Pregnant on the Other Side of the Border

Amid the bustle of Tijuana, the average onlooker might miss the bulge in Claudia’s belly. 

That’s partially by design: Claudia, a petite 32-year-old who has been in limbo in Tijuana for over a year while waiting her turn to seek asylum, has become adept at keeping a low profile in a city that ranks among the most dangerous in the world. 

In her mind, the fetus is already a child, even if he is months away from breathing his first breath. So she has already given him a name: Johan Santiago. 

After Claudia’s prenatal appointment in the city’s single clinic for pregnant migrants, Claudia trudges back to a tent encampment — nicknamed “El Chaparral” — that acts as the waystation for hundreds of families fleeing poverty, violence and persecution. As she reaches the high point of the overpass connecting the camp to downtown Tijuana, she can just make out the rusting steel slits of the multibillion-dollar barrier, known as Trump’s border wall, to the north.

In that camp, where people like Claudia depend on Catholic charities for their meals and hand-me-down clothing from departing families, she joins her partner Michal and her six-year-old son Joseph. She sits with them beneath the undersized blue tarp they currently call home, swaddled beneath a colorful knee-length sarape-style cardigan. And, together, they wait.

“Being hungry, thirsty, cold — these things are what you have to go through,” Claudia says, referring to her mission of moving to — and giving birth in — the United States. 

“But we can’t afford to fail,” she adds. “I can’t risk my baby.” 

Claudia is one of the thousands of pregnant women among the hundreds of thousands of migrants who reach the U.S.-Mexico border each year with hopes of crossing it. She’s also one of the millions of migrants who, during the pandemic, have been turned away from seeking asylum on the soil of the United States. 

Since March 2020, intensified border policies initiated by the Trump administration have largely been maintained by U.S. courts. Contrary to Biden’s campaign promises, little has changed since his inauguration in January 2021, and some anti-immigration programs have been expanded under his watch. And despite a June 30 ruling by the Supreme Court in favor of reversing one of these policies forcing migrants awaiting asylum hearings to stay in Mexico, the White House’s ongoing implementation of others means the court’s decision is, for the time being, little more than symbolic.

Moreover, these decisions in D.C. have left the many asylum-seekers like Claudia fenced off in Mexico’s northernmost cities beneath advertisements for popcorn chicken buckets and cheap liposuction. As tens of thousands of migrants from exempted countries, like Ukraine, pass largely unimpeded through the San Ysidro border station, migrants just miles south of California, Arizona, New Mexico, and Texas remain mired in a disconcerting — and dangerous — limbo. 

Border towns like Matamoros, Reynosa, and Ciudad Juárez — which are overrun by ubiquitous and particularly ruthless gangs — can be perilous places for anyone, let alone those who have fled their homelands carrying little more than a backpack. This is especially the case for pregnant women. There have been more than 10,000 violent attacks on migrants living at the border since the Trump anti-immigration policies were enacted, according to the nonprofit group Human Rights First. And those are just the ones that victims or witnesses report, attorneys and NGOs working in the region say. 

Pregnant women, advocates say, make for some of the easiest targets for the cartels that menace, exploit, and extort migrants at the border because they tend to be among the most desperate and most physically vulnerable. Women have been kidnapped, beaten, and shot by gangs hungry for profits, advocates say — violence that, on more than one occasion, has triggered women to go into labor.

Civil rights attorneys like Mitra Ebadolahi believe the prohibitive immigration policies have only intensified the risks pregnant women face.

“In the past three years, there’s been a real dismantling in the right to apply for asylum,” says Ebadolahi, who is a senior staff attorney with the ACLU’s Border Litigation Project. “That’s led to a tremendous amount of human suffering, where vulnerable people are trapped in dangerous border towns where they’re routinely preyed upon.”

In such circumstances, pregnant women also carry additional health risks. 

Across the world, the lack of maternal health care is a leading cause of mortality among mothers and infants, causing death rates that are routinely 10 times higher in low-resource settings than they are in the U.S. In border towns like Tijuana, pregnant migrants struggle to access routine care due to costs, lack of awareness about access and transportation, and discrimination.

