Detention of Pregnant Women at the US-Mexico Border

Every year, thousands of migrants are detained at the US-Mexico border, of which a small proportion are pregnant women. However, this proportion has significantly increased throughout the past decade and continues to be a significant problem today. The U.S. Immigration and Customs Enforcement (ICE) and Removal Operations reported that pregnant women accounted for roughly 0.3% of all detainees (965 detainees) in 2008, which had risen to roughly 0.4% (1377 detainees) and 0.5% (2094 detainees) in 2016 and 2018, respectively. Although these proportions may not be very large, the sheer number of mothers affected is cause for concern. Furthermore, investigations have found evidence of frequent mistreatment and abuse in ICE detention centers and U.S. Immigration Facilities, leading to miscarriages, adverse birth outcomes, and serious physical and mental impacts on the mothers (Immigration Detention: Care of Pregnant Women in DHS Facilities, 2021).

In 2018, the Trump administration gave immigration authorities full jurisdiction regarding the detainment and detention of pregnant women when they did away with presumptive release guidelines that required all pregnant detainees to be immediately released under another federal law or when deemed a national security threat. As a result, the number of detained pregnant individuals nearly doubled, decreasing available resources at facilities and posing serious health risks for expectant mothers and their babies. Although the Biden Administration has reimplemented presumptive release guidelines through executive order, it has failed to address numerous reports of inadequate and improper care at border facilities. (U.S. Immigrations and Customs Enforcement, 2017).

For example, while Customs and Border Protection (CBP) policy explicitly prohibits detention of individuals longer than 72 hours, an American Civil Liberties Union (ACLU) report found that pregnant women are regularly held beyond this limit and experience improper living conditions, verbal abuse, poor medical care, and even separation from their newborns (ACLU, 2020). Additional investigations by Human Rights Watch revealed CBP admitting to being unable to provide sleeping mats, basic hygienic products, and clean food and water. Furthermore, families are often separated when adults and children are held in different cells, which has adverse mental and physical effects on the childrens’ well-being (Rabin, 2009). In some cases, this mistreatment has become inhumane: detainees have reported being denied breast pumps and being shackled during labor despite physician orders, which patients have described as horrifying and causing feelings consistent with post-traumatic stress disorder (Preston, 2008).

The United States has long stated its commitment to uphold principles of basic human rights, yet such reports of mistreatment of pregnant migrants have persisted for decades. The Biden Administration’s Executive Order significantly reduced many detentions of pregnant women, yet the lack of consistent health standards has made additional progress difficult (Spiegel, 2019). While rewriting health standards may have some impact, the lack of accountability and oversight of US Immigration Centers and ICE-CBP officers further complicates matters.

Immigration policy has been the center of a long political debate. However, the humane treatment of detainees and asylees—especially pregnant women—should not be controversial. As the United States pursues new immigration policy, it is crucial that there is a focus on the proper treatment of pregnant women, who are experiencing one of the most vulnerable and risky periods of their lives and require sufficient medical care. Ensuring the safe and respectful treatment of pregnant women at the border is not only a moral obligation, but a necessary step towards building a just and compassionate immigration system.

Edited by: Reena Kagan

Graphic Designed by: Simone Nabors

References

1. ACLU. (2020, January 22). ACLU of San Diego and Imperial Counties. https://www.aclu-sdic.org/wp-content/uploads/2020/01/2020-01-22-OIG-Complaint-1-FINAL-1.pdf

2. Immigration Detention: Care of Pregnant Women in DHS Facilities. (2021, April 21). U.S. GAO. https://www.gao.gov/products/gao-20-330

3. Preston, J. (2008, July 19). Immigrant, Pregnant, Is Jailed Under Pact. The New York Times. https://www.nytimes.com/2008/07/20/us/20immig.html

4. Rabin, N. (2009). Unseen Prisoners: A Report on Women in Immigration Detention Facilities in Arizona. Social Science Research Network.

5. Spiegel P, Kass N, Rubenstein L. Can Physicians Work in US Immigration Detention Facilities While Upholding Their Hippocratic Oath? JAMA. 2019;322(15):1445–1446. doi:10.1001/jama.2019.12567

6. U.S. Immigrations and Customs Enforcement. (2017, December 14). ICE Directive 11032.3: Identification and Monitoring of Pregnant Detainees [Press release]. https://immpolicytracking.org/policies/ice-ends-presumption-of-release-for-pregnant-detainees/#/tab-policy-documents

Since Henrietta Lacks: What Has Changed?

