national asian pacific american women’s forum
Issue Brief
Immigration Reform and the Impact on Pregnant and
Birthing Asian and Pacific Islander Immigrant Women
February 2007
On the stroke of midnight on New Year’s, a policies to address the so-called immigration
Chinese immigrant woman gave birth to her “crisis.”
daughter Yuki Lin in a New York City hospital.
Yuki and her family soon learned that she was Unfortunately, anti-immigrant groups are
the winner of a random drawing among three targeting their reform efforts against immigrant
babies tied for a national Toys “R” Us women of childbearing age in particular. Such
sweepstakes. The company promised a $25,000 groups want to limit the ability of immigrant
U.S. savings bond to the “first American baby women to give birth on U.S. soil because under
born in 2007.”1 However, Toys “R” Us later current law, U.S.-born children are
disqualified Yuki Lin after the company learned automatically deemed American citizens. This
that her mother was an undocumented U.S. issue brief discusses the unique challenges and
resident. Instead, sweepstakes administrators barriers that Asian and Pacific Islander (API)
awarded the savings bond to a baby in immigrant women face when pregnant and
Gainesville, Georgia described by her mother as giving birth in the United States.
“an American all the way.”2
NAPAWF works to secure reproductive justice
The toy retailer soon found itself in the midst of for API women and girls. Reproductive justice
the country’s heated immigration debate. is achieved when all women and girls have the
Asian-American and immigrant rights groups ability to make well-informed decisions about
mounted media campaigns against the company, their bodies, health, sexualities, families, and
accusing Toys “R” Us of treating Yuki and her communities. It is connected to broader
family like second-class citizens and arguing struggles for social justice and human rights.
that the winner was Yuki, a U.S.-born citizen, Due to increasing anti-immigrant sentiments,
and not her mother. Under mounting pressure, pregnant immigrant women must overcome
Toys “R” Us quickly reversed its decision and numerous obstacles to access needed health and
awarded savings bonds to all three babies, social services. Reproductive justice advocates
including Yuki. Anti-immigrant advocates must work closely with immigrant rights
responded to the decision with articles such as advocates to preserve the reproductive health
“Toys ‘R’ Us Pays Blood Money to Chinaman,” and dignity of all women, regardless of
and some urged its members to boycott the toy citizenship status.
company.3
Demographic Profile
As the Toys “R” Us controversy demonstrates, According to the 2003 Census Population
immigration is a hot topic in today’s socio- Survey, there are approximately 33.5 million
political climate. In the last three decades, the foreign-born people living in the United States.5
majority of immigrants have been Asian or The term “foreign-born” refers to anyone who is
Latino, prompting media writers and anti- a naturalized citizen, refugee, temporary
immigrant advocates alike to speculate about the migrant, legal permanent resident, or
nation’s future demographic landscape.4 Over undocumented immigrant.6 About 53% of the
the past few years, politicians have also U.S. foreign-born population immigrated from
proposed more and more immigration reform
"Building a movement to advance social justice and human rights for APA women and girls." 1
Latin America, 25% from Asia, and 14% from Attack on Birth Citizenship Rights
Europe.7 Fortunately, the House bill was never enacted,
however its passage in one chamber of Congress
The Asian and Pacific Islander community itself reflected the growing anti-immigrant sentiment
is mostly immigrant; approximately 60% of on Capitol Hill and throughout the country.
APIs are foreign-born.8 The API population Immigrant women of childbearing age in
represents a diverse community of over 30 particular are increasingly becoming the target
ethnic subpopulations and more than 200 of unjust immigration reform policies. Under
languages and dialects.9 The API population is our current citizenship laws, persons born on
also growing at a dramatic rate. Between 1994 U.S. soil are automatically considered U.S.
and 2004, the API population doubled in size citizens. The granting of automatic citizenship
and remains one of the fastest growing racial is a 14th Amendment right that has been in place
and ethnic groups in the country.10 since it was enacted in 1868.
Foreign-born women represent 5% of the total However, anti-immigrant groups such as the
U.S. population. Immigrant women are twice as Federation of American Immigration Reform
likely as their male counterparts to be widowed, (FAIR) want to change birthright citizenship
divorced, or separated. They are also more laws because they believe immigrant women of
likely than U.S. born women to live in poverty, childbearing age are a significant source of the
be unemployed, and lack health insurance. country’s so-called “illegal immigration crisis.”