Procedural strangleholds created by U.S. policies have helped lead to ballooning migrant populations in towns like Tijuana, placing additional strain on stretched health systems. Tijuana’s hospitals were among the many in cash-strapped settings around the world that stopped treating anything other than Covid-19 during the pandemic. Meanwhile, stopgap nonprofit clinics — overwhelmed and under-resourced in normal times — were stretched thinner still.

“It’s a completely untenable situation that has just exploded since so many people have no pathway in,” says Andrea Leiner, chief communications officer for Global Response Management, a humanitarian aid organization that operates medical clinics throughout Central America.

Taken together, interviews with more than three dozen migrants, clinicians, advocates, attorneys, and government officials spread across five border cities over two years convey how living indefinitely at the border has aggravated the risks faced by many like Claudia and Johan. 

“In a lot of ways, it’s worse than it’s ever been,” Leiner says.

The ‘feminization of migration’

At a Honduran police station in 2019, Claudia realized she had no choice but to leave the country of her birth. She had endured years of verbal abuse and violent fits from her husband, she says, and “just couldn’t take it anymore.” 

But quickly, Claudia intuited that the police wouldn’t help her. “They said, ‘Show us the proof,’” she recalls. “I told them, ‘What, do I need to die for you to investigate?’” 

Amid escalating threats from her partner, Claudia and her son Joseph fled north several weeks later as part of an 80-person migrant caravan — similar to the one that President Trump claimed was made up of groups of “stone-cold criminals” mounting an “invasion” on the U.S.

Claudia’s experience represents a fairly new trend in global migration patterns: something the Population Council, an international nongovernmental research organization, calls the “feminization of migration.” 

A 2021 investigative report, which was the result of a collaboration between the Mexican government and several NGOs, noted that migration through the country has historically been dominated by the movement of men traveling solo, usually in pursuit of economic opportunities. 

However, in recent years, the proportion of female migrants in Mexico from Central America has jumped 70 percent from El Salvador, and 140 percent from Guatemala. Women flee their homes for different reasons, including “intractable, unresolved and recurring conflicts and violence,” according to the United Nations Migration Agency (UNMA), in addition to longstanding poverty.

“The situation in home countries has become so untenable,” Leiner says, “women and families have no choice but to move.”

Under these circumstances, the UNMA called women (and their children) a “particularly vulnerable population,” both in terms of their susceptibility to violence and the health consequences of poverty. The extent of displacement in Central America in 2021 was “unprecedented,” the U.N.’s migration agency said.

The destabilizing pressures on many women in the region likely increased after the Trump administration cut hundreds of millions of dollars in humanitarian aid to pressure Central American governments into taking “concrete actions to reduce” the number of migrants coming to the U.S. border. 

A September 2021 report by the Government Accountability Office found that Washington’s decision nixed funding to an array of efforts to improve Guatemalan police forces, Salvadorian forensic labs, and criminal recidivism programs in Honduras, causing the U.S. Agency for International Development to miss up to 35 percent of its performance targets. 

The report’s authors highlighted the concerns of international observers that “the suspension and reprogramming of this assistance funding could be counterproductive.” 

“Cutting [the humanitarian aid] programs off just increases people’s vulnerability and can make a real difference in people’s calculations to leave,” Geoff Thale, then-vice president for programs at the Washington Office on Latin America think tank, told NPR at the time. 

For Claudia, those calculations meant fleeing her home.

‘We took a number and we waited’ 

Days after they fled with the caravan, Claudia and her son first met Michal at a migrant camp in Tapachula, a city in southern Mexico that many U.S.-bound migrants pass through. A gang in Nicaragua had just killed one of his cousins, Michal recounts, which led him to flee his country. 

After a month, Claudia, Joseph, and Michal’s caravan made it to Tijuana. But any thoughts that they were in the home stretch shifted as they realized they were simply at the beginning of a new chapter of their journey.

