For Undocumented Women Seeking Reproductive Healthcare, Policing and Politics Create a Maze of Barriers
In September 2015, an undocumented woman arrived at a healthcare clinic outside of Houston, Texas for a routine follow-up exam. Blanca Borrego handed a false driver’s license to the receptionist at the Memorial Hermann women’s clinic upon check-in and waited to be called into the examination room with her two daughters at her side. They sat in that waiting room for two hours. Finally, when her name was called, her daughters stayed behind as she was led to an exam room where a Harris County Sheriff’s deputy was waiting for her. He handcuffed her and brought her through the clinic’s office, where her daughters waited and her eight-year-old burst into tears when she saw her mother under arrest. Her 22-year-old daughter, who has an open application for legal status through Obama’s Deferred Action for Childhood Arrivals, told The Houston Press that the sheriff’s deputy turned to her and said they were arresting her mom for false papers: “She’s going to get deported.”
Borrego has been released from Sheriff’s custody, and it’s likely that the arrest violates federal patient-doctor privacy laws, but charges are still pending and she risks being turned over to Immigration and Customs Enforcement (ICE). As Borrego’s case works through the courts, reproductive health experts in Texas are concerned that her highly publicized arrest will prevent many undocumented immigrants from seeking medical attention, with fears that they will also be delivered into ICE custody by their medical providers.
National discussion about access to reproductive healthcare remains a hot topic, like the most-recent campaign to defund Planned Parenthood based on a falsified video that is supposed to show that the organization is “selling baby parts.” Planned Parenthood president Cecile Richards was called to testify before Congress, where she had to defend the organization’s use of funds. During these discussions, the high stakes and numerous hurdles that undocumented immigrants face to get basic care often remain out of the spotlight. In addition to the barriers imposed by anti-abortion legislation, there are literal borders set in place that prevent many immigrants from accessing federally funded clinics.
While Borrego’s arrest occurred in a Texas suburb, racial profiling and border checkpoints directly thwart many people along the U.S. and Mexico border in the Rio Grande Valley from seeking healthcare. A Nuestro Texas report shows that Texas Latinas ages 21-64 are less likely than Latinas nationally and less likely than white or Black women in Texas to have received a Pap test within the last three years. Additionally, women living in colonias (U.S. communities along the Mexican border) are 31 percent more likely to die of cervical cancer compared to women living in non-border counties. The report also shows that Latinas in Texas have a higher rate of general health problems that includes diabetes, cardiovascular disease, and obesity. According to a national report by the Centers for Disease Control and Prevention, Black women have the highest cervical cancer incidence and mortality rates, with Latinas experiencing the second highest among all racial and ethnic groups. This all adds up to a grim picture: Because of the barriers to healthcare, many Latinas die from untreated and undiagnosed cancers at late stages of development. Racism, policing of immigrants, and the recent restrictions on affordable healthcare lead to tragic, preventable deaths.
In colonias, many people are uninsured and/or undocumented. Many migrant communities rely on Title X providers—federally funded clinics that provide services to anyone whose income is150 percent below the federal poverty level, regardless of documentation status. But border cities often exist in remote areas, far from abortion and family planning clinics. It can be dangerous to cross through U.S. border patrol interior checkpoints in outside counties if you do not “pass” as a white Anglo U.S. citizen. The ACLU of Arizona recently released a report that documents abuses committed by Border Patrol agents in these areas, which includes threats with assaults and unlawful search and seizure of property. Fears of traveling between counties and across state lines to access medical care are spurred by these reports of deaths, arrests, and deportations.
“Many women live on the outskirts of communities where there is not even a bus service,” explains Ana Rodriguez DeFrates of the National Latina Institute for Reproductive Health. “You have to walk at least 45 minutes to get to the bus. And that 45-minute walk exposes you to border patrol agents and an increase in Department of Public Safety Texas agents.” Fears of deportation, harassment and abuse from border patrol agents keep many immigrants in their homes. “What you have is a recipe for people too fearful of immigrant consequences to travel the great distances that are required for getting the care you need,” explains DeFrates.
Meanwhile, over the past two years, many abortion clinics in Texas have been forced to close due to increased budget cuts to women’s health and the enactment of the HB-2 bill that sets strict restrictions on reproductive health clinics that provide abortion care. This past June, Texas Governor Greg Abbott signed off on a proposal that would take away funding for breast and cervical cancer screenings from Planned Parenthood and other abortion care providers. The state of 27 million people now has just eighteen clinics that provide abortions, compared to 41 clinics in 2012. This means people seeking reproductive healthcare have to drive very long distances or cross state lines just to get to a clinic. For those who can secure transportation, treks like these expose people of color to checkpoints and border security when seeking abortion care.
