Joining the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) in promoting an immigrant-friendly prenatal policy would enable the American Medical Association (AMA) to capitalize on its platform and advocate for “ethical public policy change,” according to an article published in the AMA Journal of Ethics.
Rachel Fabi, PhD, an assistant professor of public health and preventive medicine at SUNY Upstate Medical University in Syracuse, New York, laid out the issues surrounding the provision of prenatal care to undocumented immigrants and called for physicians to advocate for their access to such care.
Dr Fabi noted that 7% of American births each year are to undocumented parents. These babies receive American citizenship at birth, but current federal policy restricts access of undocumented immigrants to publicly funded health care.
ACOG recommends health care access for all pregnant women. Yet, undocumented immigrants are less likely than the general American population to receive adequate prenatal care, and these women are also more likely to experience labor complications. Furthermore, undocumented Latinas are at increased risk for delivering low birth weight babies.
Although federal programs restrict access for undocumented immigrants to all but emergency care through Medicaid and Medicare, 18 states and the District of Columbia do provide some public insurance to pregnant undocumented immigrants. Most use the “unborn child” option to define the fetus as a targeted low-income child to allow access under the federal Children’s Health Insurance Program and coverage of the prenatal period from conception to birth with the child being the beneficiary. Two states — New York and New Jersey — and the District of Columbia provide coverage through a Medicaid look-alike program to allow coverage of undocumented pregnant women during the pregnancy and for 3 months after birth.
However, Dr Fabi argued that using the unborn child option involves some ethical issues. By naming the unborn fetus as a beneficiary of public insurance and making the fetus’ rights the determining factor in a pregnant woman’s ability to access health care, the fetus is given official recognition of personhood, which may undermine the reproductive rights of women. In addition, services that are not for the benefit of the child but are exclusive to the mother might not be covered. For policy makers who wish to avoid such dilemmas, the state-funded Medicaid look-alike option is preferable.
Clinicians experience moral distress when they are unable to provide necessary care to patients. Dr Fabi maintained that policy restrictions are inherently unjust because immigration status is the only factor limiting access to medical and social services for pregnant women, which may increase clinicians’ moral distress.
Dr Fabi argued that the AMA, which in 2017 voted to adopt policies aimed at improving the health of immigrants and refugees, should join with other organizations such as ACOG and the AAP to support the adoption of state or federal policies that would improve access to health care for these vulnerable populations.
Fabi R. Why physicians should advocate for undocumented immigrants unimpeded access to prenatal care. AMA J Ethics. 2019;21(1):E93-E99.