Washington’s modern history of using immigration policy to leave migrants languishing at the border began, in large part, under President Obama. Amid a surge of Haitian asylum seekers in 2016, the Obama administration initiated a set of “queue management” protocols that repurposed the deli line for immigration: Migrants were given a number and told to wait at the border until they were called. 

In 2019 — due to what the Trump administration called “a security and humanitarian crisis on the southern border” — the White House unfurled a policy known as the Migrant Protection Protocols (MPP) to “decrease the number of those taking advantage of the immigration system, and … [ensure] that vulnerable populations receive the protections they need.” 

Functionally, however, the MPP — nicknamed the “Remain in Mexico” policy — imposed further restrictions on people seeking asylum from Guatemala, Honduras, and El Salvador. Makeshift tent camps began forming at the border towns. Exhausted, sick, and poverty-stricken migrants patiently awaited their turn.

“[The MPP] was devastating to the rule of law and human rights,” says Ebadolahi at the ACLU. “It’s caused enormous backlogs, confusion and suffering.”

Then came Covid-19. 

In March 2020, citing the risk that migrants might carry Covid, the Department of Health and Human Services (HHS) resurrected a dusty piece of legislation. The law — often referred to as “Title 42” — was written in 1893 during a cholera pandemic with a straightforward goal: Keep migrants out.

Evidence indicates that the U.S. border authorities specifically targeted a particularly vulnerable group of women: “[The U.S. Border Patrol] reserves MPP as a reliable alternative for expelling pregnant females,” the agency wrote in a May 2020 memo obtained by Human Rights First.

In so doing, the policies may have satisfied the Trump administration’s longstanding obsession with pregnant migrants by banning what he pejoratively called “anchor babies” — infants born on U.S. soil who have an automatic legal right to citizenship. The policies may also have satisfied his 2018 pledge that birthright citizenship, as sanctified by the 14th amendment, “has to end.”

Charlene D’Cruz, border rights program director for Lawyers for Good Government, says that, collectively, MPP and Title 42 have achieved those goals. 

“The government has put a chokehold on the border,” she says. 

As of July 2022, more than two million migrants have been required by MPP and Title 42 to wait their turn south of the border.

Claudia, Michal, and Joseph were part of Tijuana’s portion of that vast group. 

“We took a number,” Claudia says, “and we waited.” 

‘Sitting ducks’

Their early months in Tijuana were largely uneventful. The budding family found a shelter to stay in, and Claudia and Michal obtained part-time work doing odd jobs — cooking one day, construction the next. 

In March 2021, after returning from work, they discovered that their possessions and identification had been stolen. Claudia suspects this was retaliation for being a week late on their rent that month. As the shelter proprietor evicted them, Michal noticed the owner’s son wearing Joseph’s sunglasses. 

They left with “nothing but the clothes on our back,” Claudia says, and an oversized black garbage bag to sleep in. They walked straight to the only semi-sheltered place they knew they could go: El Chaparral, the tent camp under the bridge.

El Chaparral, a nickname meaning inhospitable patches of desert, was not much of a refuge. Claudia’s family was exposed to the elements on all sides. They were also exposed to gangsters, profiteers, and organized crime. (About eight months after Claudia’s family stayed there, the encampment was cleared by Tijuana police.)

Too often, says Tami Goodlette, camps like El Chaparral become the destination of last resort along the border for migrants who have exhausted whatever scarce resources they started out with. Goodlette, who is the director of litigation for the Refugee and Immigrant Center for Education and Legal Services (RAICES), calls migrants in these camps “sitting ducks” for organized criminals that terrorize border towns.

“[Migrants are] vulnerable because they need so many things — housing, food, water — and in order to get those things, they need to place their trust in strangers,” Goodlette says. “Next thing you know, you’re sleeping in someone’s room; next thing you know, you’re being trafficked; next thing you know, your husband is kidnapped.”

