Sarah Krajewski, CNM, PMHNP-BC, PMH-c & Carla Braga, CNM
Brockton Neighborhood Health Center
Div. Reproductive Psychiatry

Healthcare can feel like a rocky boat nowadays. Facilities have a new focus on trying to address patient’s healthcare barriers. Screening for social determinants of health (SDOH) may seem like a foreboding undertaking but it has never been more important. In the context of pregnancy and family dynamics, these factors are even more critical, as they directly affect maternal health, prenatal care, and the overall health of families.

One of the most pressing and complex issues in recent years has been the role of immigration policies in influencing health outcomes, especially for pregnant women and families. The separation of foreign-born parents from their American-born children, a byproduct of the policies implemented under the Trump administration, has had far-reaching consequences on both the immediate and long-term health of these families. The Trump administration's "zero tolerance" policy, which was introduced in 2018, aimed to criminally prosecute individuals who crossed the U.S. border illegally. As part of this policy, parents were separated from their children, many of whom were American citizens, while their parents’ faced prosecution or detention. This policy not only had devastating psychological impacts on families but also created a cascade of health-related issues that continue to affect them today.

One of the most significant consequences of family separation is the psychological toll it takes on both parents and children. For pregnant women, the trauma of separation and the uncertainty of their family’s future can have severe consequences for their mental and physical health. Pregnancy itself is a vulnerable time for a woman, and the added stress of family separation exacerbates existing risks. Stress during pregnancy is associated with premature birth, low birth weight, and developmental delays for the child. For parents, especially mothers, the mental strain of being separated from their children can lead to depression, anxiety, and post-traumatic stress disorder (PTSD).

A study published in the American Journal of Public Health found that children who experienced family separation were at higher risk of developing mental health disorders, including depression, anxiety, and attachment issues. These mental health issues can expand well into adulthood, affecting the ability of children to function in society and form healthy relationships. Under the Trump administration, the implementation of policies such as the “public charge” rule, which penalized immigrants who used public assistance programs, discouraged many from seeking necessary healthcare services for fear of jeopardizing their immigration status. This is particularly problematic for immigrant women, who may face difficulties accessing prenatal care and other maternal health services essential for a healthy pregnancy. These authors can report that our federally qualified health center (FQHC) has seen a dramatic reduction in patient visits. When we survey our community, we hear back again and again it is the fear of encountering U.S. Immigration and Customs Enforcement’s (ICE) at our facility that keeps them away. The lack of access to care not only affects pregnant women but also has significant consequences for their children, who may not receive appropriate medical care after birth, especially if they are born into families with limited resources or in unstable conditions.

Under U.S. law, children born on U.S. soil are automatically granted citizenship. However, many of these children, especially those with foreign-born parents, were subjected to the trauma of being separated from their parents during the Trump administration's crackdown on immigration. American-born children who experience family separation face unique challenges. Research shows that prolonged separation can lead to developmental delays, behavioral issues, and emotional trauma. Children may experience feelings of abandonment, confusion, anger, and fear. These children may also struggle with attachment issues and have difficulties reintegrating with their parents once they are reunited. In some cases, these children may be placed in foster care, further disrupting their sense of stability and security, along with adding more burden to our overly stressed foster system. One of these authors has first-hand experience as an immigrant child who was separated from her mother at just 11 years of age, and can attest to how traumatic these experiences can be. She stated, “The experience forever changed me, both psychologically and emotionally.” Experiencing familial separation and deportation as a child creates a psyche of distrust and anxiety. Although, her family was able to return to states and have what many other immigrant families would consider a “happy ending,” they will never forget those experiences that have now shaped our relationships and lives. She stated “This country has granted us immense opportunities, but with much sacrifice. It is extremely challenging to be able to pinpoint all the feelings felt during that time and its effects. But reality is that many children are living similar experiences and despite each one being unique, we are all left with continued unparalleled challenges.”

As families continue to rebuild after the trauma of separation, they may face ongoing economic difficulties, barriers to healthcare, and other challenges related to their immigration status. The ripple effects of these policies are likely to be felt for generations to come, as children of immigrant families may struggle to overcome the emotional and social consequences of their early experiences.

To address the health disparities that have been exacerbated by immigration policies, it is essential that policymakers and healthcare providers work to dismantle the barriers faced by immigrant families. This includes expanding access to healthcare, ensuring economic stability, and providing trauma-informed care to those who have experienced family separation. Immigrant Legal Resource Centerhas created an online resource for immigrants and refugees that includes a comprehensive Family Preparedness Plan. This document can aid families navigating the complex immigration system and assess their specific needs. Legal reforms that protect immigrant families from unnecessary separation and promote family unity must be prioritized to ensure that the health and well-being of future generations are safeguarded.

The separation of immigrant families under the Trump administration’s immigration policies has had a profound impact on the health and well-being of parents and children alike. The trauma caused by family separation has led to lasting mental, physical, and emotional consequences that continue to affect immigrant communities today. By addressing the social determinants of health and implementing policies that prioritize family unity, it is possible to mitigate the negative effects of these policies and promote the health and well-being of immigrant families in the United States. It is critical that the voices of affected families are heard and that the necessary resources are provided to help them heal and thrive.

References

1.            American Academy of Pediatrics. (2018). "Detention of Immigrant Children and Family Separation." Pediatrics, 142(6), e20182804.

2.            American Journal of Public Health. (2020). "The Impact of Family Separation on Immigrant Health: A Public Health Crisis." American Journal of Public Health, 110(2), 157-159.

3.            Amnesty International. (2019). "USA: 'You Will Be Punished': The Impact of the U.S. Family Separation Policy."

4.            National Immigration Law Center (NILC). (2020). "The Public Charge Rule and Immigrant Families' Health."

5.            Sastry, N., & Gregory, J. (2020). "The Long-Term Effects of Family Separation on Child Health." Journal of Child Psychology and Psychiatry, 61(7), 839-850.

6.            U.S. Department of Health and Human Services (HHS). (2020). "Trauma-Informed Care and Mental Health Services for Immigrant Families."

7.            U.S. Government Accountability Office (GAO). (2019). "Family Separation and Its Effect on Children: A Federal Health and Legal Analysis."

8.            Rosenblum, M. R., & Siskin, A. (2020). "Immigration and Public Health in the U.S." Migration Policy Institute.

9.            Rosenberg, K. D., & Hamilton, A. (2018). "Maternal Health and Family Separation: What We Know About the Impact on Immigrant Pregnant Women." Journal of Immigrant and Minority Health, 20(2), 293-305.

10.          UNICEF. (2019). "Children in Immigration Detention: The Impact of Family Separation on U.S.-Born Children."

11.          Boston Medical Center – Resources for Immigrants and Refugees: https://www.bmc.org/immigrant-refugee-health-center/resources-for-immigrants-and-refugees. Immigrant Legal Resource Center | ILRC