Further, the majority of foreign-born women Groups like FAIR believe immigrant women
are of childbearing age. Approximately 42% of enter the U.S. to give birth to “anchor babies,”
immigrant women are between the ages of 25-44 who, upon reaching the age of 21 can sponsor
years old, while U.S. born women comprise the immigration of other relatives. 12 Babies
about 26% of that age segment. The proportion born in the U.S. by immigrant women are seen
of childbearing-aged women increases among as the anchor for an “entire clan” of new
Asian and Pacific Islanders; about half of API immigrants, and anti-immigrant groups are
women are of reproductive age.11 urging Congress to deny birth citizenship rights
to undocumented immigrants.
Impact of Federal Immigration Reform
Unfortunately, some Congressional members
on Immigrant API Women
th have introduced such legislation over the last
With the recent start of the 110 Congress,
three sessions of Congress. In the 108th and
lawmakers and policy advocates are expected to
109th Congresses, Rep. Nathan Deal (R-GA)
continue the debate over comprehensive
introduced the Citizenship Reform Act, which
immigration reform legislation. During the last
sought to amend the Immigration and
session, President Bush signed the Secure Fence
Nationality Act to deny citizenship at birth to
Act, which authorized the construction of a 700
children born in the U.S. of parents who are not
mile long fence along the U.S.-Mexico border.
citizens or permanent resident aliens. Although
In December 2005, the House passed the Border
the legislation did not make it out of committee
Protection, Antiterrorism, and Illegal
and therefore never became law, the bill had 87
Immigration Control Act, an incredibly anti-
co-sponsors when it was introduced in the 109th
immigrant bill. The legislation would have
Congress. The bill was reintroduced in the 110th
imposed criminal sanctions on undocumented
Congress by Rep. Elton Gallegly (R-CA) and is
immigrants simply for being in the U.S. without
pending committee action.13
proper paperwork. Prosecution under the bill
would have constituted an aggravated felony,
and the person prosecuted would more than Targeting of Pregnant Immigrant API
likely face deportation charges. Women
In addition to Congressional efforts to deny
automatic birth citizenship rights to the babies of
"Building a movement to advance social justice and human rights for APA women and girls." 2
certain immigrant women, there have been Barriers to Prenatal and Maternal
reports that immigration officials are targeting Health Care
pregnant immigrant women for deportation. On The increasing fear of immigrant motherhood
February 7, 2006, Jiang Zhen Xing, a Chinese has also manifested itself in health care policy,
woman pregnant with twins, miscarried after where changes to Medicaid and State Children’s
federal immigration officers forcibly tried to Health Insurance Programs (SCHIP) have made
deport her.14 Ms. Jiang and her family had it more difficult for immigrant women and their
arrived at the immigration office near her children to access much needed reproductive
Philadelphia home for what she thought was a health and maternal health services.
routine interview. While her husband and two
sons waited for her in the lobby of the
immigration office, Immigration and Customs
Lack of Health Insurance
Foreign-born women are almost twice as likely
Enforcement (ICE) officials “pushed Ms. Jiang
as U.S. born women to lack health insurance.19
into a minivan, bruised her and bumped her
abdomen against the backseat” and drove her to An estimated 2.3 million Asian and Pacific
New York’s JFK airport for immediate Islanders do not have health insurance
coverage, and uninsurance rates vary
deportation back to China.15
significantly among different API populations. 20
For example, 34% of Korean Americans and
Ms. Jiang was seized for eight hours and was not
27% of Southeast Asians lack health insurance.21
given anything to eat, even though the officers
stopped to eat lunch themselves. According to
One of the primary reasons for the high
Ms. Jiang, ICE officials also denied her requests
uninsurance rates among immigrant API women
for medical care when she told officials that she
is due to misconceptions about the rate that
was unwell. Once they reached the airport, Ms.
immigrants utilize the U.S. health care system.
Jiang suffered from severe abdominal pain and
Many policy makers and advocates blame
begged for help in a public waiting area. She
immigrants for draining social services budgets.
was eventually taken to a hospital where doctors
Consequently, federal and state governments
found that she had miscarried her twin fetuses.
have made it increasingly difficult for
immigrants to access health care benefits.