Studies undertaken by humanitarian organizations show that torture, sex trafficking, kidnapping and homicide are rife at the border. Statistics from the Population Council showed that one in five women at the border were physically beaten and/or sexually abused, two in five were robbed, and 20 percent were kidnapped. Pregnant women were even more likely to endure such crimes. 

Attorneys and advocates say that stories of such abuses are seared into their minds: 

The mother who escaped kidnapping in the Mexican city of Nogales at the Arizona border — only to be denied entry to the U.S. while in active labor, and expelled back into Mexico. 

The mother who was expelled from the U.S. twice, separated from her family the second time around — and subsequently beaten so severely by cartel members that it caused her to go into labor. 

The woman who was ambushed by gang members and shot seven times — before watching her husband die in front of her. Soon after, she gave birth to an infant with severe birth defects.

A bullet remains in her cervix.

‘Birth is a dangerous thing’

Lack of access to health care can put the lives of pregnant migrants in peril, too.

Luzette and her husband Almick fled Haiti in spring 2020. A combination of political persecution and economic desperation forced them to leave; ravaged by corrupt politicians, powerful gangs, and recurring natural disasters, Haiti has long been the poorest nation in the Americas. 

When Luzette was pregnant with their third child, a cousin was kidnapped and killed. Soon after, the young couple fled the beleaguered Caribbean nation to avoid a similar fate.

Instead of risking a perilous journey on a 700-mile span of open ocean between Haiti and the U.S., the couple traveled by airplane to Chile, and then by land through Peru, Ecuador, Colombia, Panama, Costa Rica, Nicaragua, Honduras, and Guatemala to Tapachula in southern Mexico and, finally, all the way up to Tijuana. 

Upon arrival at the U.S. border, they discovered that — like Claudia’s family and so many others — they would have to wait. 

When the couple arrived in May 2020, Luzette was in her third trimester. And when she went to the city’s general hospital in search of medical care, she was repeatedly turned away. The hospital had shut down services for everything other than Covid-19. Meanwhile, private clinics, she discovered, were demanding enormous sums of money for even minimal prenatal screening like blood draws. 

For a couple struggling to make rent in a rundown shared apartment, that meant “there was no one to help [us],” Almick says.

Health providers and advocates at the border say Luzette’s experience is common. 

Leiner, with Global Response Management, says that’s partially because “the Mexican health care system is already incredibly stretched.” It’s especially true in the border towns, she adds. And more recently, medical care for Covid-19 patients has filled nearly all of the beds that remained, she added.

Then, there’s the racism, xenophobia, and discrimination. 

Local hospitals near the border have repeatedly turned away D’Cruz’s clients, asking them to pay astronomical sums for minimal services or requiring them to provide their own equipment — scalpels, sutures, gauze — for C-sections. 

“I would sum it up as the haves and the have-nots,” D’Cruz says. “There’s no place [migrants] can go.”

And, according to the Population Council, even the NGOs providing aid at the border frequently do not offer the specialized services that pregnant women need. 

The health dangers resulting from all-but-absent prenatal care place both mothers and their fetuses at high risk, says Hannah Janeway, a physician with and co-founder of Refugee Health Alliance, an NGO providing medical services in Tijuana. 

Expectant mothers who don’t get prenatal care — especially those with chronic and untreated diseases who are also exposed to stressful environments and even malnutrition — run the risk of developing gestational diabetes or preeclampsia. These conditions can in turn put mothers at risk of a premature and/or complicated delivery, which can be life-threatening, particularly if mothers cannot get to a hospital quickly or at all.

Infants whose mothers lack health access face other risks, Janeway says. They may be born small, or prematurely, develop congenital anomalies or cerebral palsy. Asphyxiation, widespread infections, and bleeding out can also put the infant’s life in danger. 

Both mother and child can “become very ill and have lifelong consequences” due to a lack of health access, Janeway says, adding, “Birth is a dangerous thing.” 

Nearly every clinician, attorney, and advocate interviewed shared a story showing just how bad things get. 

