Each year, nearly 250,000 U.S. citizens are born to undocumented immigrant parents. Data from the Census Bureau’s American Community Survey (ACS) show that California has the largest number of births to undocumented immigrants at approximately 65,000 (in 2014) followed by Texas, Florida, Illinois, Georgia, New York, New Jersey and North Carolina. 

According to the U.S. Constitution, these children are full citizens of the United States, and yet their parents rarely receive the basic prenatal care necessary for a healthy start.  Ensuring that undocumented immigrants have access to adequate and unrestricted prenatal care is the morally responsible thing to do for our young citizens. In addition, such access could also save the U.S. billions of dollars in emergency care and later health needs. 

Prenatal care is critical for the health of both infants and parents. Research from the National Institutes of Health, together with a large body of literature and evidence, shows that early, regular prenatal care is the best way to promote a healthy birth. Lack of access to prenatal care increases the risk of premature birth and low birth weight in babies, and results in higher rates of labor and delivery complications. Good prenatal care also provides infants and parents with positive health benefits throughout life.

Undocumented immigrants living in the United States are less likely to have the prenatal care they need compared to other immigrants and U.S. citizens. They may lack financial resources, access to health care providers and have difficulty navigating the health care system. 

Research from the Kaiser Family Foundation show that in 2021, approximately 46% of undocumented immigrants had no health insurance coverage. A study published in the Maternal and Child Health Journal describes that immigrants without documentation may fear arrest by immigration authorities when seeking care. They may also receive misinformation about immigration-related consequences of using health care services. 

Although access to prenatal care differs widely according to state policies and state-level interpretations of federal policies, across the board,  The Hastings Center reports that undocumented immigrants in the U.S. are less likely to have early and adequate prenatal care and that undocumented women and other birthing individuals begin prenatal care later and have fewer prenatal visits than the general population. 

In California, specifically, emergency Medi-Cal coverage and services are available to all individuals regardless of immigration status. While undocumented pregnant immigrants are eligible for prenatal and pregnancy-related Medi-Cal coverage, not all undocumented immigrants are covered by full-scope Medi-Cal benefits. 

This lack of care has a high individual costs for our new citizens and their parents, but also a high financial cost for the U.S. A cost/benefit analysis from 2000 (one of the few studies of this kind for this population) found that every dollar cut from prenatal care increases the cost of post-natal care by $3.33 and raises other long-term costs by $4.63. The Hastings Center reports that in some states, undocumented immigrants may account for as much as 99% of Emergency Medicaid expenditures; approximately 80% of these costs are related to childbirth or to complications of pregnancy and labor. 

Medicaid data on state-level spending show that in 2016, (the most recent statistics available), emergency medical services for undocumented individuals in California cost $174 million, which represented 0.6% of California’s Medicaid expenditure for that year. Nationally that year, the federal government spent $974 million in total emergency and lifesaving services for undocumented immigrants, which is approximately 0.2% of total Medicaid expenditure. This limited coverage and access to essential health care services occurred even though undocumented immigrants paid for it: They contributed over $20 billion in federal taxes and nearly $12 billion in state and local taxes in 2018 alone. 

Existing policies are inadequate to safeguard the health of all immigrants.  For instance, the Emergency Medical Treatment and Active Labor Act (EMTALA) prevents hospitals from turning away uninsured patients in need of emergency treatment, which encompasses labor and delivery—the most common emergency health services used by undocumented immigrants. But this option is unacceptably risky.

It requires the patient’s condition to deteriorate to an emergency before care can be accessed. This ends up being far more expensive than care through regularly scheduled prenatal visits. 

Another program that allows undocumented immigrants to access prenatal care is the CHIP Unborn Child Option. Under this program, a fetus may be considered a ‘targeted low-income child’ eligible for benefits. While this program circumvents antiquated rules and regulations, to offer prenatal care for undocumented pregnant immigrants, only 16 states offered this option in 2018, according to the American Medical Association Journal of Ethics

State Funded Medicaid Lookalike Program can also be used to provide all Medicaid services to financially eligible pregnant immigrants during pregnancy and for two months post-partum, but again, only a handful of states use this policy mechanism to provide coverage to immigrants without documentation. Clearly, we have the mechanisms in place to deliver better care while saving money, if only policymakers had the will to extend them. 

To be sure, some people resent the idea that undocumented immigrants in the U.S. have children born as citizens. But as long as the U.S. Constitution protects the rights of these children, we owe it to them to give the best and healthiest start to nurture their tremendous potential. And true, access to early and adequate prenatal care requires money, but the cost of underinvestment is far too high, both in the incalculable harm done to pregnant individuals and their children, and in terms of the fiscal cost. 

What we need is a national policy that provides and protects early and adequate prenatal care for pregnant immigrants without documentation. Policymakers must find a way to work together to do the morally, ethically, and fiscally responsible thing. Until a national policy can be drafted and enacted, policymakers and stakeholders should advocate for individual states to offer prenatal care for undocumented immigrants through existing programs like the CHIP Unborn Child Option and state-funded Medicaid Lookalike Programs. While advocacy should continue in all states across the nation, advocacy efforts should be focused on states which have the highest numbers of births to undocumented immigrant parents. To support these policies and advocacy efforts, we also need better data, collected in a respectful and sensitive manner, about undocumented immigrants, who make up some 3% of the U.S. population.

Early and adequate prenatal care for undocumented women and other birthing individuals will set up young U.S. citizens with a much higher likelihood for positive health outcomes throughout their lives. Families – all families – deserve to be together, and healthy.

Dr. Theekshana Fernando is a researcher at the Center for Health Workforce Studies and is a Public Voices Fellow of AcademyHealth in partnership with TheOpEdProject.