At the time of her attempted deportation, Ms.
Under the 1996 “Welfare Reform Act,” lawfully
Jiang had lived in the U.S. since 1995. Although
present immigrants arriving in the U.S. after
she entered the country as an undocumented
August 1996 are prohibited from accessing
immigrant, she made an agreement with ICE
Medicaid or SCHIP benefits for five years.22
officials that allowed her to remain in the U.S. as
However, deeming and sponsor liability rules
long as she attended routine check-in interviews
often render many immigrants ineligible for
at an immigration office in Philadelphia.16 It
services even after 5 years.
was during one of these routine interviews that
immigration officials forcibly tried to deport her.
The complex nature of the U.S. immigration
system also contributes to the high number of
Jiang’s case raised an important question: Why
immigrant API women who lack health
would immigration officials be in such a rush
insurance. Many immigrant families live in
to send a pregnant woman back to her country
mixed-status households, where the child of an
of origin after she had been allowed to stay in
immigrant parent may be eligible for services
the United States for over 10 years?17
while the parent is not. According to the U.S.
Supporters of Ms. Jiang and other immigrant
census data, approximately 85% of immigrant
women who were similarly targeted when
families with children are mixed status
pregnant believe the harassment stems from
families.23 Thus, the confusion over eligibility
nativist fears of immigrant mothers giving birth
under the immigration and legal systems
to U.S.-citizen children.18
discourages many immigrant women from
"Building a movement to advance social justice and human rights for APA women and girls." 3
seeking preventive care for themselves and their Fear of Deportation or Loss of Lawful
children. Residency Status
All immigrants—documented and
Barriers to Medicaid undocumented—are eligible to receive free
On July 1, 2006, new documentation emergency health services, and services that
requirements imposed by the Deficit Reduction protect the public health, such as
29
Act of 2005 (DRA) took effect. Under the new immunizations. Labor and delivery services
law, American citizens applying for, or already are covered under emergency Medicaid, and
enrolled in, Medicaid, must submit proof of pregnant immigrant women in some states can
citizenship, such as a U.S. passport or birth also receive some prenatal care under SCHIP.30
certificate.24 Although the provision is aimed at
citizens, it has repercussions for immigrants Yet many immigrants are reluctant to seek
because it adds to the confusion over Medicaid medical care due to deportation fears and other
eligibility rules. potential repercussions on their citizenship
status. Studies have shown that immigrants use
The new Medicaid regulation also makes it more preventative and emergency medical services at
difficult for immigrant women to access lower rates than native-born citizens.31 This gap
Medicaid services for their newborns. Soon in utilization began soon after the passage of the
after the new documentation requirements went 1996 welfare reform act, which imposed a five
into effect, the Centers for Medicare and year ban on eligibility for Medicaid benefits.
Medicaid Services (CMS) issued interim The legislation discouraged the immigrant
regulations on the DRA. In its opinion, CMS community from participation, and escalated
stated that the U.S. citizen newborns of concerns that accessing public health insurance
immigrant women receiving emergency could harm an immigrant’s chance of getting
Medicaid coverage are subject to the lawful residence, remaining in the U.S., or
citizenship verification requirements of the becoming naturalized.32
DRA, and must submit proof of citizenship to
apply for Medicaid.25 Thus, contrary to For pregnant API immigrant women,
longstanding federal law that authorizes accessing prenatal care through the public
automatic Medicaid coverage for all U.S.-born health care system represents an additional risk
infants regardless of the mother’s status, CMS to their citizenship status. SCHIP rules allow
issued a policy change that imposes an states to report pregnant immigrant women who
unnecessary barrier to well-infant care.26 apply for prenatal care to the Department of
Homeland Security.33 Thus, pregnant API
The added requirement significantly interferes immigrant women often delay or go without
with the ability of low-income API immigrant prenatal care because they cannot afford such
mothers to access preventive check-ups and services, they don’t qualify for Medicaid, their
medical care for their babies. In New York City, state does not fund prenatal care, or they are
Medicaid covered 52% of API births in 1999.27 afraid to seek care. As a result, pregnant API
The Medicaid application process can be a immigrant women are often at risk of poor
lengthy one, and factors such as obtaining a birth health outcomes because they do not have access
certificate can prevent a newborn from receiving to timely maternal health care.