Janeway says that ambulances have repeatedly arrived long after some of her highest-risk mothers went into labor and then, after the hospital refused to take them, dumped them back at Refugee Health Alliance’s makeshift clinic. In other cases, the ambulances simply didn’t respond to calls to pick up women in labor. 

Nicole Ramos, an attorney at Al Otro Lado (AOL) — which provides legal services to migrants — recalls one client who needed an emergency C-section at a hospital but was turned away until she found eight blood donors to bolster the hospital’s stockpile. 

D’Cruz recalls a pregnant woman who was denied an emergency C-section because she didn’t have a negative Covid-19 PCR test, only a negative antigen test. That woman gave birth clutching a bathroom stall in the hospital’s lobby.

“You don’t force people into this situation unless you are completely OK with them dying,” Ramos says, “[and] it is not uncommon that our attorneys will receive a call telling them [that] a client died.”

For Leiner, the issue is personal: She had an emergency C-section herself after suffering from labor arrest so severe that she says she lost consciousness with every contraction. “I know just how scary it is for things to go wrong in your pregnancy,” Leiner says, “and I know I wouldn’t have survived if I was in Mexico in their situation.”

Amid such life-threatening challenges, American law, in theory, offers a source of respite for pregnant migrants under Title 42 and the MPP: humanitarian parole.

But that’s assuming pregnant migrants know they are eligible for parole and are able to find a lawyer, D’Cruz says, which is rarely the case.

“There are only a handful of us doing this work at the border,” she adds. “We can’t meet even a smidgeon of the need.”

Moreover, attorneys say, applications for humanitarian parole often face delays, or are simply ignored or denied. Collectively, these hurdles make successful parole hard to come by. Staff at AOL say that, as of early 2022, more than two-thirds of the 147 parole applications they had filed had been rejected. 

“It was almost as if, unless a pregnant woman was dying, I couldn’t get them across,” D’Cruz says.

‘It’s literally like families are walking a plank’

As of now, advocates say, there is little indication that the plight of pregnant women at the border will improve. 

In December 2021, the MPP was expanded to include migrants from every country in the Western hemisphere, providing few assurances for their safety. Describing the ostensibly more humane policy, D’Cruz says that “putting lipstick on a pig doesn’t make it prettier.” 

More recently, the Supreme Court’s June 30 decision paved a path to put MPP to bed. But it’s unclear whether the Biden administration will go that route, or whether it will leave the previous iteration intact — and if so, for how long.

At the same time, Title 42 lives on. It was scheduled to expire on May 23 after a D.C. court rejected appeals by the Biden administration, but on May 20 a judge in Louisiana blocked the administration from ending it. On July 21, the Supreme Court said it would take up an appeal of the case later this year. Amid the limbo, Title 42 continues to keep large numbers of migrants in danger. 

Meanwhile, attorneys continue to file legal complaints to protect the health of pregnant migrants and their children. 

One July 2021 complaint by the American Civil Liberties Union and Jewish Family Service of San Diego noted that the Customs and Border Patrol (CBP) continues to split up families, despite a 2018 court-ordered injunction against the practice. 

In December 2021 alone, the International Rescue Committee documented 16 cases of pregnant women separated from their families either at the border, on the way to the hospital, or when family members were flown hundreds of miles for expulsion via a different border town. 

Since March 2021, when this practice began, more than 600 such flights have been commissioned by CBP.

Goodlette, at RAICES, says this leaves already-powerless women expelled after giving birth, along with their infants, particularly susceptible to danger. They are, she says, “dumped in a place where they know nobody.”

Some pregnant migrants have been handcuffed by CBP when they were arrested, transported, or expelled. Known as “shackling,” this practice has been implemented despite “strong opposition” from the American College of Obstetrics and Gynecology. An April 2020 letter from 13 U.S. senators to the DHS inspector general requested an immediate investigation into the practice amid “potentially fatal complications.”

