Pregnant immigrants may not be showing up for care, clinicians say

“It is disturbing that we are creating impediments to them being able to deliver healthy pregnancies,” said Michael Curry, chief executive of the Massachusetts League of Community Health Centers.

It is especially troubling, he said, in communities that rely on CHCs, nonprofit health centers that have a mandate to provide care to anyone regardless of their ability to pay, and that serve a large number of people of color and immigrant communities, which already have higher rates of maternal and infant health complications.

Curry said he has also been hearing “anecdotal stories of pregnant women not coming in for their care because of fear,” although he stresses there’s no data he’s aware of to demonstrate how prevalent this might be.

Still, the stories are harrowing, said several doctors at community health centers in the region, who spoke to the Globe on the condition of anonymity for fear their organization would be targeted by the Trump administration.

One clinician, reviewing notes from her obstetrics and gynecology team, told of a woman whose husband was deported the day before she gave birth. She had no one with her during her labor, two kids at home, and no alternative source of income. There was another mother whose baby needed a fetal echocardiogram to check for a potential heart abnormality but refused to go to the hospital in Boston for fear of immigration authorities. And another woman, nine months postpartum, who was still breastfeeding when she was deported. Her baby, who is a US citizen, stayed behind.

Clinicians and health care advocates who work with immigrant communities said they’re worried about what these stories might indicate about the health of these moms and their babies, as well as health care for immigrants more broadly. The reports come as new federal policy limits access to Medicaid and Affordable Care Act Marketplace insurance programs for immigrants.

While it’s too soon to know whether there’s a sustained dip in access to maternal care, previous studies show worrying outcomes for mothers and babies — including reduced birth weight and pre-term births — when immigration enforcement is ramped up. Across the country, and more recently in Minnesota, pregnant immigrants are missing prenatal and other pregnancy-related visits, with some providers reporting an increase in pregnancy-related complications and patients saying they plan to give birth at home.

Elaine Mendes, a pastor at Revival Chelsea, which runs a food pantry and other support services to local families, said pregnant clients are telling her they are afraid to give birth at a hospital because they worry they’ll be deported and that their children will be given away.

“People generally are more likely to attend their pre- or post-natal visits than other visits, so when there is a dip in those, it signifies something louder,” said Margaret Sullivan, a nurse practitioner and director of programs on immigrant families and unhoused communities at Harvard’s FXB Center for Health and Human Rights. “From a public health standpoint, it’s enormously concerning. The degree of fear and the impact it’s having will have negative health impacts for decades to come.”

Henning Tiemeier, a Harvard professor of maternal and child health, said he would not be surprised by a reduction in access to services for moms and babies, although he is not treating patients in the community, so he cannot comment on whether there is a decrease in patient visits.

“It doesn’t take much for vulnerable populations to reduce their visits to health care centers,” he said. “We always see the pattern: If the policy is more restrictive, people withdraw.”

Some service providers said they notice dips associated with recent news of immigration enforcement. If an ICE raid has been reported nearby, there will be fewer clinic visits. In the weeks before Temporary Protected Status was set to expire for Haitians in early February, several clinics noticed a dip in their Haitian patients. (TPS expiration for Haitians was temporarily blocked by a federal judge.)

“If patients are afraid, if they’re not coming in, if they’re swept up in a health center, we know that that’s not in the best interest of that patient’s health and that’s certainly not in the best interests of that family,” said Curry, with the Massachusetts League of Community Health Care Centers. “Anytime people don’t come in for care because they’re afraid is bad public health policy.”

Tiemeier said a decrease in prenatal care may not have as much of an impact on a mother and baby’s health as lost income, lack of food, social isolation, or increased stress and fear. “What drives poor outcomes is underlying poor health,” he said. “This situation does not improve health.”

Food pantries across Massachusetts said they’re hearing reports of a drop in immigrants using their services at the same time many are afraid to use government services.

Angie Coronado, health equity director at La Colaborativa, a Chelsea nonprofit that works with immigrants, said she’s met pregnant women at the organization’s food bank who said they do not want to apply for the Supplemental Nutrition Assistance Program or Special Supplemental Nutrition Program for Women, Infants, and Children, known as WIC, because they worry doing so will signal their immigration status to federal authorities. Coronado said she also knows women who are delaying their children’s vaccines to limit their time in public, as well as a woman who only learned she was HIV positive in her second trimester, because she had avoided getting medical care.

A 2023 study by the Urban Institute found that one in six adults in immigrant families with children avoided public programs in 2022 because of fear that doing so would affect their ability to be approved for green cards or temporary visas, a reaction to the so-called public charge rule implemented in the first Trump administration, which the second Trump administration is now considering making changes to.

Mendes, of Revival Chelsea, said on a couple of occasions, ICE agents have shown up to the organization’s food pantry, scaring away clients who need food. Service providers have been trying to bring services to people too afraid to go outside, including by increasing telemedicine appointments, mobile clinics, and home deliveries of food.

“We need to find a way to live with this situation,” Mendes said. “It’s very hard. But we at least have to live.”

This story was produced by the Globe’s Money, Power, Inequality team, which covers the racial wealth gap in Greater Boston. You can sign up for the newsletter here.

Mara Kardas-Nelson can be reached at [email protected].