. 2013;41(6).

  41. Wadhwa PD, et al. The contribution of maternal stress to preterm birth: issues and considerations. Clin Perinatol. 2011;38(3):351–84.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Dole N. Maternal stress and preterm birth. Am J Epidemiol. 2003;157(1):14–24.

    Article  CAS  PubMed  Google Scholar 

  43. Page KRPS. Chilling effect? post-election health care use by undocumented and mixed-status families. N Engl J Med. 2017;376(12): e20.

    Article  PubMed  Google Scholar 

  44. Changes to “Public Charge” Inadmissibility Rule: Implications for Health and Health Coverage: Kaiser Family Foundation; 2019 [4/20/2022]. Available from: https://www.kff.org/racial-equity-and-health-policy/fact-sheet/public-charge-policies-for-immigrants-implications-for-health-coverage/.

  45. Healthcare in the Shadows: Latino Decisions; 2015 [Available from: https://latinodecisions.com/blog/healthcare-in-the-shadows/.

  46. Tucker W, Zachary C. Medicaid coverage for pregnant women. N C Med J. 2020;81(1):51–4.

    PubMed  Google Scholar 

  47. Kemmick Pintor J, Call KT. State-Level Immigrant Prenatal Health Care Policy and Inequities in Health Insurance Among Children in Mixed-Status Families. Global Pediatric Health. 2019;6:2333794X1987353.

  48. Swartz J et al. Expanding Prenatal care to unauthorized immigrant women and the effects on infant health. Obstetrics & Gynecology. 2017;130(5):938–45.

  49. Brown M. Burlington ICE raids leave lasting fear in the community2019 2/3/22. Available from: https://www.elonnewsnetwork.com/article/2019/02/ice-raids-lasting-fear-alamance-county.

Download references

Acknowledgements

Daniel Deng, MS, for his assistance early in the project with a preliminary data analysis.

Funding

Funding was provided by the Children’s Miracle Network Hospitals Program. Dr. Cholera was supported by K12HD105253 from the National Institute of Child Health and Human Development (NICHD). Dr. Swartz is supported by grant K12HD103083 from the National Institute of Child Health and Human Development (NICHD) of the U.S. National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Author information

Authors and Affiliations

  1. Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Brittany J. Raffa

  2. The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Brittany J. Raffa

  3. Division of Women’s Community and Population Health, Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA

    Jonas J. Swartz

  4. Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Shabbar I. Ranapurwala

  5. Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA

    Congwen Zhao

  6. Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA

    Rushina Cholera

  7. Duke Margolis Center for Health Policy, Duke University, Durham, NC, USA

    Rushina Cholera

  8. Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA

    Rushina Cholera

Authors
  1. Brittany J. Raffa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jonas J. Swartz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shabbar I. Ranapurwala
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Congwen Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Rushina Cholera
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Brittany J. Raffa.

Ethics declarations

Conflict of Interest

The author declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Appendices

Appendix A

Sensitivity analysis by intervention.

See Tables 4, 5.

Table 4 Quarterly outcomes pre- and post-inauguration date
Full size table
Table 5 CITS outcomes among different groups pre- and post-intervention
Full size table

Appendix B

Sensitivity analysis by WCC adherence.

See Tables 6, 7, 8.

Table 6 Study population by mean WCC adherence
Full size table
Table 7 Quarterly-level WCC outcomes among different groups pre- and post-intervention
Full size table
Table 8 CITS results for establish care at least 1 follow-up visits in 45 days
Full size table

Appendix C

Sensitivity analysis by study population.

See Table 9.

Table 9 Subgroup analysis by ethnicity and time period
Full size table

Appendix D

See Table 10.

Table 10 Dichotomized Edinburgh scores
Full size table

Appendix E

CITS figures. See Figs. 2, 3, 4, 5, 6, 7.

Fig. 2
figure 2

LBW among EMS and control non-Latino cohorts

Full size image
Fig. 3
figure 3

Preterm births among EMS and control non-Latino cohorts

Full size image
Fig. 4
figure 4

WCC adherence among EMS and control non-Latino cohorts

Full size image
Fig. 5
figure 5

LBW rate among EMS and control Latino cohorts

Full size image
Fig. 6
figure 6

Preterm birth rate among EMS and control Latino cohorts

Full size image
Fig. 7
figure 7

WCC adherence among EMS and control Latino cohorts

Full size image

Appendix F

WCC adherence definition

  1. I.

    For those infants born before November 1, 2015 and after November 1, 2016 use the following definition:

Anchor the percent of WCC adherence to the birth month and calculate the well visits out of 6 possible encounters through the end of the 13th month of lifei.e., infant born Jan 2019, then look a year from birth to see how many well visits they had and anchor the percent WCC adherence to that birth month. I.e., all kids born in Jan 2019 attended on average 95% of well visits.

  1. II.

    For those infants born between November 1, 2015 and November 1, 2016 use the following:

  2. a.

    Born September 1, 2016 to October 31, 2016 (2 to 0 months old on November 1, 2016—1 visit expected.

  3. b.

    Born July 1, 2016 to August 31, 2016 (4 to 2 months old on November 1, 2016—2 visit expected

  4. c.

    Born May 1, 2016 to June 30, 2016 (6 to 4 months old on November 1, 2016—3 visits expected

  5. d.

    Born February 1, 2016 to April 30, 2016 (9 to 6 months old on November 1, 2016—4 visits expected

  6. e.

    Born November 1, 2015 to January 31, 2016 (12 to 9 months old on November 1, 2016—5 visits expected.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Raffa, B.J., Swartz, J.J., Ranapurwala, S.I. et al. Immigration Policy and the Health of Latina Mothers and Their Infants. J Immigrant Minority Health 25, 775–789 (2023). https://doi.org/10.1007/s10903-023-01476-3

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10903-023-01476-3

Keywords

Search

Navigation