In other cases, according to legal complaints from Al Otro Lado and others, CBP takes action before the mothers of U.S. citizen newborns receive a birth certificate. That would almost certainly be illegal, according to Ramos at AOL. Her organization has documented more than a dozen cases in which mothers were expelled after giving birth but before receiving their infants’ American documentation. Since CBP does not have jurisdiction over U.S. citizens, Ramos says, these expulsions are beyond its mandate.

The practice “essentially leaves the children stateless in some of the most dangerous cities in the world,” she says. 

CBP has acknowledged that its handling of pregnant women puts those women in danger. In February 2020, a pregnant woman gave birth in a CBP facility where she was denied hospital care, and delivered the child into her jeans while holding a trash can for support. 

The following year, CBP Acting Commissioner Troy Miller wrote in an internal memo that the agency’s treatment of pregnant women “raises significant humanitarian and public health interests.”

Given these admissions, advocates at the ACLU and Jewish Family Service, among others, have requested that border authorities stop detaining pregnant migrants altogether. That request aligns with a July 2021 decision by Immigration and Customs Enforcement (ICE) to stop arresting and detaining pregnant migrants — meaning that any pregnant migrants held by CBP who are not expelled will eventually be released anyway, the ACLU’s Ebadolahi says.

So far, CBP has not met the request. 

Every day these policies persist is another day migrants are at risk, according to Lee Gelernt, deputy director of the ACLU Immigrants’ Rights Project. This is especially true when migrants are expelled by foot over bridges leading back into Mexico.

“It’s literally like families are walking a plank,” Gelernt said in a court hearing.

‘These babies represent hope’

After three months in Tijuana, Luzette gave birth to an infant who takes after her father. She is mischievous and restless, with absorbing dark brown eyes and a resounding laugh that fills the room. They named her Olojannie, which combines the Latin word for “little” with the root Janus, the Roman god of conflict, transitions, and new beginnings. 

Ximena Rojas is a quick-talking, faster-moving midwife who runs Justice in Health, Tijuana’s only free maternal-care clinic devoted specifically to the care of migrants. Rojas originally started a partera fronterista (“border midwife”) clinic out of the trunk of her station wagon on the sidewalk next to San Ysidro crossing; half a decade later, she cares for hundreds of migrant mothers a year. And staring down all the odds stacked against mothers like Luzette, Rojas maintains that there’s little more urgent than bringing children like Olojannie safely into the world.

“These babies represent hope,” Rojas says, “hope for a better future.” 

Within weeks of Olojannie’s birth, Luzette and Almick decided to try to cross the border again. Luzette said at the time that “there is no life for my daughter here.” 

It was the summer of 2021. And this time, after a weeklong journey that took them more than 600 miles east, they got through. 

Within hours, the family was on a bus headed north. English, rather than Spanish, enveloped them. Soon they joined family members in New Jersey, walking distance from a convenience store and a takeout Chinese spot. Almick took a job in a candy factory, Luzette found a role in a day care, and Olojannie started eating spaghetti.

“We are still learning what it means to live here,” Almick says, “but Olojannie — she has opportunities here. She can have a good life.”

For other pregnant women, the path has been less straightforward. 

For months, Claudia, Joseph, and Michal lived in El Chaparral. The days were challenging and uncertain, Claudia said at the time, “but we’re fighting the fight.” 

In spring 2021, they also decided they could not wait any longer. They had a plan: Michal would go first, and the rest of the family would join him later. 

But after Michal left the camp, his phone line went dead. Worried, Claudia stayed in the camp with Joseph, in purgatory once more. Eventually, though, she made up her mind: She’d follow Michal and try to cross. 

The last time Rojas saw Claudia was two months before Johan was expected to breathe his first breath. That day in the clinic, Claudia felt well, requesting only a bottle of hand lotion. Her allergies were acting up, she said.

The next day, she was gone.

This story was produced in partnership with the nonprofit publication Capital & Main.

Eli Cahan is an investigative journalist, an Impact Fund fellow at USC Annenberg’s Center for Health Journalism, and a pediatrician at UCSF. His work has appeared in The Washington Post, the L.A. Times, The Guardian, VICE, and elsewhere.