Neglected Aspects of Reproductive Health and the Rights of US Immigrants

Written by Rasha Al-Lami
As a mother, physician, and immigrant to the US who has endured the painful journey of family separation, I aim to highlight the neglected aspects of reproductive health and rights for immigrants (including those entering the US legally). Having witnessed some of the struggles mentioned below, I am able to express the forgotten suffering of immigrants during their reproductive years. As a doctor, I call on wider health professionals to stand up for the reproductive rights of immigrants.

More than 13% of the US population is foreign-born with almost half being immigrant women in their reproductive age (15-44).¹ Among all children born in the US, 23% are born to immigrant mothers and 6% to undocumented immigrants.¹ Migrants face a myriad of challenges that can affect their reproductive health. To date, the existing literature has focused primarily on limited use of or access to health care among immigrants. ^2.3and neglected some of the reproductive health challenges of immigrants to be discussed here.

Migrants may lose years of their reproductive life given their migratory journey

Challenging immigration process and policy change can cost immigrants years of uncertainty or temporary living conditions before they finally settle in the U.S. Recently, the backlog of cases at U.S. Citizenship and Immigration Services (USCIS) and immigration courts approached tens of millions of cases with some cases pending for over a decade.^4.5. Advanced age is one of the main factors associated with infertility. Thus, it is possible that migrants reach their extreme reproductive age and face infertility after being affected by long-term migration uncertainty.⁶ Furthermore, studies that tend to assess the impact of settlement time on family formation or expansion among immigrants are lacking, and therefore, it is important to conduct further research to study the impact of unstable immigration policies on the fertility rate of immigrants in the US¹

The trauma of family separation affects reproductive choices and trust in the US health care system

The Trump administration recently implemented a “zero tolerance” policy that forcibly separated children from their families as a way to prosecute adults who crossed the US border illegally.^7,8 Although this policy ended in 2018, reports continue to document minor children being separated from their families at the US border.⁸ Children of US-born immigrant parents were reported to be forcibly removed from their parents in detention centers.⁹ The trauma of family separation at the US border appeared to rise to the level of torture as defined by a UN convention according to a study conducted by Physicians for Human Rights.¹⁰

Even for those arriving legally in the US, wait times for USCIS applications to be finalized for family reunification have led to widespread family separations. This trauma has been shown to have lingering effects that could last into adulthood and lead to lower academic and functional achievement among children separated from their families. ¹¹

Additionally, such trauma may cause immigrants to lose trust in government entities, which could affect their trust in health care providers. For example, immigrants may try to avoid reporting their trauma to health care providers for fear of retaliation or social stigma, or they may avoid seeking medical attention altogether.¹² Whether the trauma of family separation affects immigrants’ choice to extend their families in the US is still unclear. There is a need to compile a body of evidence on the impact of family separation due to immigration processes on immigrants’ reproductive choices and their trust in the US health care system.

Reproductive rights of immigrants are often threatened

There is a general perception that incoming immigrants can boost the fertility rate in the US, despite statistics that often prove otherwise. ¹³ US news media have discussed increasing immigration admissions in the face of low fertility rates. ^13,14 On the other hand, the autonomy of immigrants is questioned regarding their reproductive rights. This is evidenced by reports from US border detention centers where immigrants have been sterilized or had hysterectomies without their consent.¹⁵ Forced sterilization has been documented globally as part of what is known as ‘stratified reproduction’, where vulnerable women (e.g. poor, incarcerated, migrant, undocumented or indigenous) do not have full autonomy and their reproduction is seen as problematic or not worth.¹⁵ These two extreme scenarios (favoring immigrants to boost the country’s fertility rate versus limiting immigrants’ fertility options) raise questions about immigrants’ autonomy over their reproductive health.

From the perspective of reproductive endocrinology and infertility, the aforementioned aspects of the reproductive health of immigrants have been neglected, and there is a critical need to study their impact on the reproductive choices of immigrants. All of these challenges may promote a state of fear among immigrants and could hinder their use of the US health care system.¹⁶ Immigrants to the US, whether legal or undocumented, face persistent circumstances that violate the Reproductive Justice framework. Health professionals, among other community leaders, are in a unique position to take action to advocate for immigrants and negotiate with policymakers to advance immigrant rights, especially in the area of ​​controversial U.S. immigration politics and policies. Such actions have the potential to change the trajectory and secure reproductive rights in the US that can extend for generations to come.

Bibliographical references:

1. Health Care for Immigrants: ACOG Committee Statement No. 4. Obstet Gynecol. February 1, 2023; 141(2):e427-e433. doi:10.1097/aog.0000000000005061
2. Tapales A, Douglas-Hall A, Whitehead H. The sexual and reproductive health of foreign-born women in the United States. Contraception. 2018 Jul; 98(1):47-51. doi:10.1016/j.contraception.2018.02.003
3. Hasstedt K, Desai S, Ansari-Thomas Z. Immigrant Women’s Access to Sexual and Reproductive Health Coverage and Care in the United States. Issue Brief (Commonwealth Fund). November 1, 2018; 2018: 1-10.
4. Collection of pending immigration court cases as of January 2023. Accessed March 2023.
5. Bier D. Backlog processing in the US immigration system: Describing the scale of the problem. Accessed in 2023, 2023.
6. Carson SA, Kallen AN. Diagnosis and Management of Infertility: A Review. GLASS. 2021? 326 (1): 65-76. doi:10.1001/jama.2021.4788
7. US border agents are separating migrant children from their parents to avoid overcrowding, inspector finds. 2024. https://www.cbsnews.com/news/migrant-children-separated-parents-us-border-agents-overcrowding/#:~:text=Under%20the%20%22zero%20tolerance%22%20policy,uproar% 20and%20a%20court decision%20.
8. Children are still separated from their families at the border. 2024.
9. Children born in the US have also been separated from parents at the border. 2024.
10. Trump’s border separations left children and parents deeply traumatized, study finds. 2024.
11. Hampton K, Raker E, Habbach H, Camaj Deda L, Heisler M, Mishori R. The psychological effects of forced family separation on asylum-seeking children and parents at the US-Mexico border: A qualitative analysis of forensic documents. PLoS One. 2021? 16(11):e0259576. doi:10.1371/journal.pone.0259576
12. Stutz M, Rivas-Lopez V, Lonquich B, Baig AA. Health effects of a culture of fear in undocumented immigrant communities. J Gen Intern Med. Sep 2019, 34(9):1903-1905. doi:10.1007/s11606-019-05161-w
13. Camarota S, Zeigler K. Fertility among immigrants and native Americans. The gap between the foreign-born and the native-born continues to narrow. Accessed March, 2023.
14. Frey W. New Census estimates show a tepid uptick in U.S. population growth, boosted by immigration. Accessed March, 2023.
15. Sullivan MM, Matache M, Peisch S, Bhabha J. Reproductive health care in immigration detention: The imperative of informed consent. The Lancet Regional Health – America. 2022;10doi:10.1016/j.lana.2022.100211
16. ‘Holding our own microphones’: How reproductive justice advocates stepped into the limelight. 2024.