Giving Birth Under Surveillance: Migrants, ICE, and Obstetric Violence

A woman with brown skin and a bare pregnant belly standing with a man who is cradling her belly. — Credit: Jeferson Santu on Unsplash

Across the United States, the visible presence of Immigration and Customs Enforcement (ICE) has begun reshaping everyday decisions about healthcare. Fear of detention or deportation is leading many immigrants to avoid medical appointments, even when those visits are essential.

This chilling effect is particularly acute among pregnant individuals, who may delay or forgo prenatal check‑ups out of concern that seeking care could expose them to immigration enforcement. The result is a growing public health crisis: expectant patients are left without consistent medical oversight, and communities face widening disparities in maternal and infant health outcomes.

Less Care Than Normal

Katherine Peeler, medical expert for Physicians for Human Rights and assistant professor of Pediatrics at Harvard Medical School, told NPQ in an interview: “As has been reported elsewhere, there has been a really big chilling effect on all types of patients, including pregnant individuals, knowing that ICE is out and about in the community.”

She explained that this apprehension keeps people from leaving their homes, driving to prenatal appointments, or seeking timely care. While some needs can be met through telehealth, much of prenatal care—examinations, ultrasounds, and lab work—requires in‑person visits. Missing them undermines care quality.

“One of the most alarming issues is the apprehension of letting strangers into the home.”

She stressed that pregnant individuals are receiving less prenatal care than they normally would, with serious consequences. Pregnancy complications demand close monitoring, delays worsen outcomes for both parent and child, and families suffer when mothers cannot care for them. As she emphasized, “Those effects are really profound.”

Amid this climate of fear of ICE arrests, in April of 2025, the American College of Obstetricians & Gynecologists (ACOG) issued new guidance calling for a transformation of prenatal care delivery in the United States. The document challenges the long‑standing model of 12 to 14 in‑person visits, and instead recommends a more flexible, patient‑centered approach.

Key elements of the new guidance include tailoring visit schedules to individual risk factors, incorporating telehealth to expand access, and screening for social determinants of health—such as housing, food security, and transportation—before 10 weeks of pregnancy.

Erin Stevens, ob-gyn hospitalist at North Memorial Health and chair of the Legislative Committee for ACOG in Minnesota, consulted by NPQ, highlighted that many pregnant immigrants are considering giving birth at home due to fear of ICE presence in hospitals and clinics. She explained that while physicians usually recommend hospital or birth center deliveries, the current climate of intimidation is pushing some patients to explore alternatives.

As she said, “There are certainly community midwives who do that type of work and who do support home[births] on a regular basis, but they can’t all of a sudden take care of everyone who is interested in that. I am sure that there are people who are deciding to give birth at home by themselves without any medical presence and that that is what is really frightening to me.”

Stevens explained that one of the most alarming issues is the apprehension of letting strangers into the home: “That fear extends even to welcoming health professionals.”

Her observations find an echo in the experiences described by Lupe M. Rodríguez, executive director of the National Latina Institute for Reproductive Justice, who underscores how fear and systemic barriers further prevent families from seeking essential care.

“We’ve seen many reports of people—even pregnant women seeking prenatal care—not pursuing that care, and parents not taking their children to medical appointments, which can lead to adverse outcomes down the line. Just recently, we heard about a woman eight months pregnant who was detained on her way to a checkup and is now in a detention center. This is a very real fear, and it’s keeping people from getting the care they need,” she said.

In her conversation with NPQ, Rodriguez noted that the lack of access to care has clear consequences, pointing to its impact on maternal mortality rates and other adverse health outcomes. She stressed that the risks affect not only pregnant immigrants but also their children, leading to needless suffering and, in some cases, even death.

Pregnant in ICE Custody

The atmosphere of intimidation does not stop at the clinics; it reaches into detention facilities, where pregnant and postpartum individuals face severe consequences under ICE custody.

Pregnant and postpartum individuals face severe consequences under ICE custody.

In September 2025, Women’s Refugee Commission (WRC) launched the Detention Pregnancy Tracker, the first nationwide tool designed to collect real‑time reports on pregnant, postpartum, and nursing women held in US immigration detention centers. The initiative was created to collect comprehensive data from advocates and legal service providers who have been independently documenting testimonies of serious harm to pregnant individuals in ICE detention.

Reports gathered by WRC highlight that many detained women face medical complications, malnutrition, inadequate access to health care, and emotional suffering due to detention conditions.

The commission stresses that ICE’s own policies state pregnant individuals should not be detained, yet enforcement practices have led to increasing numbers of pregnant people in custody. This underscores how immigration enforcement is not only discouraging women from seeking care outside detention but also creating dangerous gaps in medical oversight once they are detained.

Medical care inside detention facilities is inconsistent and inadequate. “We know that access to medical care is insufficient in a lot of these facilities. There was a story of a woman who was early pregnant and bleeding for weeks and hadn’t been able to see a doctor and be able to have any medical care in that time,” Stevens said.

The gravity of these situations is reflected in accounts from Minnesota. In January, doctors and health specialists published an open letter titled “We Do Care” in The New England Journal of Medicine. In the letter, the writers explain that they witnessed a pregnant woman being dragged through the snow in Minnesota by federal agents: illustrating why many patients choose to remain at home instead of seeking prenatal care.

They state that, as a result of this fear, some pregnant people arrive at hospitals with very little prior medical attention because they are afraid of being detained by ICE. These patients are often in poor health, with some in critical condition. The physicians also report that they keep vigil with women in labor who are terrified when their husbands suddenly stop answering the phone, fearing detention or deportation.

The Responsibility of Institutions

Physicians emphasize that this moment requires a strong stance from medical institutions, underscoring their responsibility in safeguarding immigrant patients. They argue that hospitals and health organizations must guarantee safe access to care, free from intimidation or surveillance, and that the presence of enforcement agents—even outside hospital doors—undermines trust and deters vulnerable people from seeking the medical attention they need.

“It’s not enough to say ICE agents shouldn’t be inside hospitals; they also shouldn’t be in parking lots, ambulance bays, or anywhere they can intercept patients or create a frightening presence that keeps people away,” Stevens said.

This moment requires a strong stance from medical institutions, underscoring their responsibility in safeguarding immigrant patients.

In this context, advocacy organizations highlight the need for medical institutions to provide training for their professionals and staff on how to protect patients. Reports have surfaced of ICE agents present in examination rooms alongside individuals brought from detention centers—a practice that violates federal medical privacy laws (HIPAA). Institutions must therefore ensure strong privacy protections for patients–safeguards that, at present, are not consistently enforced.

Rodriguez underscored also the need for advocacy before local governments and policymakers to ensure that protections are enforced, noting that legislators still have a role to play in defending patients and communities. She pointed to examples across the country, such as Santa Clara County, CA, where the Board of Supervisors recently passed an ordinance making it illegal for ICE to enter certain spaces.

“One of the things we are thinking about is how to organize people so they can demand that local policymakers put protections in place for their patients,” she said.

Alongside these calls for policy action, health experts stress the importance of documenting the consequences on patient care. Peeler emphasized the important role of health advocacy organizations in documenting every change in patient behavior—from canceled clinic appointments to shifts toward telehealth—in order to build a solid evidence base.

She pointed out that increases in diseases such as measles must also be recorded alongside policy decisions, like changes in vaccine recommendations, to understand their impact. For her, data collection is essential not only to track health outcomes but also to capture what happens during ICE raids, protests, and inside detention centers.

“Advocacy groups need to document, gather solid evidence, and then advocate based on that evidence,” she said, stressing: “They also need to provide resources that help ensure the rights of the people they are trying to support.”