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From the President: Emerging Issues

 For Immigrants, Fear Emerges In Seeking Care

Atyya-Chaudhry-FINAL.jpgBy Atyya Chaudhry, MPP
Senior Program Manager, Health Systems Transformation
Association of Maternal & Child Health Programs

Physicians and public health professionals are increasingly concerned that federal efforts to find and detain undocumented immigrants have compelled many immigrants to forgo health care and other essential services, such as food assistance and schooling. While the evidence is anecdotal, community health centers and physicians in hospitals are noting fewer immigrant patients making medical appointments and attending follow-up care, no matter what their documentation status. In Multnomah County, Ore., for example, officials have received notifications from health care facilities, schools and courthouses that immigrants – including those with legal status – are keeping children home from school and failing to show for appointments because of rumors that U.S. Immigration and Customs Enforcement (ICE) agents are stationed near schools and hospitals.

Regardless of what one believes about federal immigration policy, the climate of fear, uncertainty and misinformation surrounding immigration is having a chilling effect that has serious consequences for the well-being of maternal and child health (MCH) populations. In an interview with Modern Healthcare, Carlos Olivares, CEO of the Yakima Valley Farm Workers Clinic, noted an increase in appointment no-shows in recent months. Olivares indicated that a top concern of the clinic is the growing number of women with high-risk pregnancies who no longer attend prenatal care visits, including many who were formerly compliant.

visa.jpgSome providers are proactively addressing patients' fear in seeking health care services. Boston Medical Center, for example, has sent letters to patients reassuring them that their medical records will not be shared with federal immigration agencies.

The health implications extend beyond health systems. In some communities, public officials report that immigrants are increasingly fearful of seeking help from food pantries, domestic violence prevention programs and other critical services. Some immigrant parents have reportedly kept their children home from school, where school nurses often serve as early detectors of children's health problems. Advocates are working with these communities to educate them on their legal rights relative to their immigration status.

The growing fear and uncertainty has caught the attention of lawmakers. Several states have introduced legislation to protect settings such as schools and health care centers from certain types of immigration enforcement efforts. Representatives in the Illinois General Assembly introduced the "Immigration Safe Zones Act" (HB0426). This bill stipulates that "schools, medical and health care facilities, and places of worship should not grant permission to state and local law enforcement agencies working with ICE to detain, or arrest individuals in violation of immigration law, unless there is legal precedence, such as a warrant." The bill also requires the "Department of Human Services to provide training or make training available to teachers, administrators, and other staff of elementary and secondary schools, as well as to medical treatment and health care facilities, on how to deal with immigration issues and how to notify families of those issues in multiple languages"

At the local level, cities such as New York and Denver are making public announcements to provide immigration guidance to schools and families.

With the heightened sensitivity around immigration procedures, it is important for state and local MCH programs to engage with legislative leaders to better understand the protocols, protective factors and policies around the issue.

While several of these stories provide anecdotal evidence, what is becoming increasingly clear is that there is apprehension among pockets of vulnerable populations throughout the country. State and local MCH programs serving these populations are noting this trend in their communities and are raising concern. In times like these, it is important to continue serving and educating women, children, and families in a culturally competent manner on the importance of seeking care and reassuring them that they are protected in seeking care and services (relative to the laws of the state). It is also important to establish partnerships with other programs to better serve those populations that may feel threatened or fearful about seeking important services.