Originally posted in The Conversation, 4/25/18.
The health of children born to unauthorized immigrants – who are U.S. citizens – is affected by local and federal immigration policies. There are as many as 4 million children who have at least one parent who is undocumented.
Along with colleagues at Stanford’s Immigration Policy Lab and Oregon Health & Science University, we measure the impact of immigration policy on the health of individuals and communities. Our research reveals the public health benefits of laws that make it easier for unauthorized immigrants to integrate into society.
An Obama-era policy that temporarily shielded some Dreamers from deportation, Deferred Action for Childhood Arrivals, offers a a dramatic example of how this has worked at the federal level.
Power of policy
We looked at Oregon’s Emergency Medicaid program, which overwhelmingly covers the medical expenses of unauthorized immigrant mothers when they give birth.
We identified mothers who were born just before and just after the cutoff to be eligible for DACA. Their children, native-born U.S. citizens, were all covered by Medicaid. This allowed us to follow their children’s health over time and compare those whose mothers were either eligible or ineligible for DACA. We studied 8,610 children.
After the DACA policy was announced in 2012, the two groups of children suddenly diverged. Children whose mothers were eligible for DACA saw an immediate improvement in their mental health; they were diagnosed with anxiety and similar stress disorders at half the rate of the other children.
These findings suggest that in the absence of protections included in DACA, children inherit the stress and anxiety of their parents’ lives without legal status. Mental illness in childhood is associated with a cascade of long-term challenges: struggles in school, limited job prospects, chronic health problems and substance abuse. Child and adolescent mental health is also a growing concern among medical professionals. Up to 1 in 5 children and adolescents experience mental disorder in a given year, according to a recent Centers for Disease Control and Prevention report. Our study’s findings identify the critical role immigration policy may play in this growing problem.
Good health begins before birth
An inclusive approach to unauthorized immigrants can also benefit their children’s health as early as birth, our research suggests. Health care during pregnancy has far-reaching implications for women and their children: It often involves diagnosing and treating chronic conditions, and it can help reduce preterm birth. However, Medicaid, the nation’s largest payer for obstetric care, excludes otherwise eligible immigrant women from coverage based on their citizenship status.
Recognizing this problem, Oregon is one of 32 states that use a provision of the federal Children’s Health Insurance Program to extend prenatal care coverage to unauthorized immigrant women. CHIP’s unborn child option allows states to receive federal funds for prenatal care to immigrant women because the care benefits a future U.S. citizen. However, maternal coverage only includes care that benefits the fetus, and coverage ends the day a woman gives birth.
Because Oregon expanded the program gradually, county by county, we were able to compare women and their babies who were covered with those who were not.
Women who got prenatal care coverage had an average of 7 more doctor visits per pregnancy. They were 61 percent more likely to be screened for gestational diabetes and were 74 percent more likely to receive a fetal ultrasound.
Access to prenatal care significantly reduced infant mortality. That means, conversely, that failure to provide prenatal care may contribute to infant deaths. And the protective effect of increased prenatal care continued through the first year of life: Infants of mothers who received coverage were more likely to receive vaccinations and screenings.
The federal government has yet to take action to address undocumented immigration. So state and local governments across the country are experimenting with policies of their own. Evidence shows that states with inclusive policies can benefit both individual health and community in profound ways.