ongoing and timely care. Alarmingly, some
states have already brushed aside longstanding Language and Cultural Differences
federal law and implemented the CMS opinion. For many immigrants who are limited English
28
These states are denying automatic newborn proficient (LEP), language differences create a
eligibility and cutting off medical care until the huge barrier to accessing the health care system,
proper paperwork is filed. Such barriers and and may help explain why many immigrants
confusion over policy regulations further deter who qualify for services still choose not to seek
immigrant API women from accessing medical preventative health services. Approximately
services.
"Building a movement to advance social justice and human rights for APA women and girls." 4
30% of immigrant households are linguistically automatic birth citizenship rights to the U.S.
isolated.34 Within the Asian and Pacific born children of immigrants, but they are trying
Islander immigrant community, the number of to control the immigrant birthrate by denying
linguistically isolated households increases to women the right to reproductive autonomy.
40%. Many anti-immigrant advocates are also long-
time anti-choice advocates who are
Title VI of the Civil Rights Act of 1964 manipulating the issue of immigration reform
prohibits any organization that receives federal to advance their anti-choice agenda.
funding from discriminating against individuals
on the basis of race, color, or national origin in In November 2006, a report from the Missouri
the delivery of their services. In Lau v. Nichols, House Special Committee on Immigration
the Supreme Court held that Title VI created an Reform concluded that abortion was partly to
affirmative responsibility for recipients of blame for the “problem of illegal immigration”
federal financial assistance to provide LEP because it caused a shortage of American
persons with “meaningful opportunity” to workers. The author, Rep. Edgar Emery,
participate in public programs.35 Subsequent explained: “If you kill 44 million of your
executive orders have further developed policies potential workers, it’s not too surprising we
intended to improve language access for LEP would be desperate for workers.”38
individuals in a non-discriminatory manner,
however language barriers continue to exist in In another example, Dr. John Wilke, founder of
the health care setting. the National and International Right to Life
organizations, testified in September 2005 as a
Language differences create significant barriers medical witness for the Report of the South
to accessing reproductive and maternal health Dakota Taskforce to Study Abortion. In his
services. Studies have found that LEP testimony, he stated:
individuals receive fewer preventative services,
such as Pap smears, mammograms, and prenatal “Muslim countries forbid abortion.
care.36 Furthermore they have large
families… Germany’s birth rate is
Cultural differences also contribute to the gap in 1.2…That is the Aryan Germans.
reproductive and maternal health service. Many What is happening? They’re
immigrant API women have misconceptions importing Turkish workers who do
about Western clinical practices, or have cultural all of the more menial labor and
ideas about diet and prenatal care that differ right now there are over 1500
from Western standards of care. For example, in mosques in Germany. The Muslim
interviews with pregnant Hmong women, many people in Germany have an average
revealed that they delayed prenatal visits of four children. The Germans are
because they feared that a doctor’s or nurse’s having about one. So it’s only a
touch would result in miscarriage.37 However, question of so many years and what
many immigrant women do not know that do you think Germany is going to
delaying prenatal care increases the risk of be? It’s going to be a Muslim
delivering low-birth weigh infants, infant country.”39
mortality, maternal mortality, and other
pregnancy related complications. Dr. Wilke’s testimony was supposed to address
an anti-choice proposal in South Dakota,
Anti-Immigrant and Anti-Choice Links therefore his statement about Germany seems to
Pregnant immigrant women and immigrant have relevance only if taken as a warning to
women of childbearing age face a political South Dakotans against liberal abortion and
climate that is increasingly hostile to immigration laws. Notably, Dr. Wilke’s
immigrants. Anti-immigrant policy makers and statement also seems to conflate U.S. post-9/11
advocates are not only working to deny
"Building a movement to advance social justice and human rights for APA women and girls." 5
fears about Muslims with nativist fears about the
15
loss of an Aryan national identity. Id.
16
Jeff Gammage, Woman Fights Deportation After
Conclusion 10 Years Here, PHILADELPHIA INQUIRER (June 20,
2006).
