On Bad Terms: The Effect of President Trump’s First Term on Preterm Birth and Prenatal Care Utilization Among Latina Immigrants

Abstract

In 2016, President Trump was elected on a strong anti-immigrant platform that dramatically changed rhetoric and policies regarding immigrants in the United States. ICE raids, deportations, anti-immigrant sentiment, discrimination, and hate crimes surged in the wake of President Trump’s inauguration and within the first year of his Presidency, news outlets leaked a draft proposal of the administration’s new “public charge” rule. This policy would expand the government’s authority to deny green cards to immigrants who have used public benefits, such as Medicaid, or were deemed likely to rely on such benefits in the future. Given immigration’s long-standing status as a social determinant of health, this thesis seeks to determine the impact that such changes had on the reproductive health of one of the nation’s most vulnerable populations: Latina immigrants.

Specifically, this thesis proposes two potential pathways by which the Trump administration has affected immigrant Latina’s reproductive health. First, the biological mechanism hypothesizes that escalating anti-immigrant sentiment in the Trump Era has triggered deleterious physiological stress responses in Latina immigrants that lead to higher rates of preterm birth. Second, the withdrawal mechanism hypothesizes that the proposed public charge rule has encouraged withdrawal from public benefits and resulted in underutilization of prenatal care.

Using a mixed-methods approach, this thesis evaluates each of these two pathways within three states: California, New Jersey, and Texas. In the quantitative analysis, logistic difference-in-difference regressions are used to determine whether foreign-born Latinas experienced increased odds of preterm birth after President Trump’s inauguration and decreased odds of prenatal care utilization after the public charge rule leak. In the qualitative analysis, interviews with stakeholders in government, academia, health care, and advocacy provide an on-the-ground perspective of how changes under the Trump administration were experienced by immigrant Latinas and how fear manifested differently across states.

The results of the quantitative analysis indicate that foreign-born Mexican and Central American women in New Jersey and Texas were at significantly higher risk of preterm birth after President Trump’s inauguration and that Mexican, Central American, and South immigrant women in Texas were nearly half as likely to utilize prenatal care after President Trump’s public charge rule was leaked. The qualitative review builds on these findings, concluding that fear is a primary driver of the biological and withdrawal mechanisms and that state and community-level environments, as seen in California, have the potential to neutralize these pathways.

Given that the public charge rule has been upheld in the Supreme Court and the Trump administration seeks another term in office, the reproductive health of Latina immigrants is at great risk. Thus, state governments and community organizations must strengthen and expand their efforts to ease fears, rebuild trust, and reengage Latina immigrants. Once the health care system and Latina immigrants are no longer on bad terms, the U.S. can guarantee healthier lives to future generations of Americans.