Blog Center for Advancing Health Services, Policy & Economics Research Health Equity

Preterm birth rates in immigrant populations on the rise under trump administration

Written by Monica Villarruel, MPH, 2019 practicum student at the Center for Community Health Partnership & Research at the Institute for Public Health; and Clark-Fox Institute Policy Scholar

A 2018 study led by researchers at the Harvard Chan School of Public Health demonstrated a connection between sociopolitical stressors and rising rates of premature births among immigrant women, surrounding the U.S. 2016 presidential election and its outcomes. The observational study looked at single births, in New York City from September 1, 2015 to August 31, 2017, to analyze changes in preterm birth rates among immigrant, Hispanic, and Muslim populations targeted by interpersonal violence, hate crimes, and other severe sociopolitical stressors.

This trend analysis showed that comparing the period before the presidential nomination to the post-inauguration period, the overall preterm birth rate increased from 7.0% to 7.3%, with foreign-born Latinas from Mexico and Central America seeing the highest increase (7.3% pre-election to 8.4% after the election). Mothers from Middle Eastern and North African countries also saw a rise in preterm birth rates; however, this finding was not statistically significant given their small sample size in the study. Although the study was observational and potential confounders were not considered, the authors believe that the observed increases are unlikely to be due to changes in other sociodemographic or medical factors, given the short time frame of observation.

This is the first study to explore the impact of the presidential campaign on preterm births and the implications for maternal and infant health.  There is clear and significant evidence that chronic stress from racism is associated with a higher risk of premature birth among African-American mothers, and similarly, Latina mothers have experienced worsening birth outcomes after immigration raids. Thus, it is plausible that sociopolitical stressors could have similar effects as racialized stressors on the health of immigrants and their children.

Why does this matter?

Preterm births (births occurring before the 37th week of pregnancy) are significant indicators of population health as they help predict the health of the next generation. When infants are born prematurely, they tend to be smaller, may have more health problems such as underdeveloped immune systems, and may face a higher risk of death. Those that survive may develop worse health outcomes as adults, such as chronic diseases, hearing and vision problems, and learning disabilities. Each year in the U.S., about 1 in 10 babies is born prematurely.

Additionally, preterm birth is a public health problem that has a significant social and economic impact on our country. Costs associated with preterm births total over $26 billion each year in the U.S. This includes medical and health care costs for babies, labor and delivery costs for mothers, early intervention services and special education services for children. In addition, there are costs beyond immediate costs incurred at birth, as preterm birth affects a child’s performance in school and a person’s ability to work later in life.

Local and state health departments have limited tools and resources available to counteract the public health impacts of federal policies that target immigrant populations. It is critical to understand the overall policy environment that influences the lives and health of immigrants. Since January 2017, the Trump Administration has banned nationals from most majority-Muslim countries, cancelled the Deferred Action for Childhood Arrivals (DACA) program, limited access to asylum, and suspended funding to “sanctuary” cities, among other actions.

While federal immigration law sets the policy stage, state immigration policies have the power to either extend rights and protections or reinforce restrictive federal policies. For example, states offering driver’s licenses to undocumented immigrants provide greater mobility and facilitate access to more economic resources and occupational opportunities for this community. In contrast, the enforcement program, Secure Communities, is a policy that has discouraged immigrants from using public services and reduced Medicaid participation among eligible children of noncitizens, by requiring state and local law enforcement to collaborate with federal immigration authorities.

The stress and trauma resulting from anti-immigrant policies and vitriolic rhetoric from political leaders could adversely affect the health of targeted immigrant populations. To improve our country’s birth outcomes and child health, we must advocate for changes to our current immigration policies and enforcement practices. Ultimately, it is in our best interest to promote safer and healthier living environments for all, especially immigrants.