Clearly, immigrant rights is a reproductive 17
For more information about Jiang’s case, contact
justice issue. Faced with a political system that the Justice for Jiang Zhen Xing Campaign. See also
increasingly seeks to restrict basic health and the case of Cynthia Lamah, a Cameroon woman who
social services to immigrants, pregnant miscarried while in custody of ICE officials awaiting
immigrant women and immigrant women of deportation.
18
childbearing age are at risk of poor health Gammage, supra note 15.
19
outcomes. Moreover, immigrant women are Approximately 19% of U.S. women 18 to 64 years
often subject to unwarranted regulation of their are uninsured, compared to 34% of foreign-born
reproductive autonomy, and face limited choices women. Kaiser Family Foundation, Women’s Health
when it comes to accessing health care services Insurance Coverage (February 2007).
20
Asian & Pacific Islander American Health Forum,
for themselves and their families. Without
Health Insurance Coverage of Asians and Pacific
support from policymakers and advocates, Islanders (December 2006).
immigrant women will have to make the 21
Id.
difficult decision between not having children, 22
The Welfare Reform Act is formally known as the
or giving birth in a society that places little value Personal Responsibility and Work Opportunity
on immigrant motherhood. Reconciliation Act of 1996.
23
Randy Capps, Michael Fix, et al., The Health and
Well-being of Young Children of Immigrants, Urban
End notes: Institute (2004).
24
1
Nina Bernstein, First-Baby Sweepstakes Fuels Center on Budget and Priorities, The New
Immigration Debate, THE NEW YORK TIMES (January Medicaid Citizenship Documentation Requirement
6, 2007). (revised Sept. 28, 2006).
25
2
Id. California Immigrant Policy Center, Access to
3
Available at http://www.byroncrawford.com/ Medicaid for Newborns of Immigrant Mothers
2007/01/toys_r_us_pays_.html. (November 2006).
26
4
Blaine Harden, America’s Population Set to Top See 42 U.S.C. Sec. 1396a(e)(4). Maternal and
300 Million, THE WASHINGTON POST (October 12, Child Health Access and the National Immigration
2006). Law Center, CMS Attacks Rights of U.S. Citizen
5
U.S. Census Pop. Survey (2003). Newborns (August 8, 2006).
27
6
Id. National Asian Pacific American Women’s Forum,
7
Id. Medicaid and Asian Pacific American Women
8
Courtney Chappell, Reclaiming Choice, Broadening (February 2005).
28
the Movement: Sexual and Reproductive Justice and California Immigrant Policy Center, supra note 25.
29
Asian Pacific American Women,1 (2005). California Immigrant Policy Center, Immigrants
9
Id. and the U.S. Health Care System (January 2006).
30
10
Asian American Justice Center, et. al, A Cynthia Dailard, New SCHIP Prenatal Care Rule
Community of Contrasts: Asian Americans and Advances Fetal Rights at Low-Income Women’s
Pacific Islanders in the United States, 3 (2006) . Expense, THE GUTTMACHER REPORT ON PUBLIC
11
Id. POLICY (December 2002).
31
12
Federation of American Immigration Reforom, See Sarita A. Mohanty, Unequal Access:
Anchor Babies: The Children of Illegal Aliens Immigrants and U.S. Health Care, Immigration
(updated June 2004), available at Policy Center (July 2006). See also California
http://www.fairus.org/site/PageServer?pagename=iic Immigrant Policy Center, supra note 29.
32
_immigrationissuecenters4608. Id.
33
13
See the Citizenship Reform Act of 2007 (H.R. Dailard.
34
133). “Linguistic isolation” is defined by the U.S. Census
14
Nina Bernstein, Protests Brew Over Attempt to Bureau as a household that has no member over the
Deport a Woman, NEW YORK TIMES (February 14, age of 14 who speaks only English, or speaks a non-
2006). English language and speaks English less than “very
well.”
"Building a movement to advance social justice and human rights for APA women and girls." 6
35
414 U.S. 563 (1974).
36
Courtney Chappell, 11, supra note 8.
37
Id.
38
David A. Lieb, Missouri Panel’s Report Links
Immigration to Abortion, THE WASHINGTON POST
(November 14, 2006).
39
Quote from testimony on file.
"Building a movement to advance social justice and human rights for APA women and girls." 7