Seventy-two years ago, a poor black woman walked into a hospital in Baltimore looking for treatment for her vaginal bleeding. When doctors examined her, they found a malignant tumor on her cervix. She was subjected to biopsies and treated with radiation that burned her skin off. Several decades later, the cells from her biopsy–the now infamous HeLa cells– were used for the discovery of medical advancements that made billions of dollars. The woman, Henrietta Lacks, and her legacy, were condemned to a single line in history books, forgotten by the physicians who treated her and forgotten by medicine.

How much has changed since then? Women, and specifically black women, are still undertreated and underserved. Black women have higher rates of chronic diseases like hypertension, diabetes, and breast cancer, and have higher maternal mortality rates than any other demographic in the United States. In other countries around the world, females are routinely subject to a horrifying procedure known as “female genital mutilation,” sometimes at an age as young as 10 and oftentimes without anesthesia. No matter how many strides in “equality” we claim to have made, a simple truth remains: the medical community has failed its women, particularly women of color.

What can we do? Many of the disparities in medical care center around harmful views of women–that women are promiscuous, that women overstate their pain, that women complain too much, that women should not be afforded the same rights as men, and other biases, implicit or explicit, that shape womens’ experience in health systems. Instituting more robust medical education that focus on the disparities faced by women in the health system, instituting bias training for health workers, and perhaps most importantly, confronting our own assumptions about women, no matter how insignificant they may seem.

**In this blog post, the term “women” is used to refer to all individuals who are female-identifying or female-presenting

Edited by: Eric Lee

Graphic Designed by: Ariha Mehta

Ethical Considerations of Gestational Surrogacy

In gestational surrogacy, the surrogate is an individual who did not provide the egg for contraception and who carries the fetus and gives birth to a child for another individual or couple. In the US, the frequency of gestational surrogacies has increased from 738 births in 2004 to 2807 births in 2015 by a gestational surrogate (1). Gestational surrogacy has provided individuals with infertility, single individuals, and LGBTQ individuals with an additional option for parenthood. However, the surrogacy process and current legal regulations in the US bring about several ethical considerations for the intended parents and the surrogate.

As there are no federal gestational surrogacy laws, regulations vary by state: 3 states deem compensated gestational surrogacy illegal, and 11 states permit gestational surrogacy for all parents, including married or unmarried heterosexual or same-sex couples and single parents (2). The remaining states have varying restrictions for the intended parent(s) based on marriage status, whether an egg/sperm donor is used, whether the intended parent is a single parent, and whether the intended parents are a same-sex couple. As evidenced by the inequity in access to gestational surrogacy, its availability is subject to political motivations and discrimination against the intended parents. In states where the law does not address gestational surrogacy entirely, biases among surrogacy agency providers may also act as a barrier to access.

In the US, the overall cost of gestational surrogacy through an agency can range from $80,000 to $150,000 (3). Particularly in light of the monetary transaction involved, opponents of gestational surrogacy state that surrogacy contracts bring unequal bargaining power and hinder accurate assessments of potential physical and psychological risk by the surrogate. In addition, concerns arise regarding a heightened lack of autonomy among those more impoverished. Meanwhile, proponents highlight the increased autonomy that gestational surrogacy provides women (4). Research profiling the demographics of surrogate mothers “[does] not support the stereotype of poor, single, young, ethnic minority women whose family, financial difficulties, or other circumstances pressure her into a surrogacy arrangement” (5). However, further qualitative research focusing on the surrogate population is needed to better understand the driving variables involved.

The current differences in the legal status of gestational surrogacy and parental rights within the US reveal ways in which discrimination in surrogacy access for intended parents and potential inequities and ethical concerns for surrogates require additional attention, research, and advocacy driven by ethics rather than politics.

Edited by: Caroline Palmer

Graphic Designed by: Libby Gough

References

1. https://www.nbcnews.com/news/us-news/long-wait-legalized-surrogacy-may-soon-end-new-york-n968541

2. https://www.creativefamilyconnections.com/us-surrogacy-law-map/#:~:text=As%20an%20intended%20parent%20or,surrogacy%20agreements%20and%20surrogate%20compensation.

3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6911123/

4. https://jolt.richmond.edu/2018/01/24/americas-overlooked-surrogate-mothers/

5. https://digitalcommons.wcl.american.edu/cgi/viewcontent.cgi?referer=&httpsredir=1&article=1610&context=jgspl