Cuts to family planning funding services have coincided with increased border policing efforts. Recently, the Texas Senate voted in a new law requiring all people seeking an abortion to present legal ID. At the same time, they approved an $800 million investment in border security efforts. “As a result of that investment in immigration-related enforcement, there is a much higher presence of Texas officials patrolling areas,” says DeFrates, “And the way that it’s perceived by people who live there, whether or not it is intended this way, is that their border is being militarized.” Unchecked harassment from border patrol agents, the Republican-led closing of reproductive healthcare clinics, and stigmatizing anti-immigrant, anti-reproductive rights political rhetoric all work hand-in-hand to make basic healthcare access extremely difficult for undocumented immigrants.
During her Congressional questioning, Richards told the House Oversight Committee about the impact that defunding family planning clinics would have on poor communities: “For many American women, Planned Parenthood is the only health care provider they will see this year.” Without Planned Parenthood, they will simply go without care. Other community health centers can be impacted by the potential defunding of Planned Parenthood—many of them do not have the capacity to work with the influx of patients who would transfer from Planned Parenthood health centers. Many of these smaller clinics are not equipped with the cultural competency that undocumented immigrants rely on, such as multilingual staff and medical translation. According to Vanessa Gonzalez-Plumhoff, director of Latino Leadership & Engagement at Planned Parenthood, at least 60 percent of the 2.7 million patients who are treated at Planned Parenthood nationwide rely on federal dollars that subsidize preventative exams. “For low-income undocumented women, who already have limited options in getting the care they need, this is particularly important,” says Gonzalez-Plumhoff. “Federal law currently prevents undocumented immigrants, as well as many lawfully present immigrants, from enrolling in Medicaid and purchasing affordable healthcare coverage in the aarketplaces—even at full cost.”
While the legislature rolls back healthcare access, many public health advocates are trying to make up the difference. Across the U.S., promotores de salud, community members who provide health education in Latina communities, work to combat the misconceptions about healthcare access. Many of them are from the communities in which they serve, and provide sex education and resources on reproductive health. Planned Parenthood’s Promotoras Comunitarias program is modeled after Mexican and Central American programs that use peer-to-peer education. These educational resources help people feel comfortable talking about the taboos that surround reproductive health. In Los Angeles, one notable program is “Hablando Claro,” which is designed to improve communication between parents and preteens, specifically on human sexuality. However, given the high necessity in immigrant communities, and encroaching state laws, the work can be exhausting. “[In Texas] they’re basically scrambling every day to fill the gaps that were created by the Texas legislature’s attack on reproductive healthcare,” says DeFrates.
Since community organizers work directly with people, they see both the way individual laws impact people’s lives and the bigger picture of how many factors work together to limit access to basic healthcare. For example, in California, where the Senate passed a bill that would allow undocumented immigrants to buy health insurance, many are reluctant to believe that legislation is the sole remedy for accessible reproductive health. Although they have expanded healthcare to many undocumented people, for many, it fails to address other institutional barriers such as profiling, law enforcement brutality, ICE detention, and possible deportation. It also glosses over the deep-rooted reasons why many immigrants arrive here in the first place: to flee from political turmoil in Mexico and Central America.“At the end of the day, I think the system always works in that way,” say La Loba Loca, a birth worker in East Los Angeles. “What are we really doing to improve immigrants’ rights in the United States? Even when we talk about healthcare access, are we talking about the emotional disturbance and physical pain, and everything going on when people are scared of their families being deported, or themselves being deported?” Community educators begin conversations regarding police brutality, environmental racism, state violence, and interlink them with reproductive justice. “This work is important because we are challenging capitalist-patriarchal views and redefining what reproduction means,” says Roxanna Curiel Chávez, a member of Autonomous Communities for Reproductive and Abortion Support (ACRAS), a collective in Los Angeles that also provides knowledge shares and networks of support. “Historically, women have been marginalized, exploited, and deemed inferior which is strongly connected to our current political and economic climate.” Although neither ACRAS nor La Loba Loca receive federal funding, their alternative knowledge shares provide bridges for immigrant communities and reproductive health services where they are otherwise susceptible to threats and misinformation.
Pro-life and pro-nativist rhetoric express the sentiment that it’s important to protect life—so long as it is white and U.S.-born. These political methods target the “other,” and reinforce white fears of a non-white nation. But what’s ironic is that by undercutting access to healthcare for immigrant communities, right-wing Texans are making the state worse for everyone—the public costs of caring for an unintended pregnancy are much higher than providing birth control or abortion and the rising costs of beefed up border policing eat into state budgets. “Members of the immigrant community are our neighbors and our friends. Their children sit next to our own, and our health as a society is linked,” says Gonzalez-Plumhoff of Planned Parenthood.
Everyday, poor communities of color rely on federally funded family planning clinics for services that would otherwise be obsolete. “Defunding Planned Parenthood—and thus reducing the availability of quality, trusted health care providers—would strike yet another blow to undocumented women’s already limited access to reproductive health care,” explains Gonzalez-Plumhoff. Access—or the lack thereof—to reproductive justice is inextricably linked to a history of policing Black and Brown bodies. In our fight for reproductive justice, it is imperative to center the conversation on these marginalized experiences to work towards a humane quality of life for everyone.
Catherine Lizette Gonzalez is a writer from Miami living in Portland.