The Trump administration’s latest move toward “defunding” Planned Parenthood clinics, by withdrawing an Obama-era rule aimed at stopping state legislatures from interfering with federal funding of preventive services like breast cancer screenings and contraception, will have catastrophic effects across the country for the wide swath of people who rely on these safeguards. Low-income people of color, especially women living in rural areas where access was already an issue, are likely to see a reduction in access to quality, affordable health care. For undocumented women, who historically have had limited access to health care, the situation will become more dire.
Even in progressive states like California—which allows low-income women to obtain public funding for abortion and provides people with co-pay-free contraceptives—undocumented women may experience insurmountable barriers in accessing reproductive health care. If this is the current situation in a state consistently ranked by the Institute for Women’s Policy Research as one of the best for reproductive rights in the country, what will undocumented women experience should Planned Parenthood clinics no longer receive federal funding and are forced to close?
“Across the board in our communities it’s known that Planned Parenthood is the best place [for undocumented people] to access this kind of care,” said Concepcion, an immigrant woman from Chicago whose last name is being withheld to protect her privacy. “I’m not even at a point right now where I can process all that’s happening because it’s all happening so fast. I just feel like a lot of sickness, a lot of death, is impending in our communities.”
Bridgette Gomez, Planned Parenthood’s director of Latinx outreach and engagement, told Rewire in an email interview that there’s a common misconception that the reproductive health care organization receives a blank check from the federal government.
“We’re not in the budget. When politicians like [Vice President] Mike Pence and [House Speaker] Paul Ryan talk about ‘defunding’ Planned Parenthood, what they’re talking about is denying millions of women access to the health care provider they’ve been depending on for decades,” Gomez said. “Federal funding does not go to providing abortions” except in the cases of rape, incest, or life endangerment thanks to the Hyde Amendment. “We don’t agree with that policy, but we of course follow all laws.”
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Planned Parenthood health centers care for approximately 1.5 million patients through Title X—roughly one third of the more than 4 million people served by the program. Six in ten women who access care from a family planning health center consider it their main source of health care, according to Gomez. For many patients across the country, Planned Parenthood health centers are the only places they can turn to for reproductive health care. This includes undocumented women, since the 1996 welfare reform law barred many immigrants from receiving public benefits, leaving undocumented women with little access to reproductive and maternal health-care services.
According to the National Network for Immigrant and Refugee Rights, gender and immigration status are strong predictors of health, and multiple forms of discrimination intersect to put undocumented women at risk for numerous health challenges.
Republicans in Congress assert that those left without care through Planned Parenthood could simply go to federally qualified health centers. But as Rewire’s Amy Littlefield reported, those health centers are not equipped to fill in the health-care-provision gap; some even deny contraception based on religious objections.
“The idea that other providers could absorb Planned Parenthood’s patients is simply not realistic,” Gomez said.
In 2014, 23 percent (more than 575,000 people) of Planned Parenthood patients were Latino and 15 percent (more than 360,000 people) were Black. Seventy-five percent had incomes at or below 150 percent of the federal poverty level.
There’s also the troubling fact that in one instance, a federally qualified health center contacted by Rewire reported sending patients seeking abortion care to crisis pregnancy centers, fake clinics often run by anti-choice groups that do not provide abortions and attempt to deter people from abortion care. These federally qualified health centers also present a risk for undocumented women: They may not ask about citizenship status, but they could require an ID.
“It’s clear that this is not what the American people want, and it’s not what they voted for,” Gomez said. “In fact nearly half of Donald Trump’s supporters don’t want to see Planned Parenthood defunded. For the majority of people in this country, Planned Parenthood is the solution, not the problem.”
It was certainly the solution for Concepcion, who told Rewire in a phone interview that she has been “seeking support” from Planned Parenthood on and off since 2012. After she lost her student health insurance, the services offered by Planned Parenthood were the only health care she had access to at all.
A couple of years ago when Concepcion became pregnant, she saw Planned Parenthood as her only option to access abortion care.
“People in my community I trusted recommended that’s where I go and plus, I don’t think I could have afforded anything else. I didn’t even consider anything else,” the 27-year-old told Rewire. “The only other option for someone like me would have been a natural abortion using herbs, but I didn’t know anyone who could help me with that. Planned Parenthood turned out to be a welcoming place. I knew they wouldn’t make me feel ashamed and there were a lot of women of color working there, which felt important to me.”
Concepcion said that during no point in the process at Planned Parenthood was she “stressed” about her legal status—or lack thereof—in this country. Planned Parenthood subsidized the cost of her abortion care and her lack of citizenship was a “non-issue.”
“At first it was intimidating when you walk into the building because the windows are dark and there’s security, but I understood it was for [patient] safety. But other than that, I wasn’t made to feel scared,” Concepcion said.
But there are very real reasons why undocumented people are afraid to seek care. In August 2015 Blanca Borrego, an undocumented mother of three, was arrested by sheriff’s deputies at her gynecologist appointment in Atascocita, Texas. Advocates and supporters were outraged, but undocumented communities knew it wasn’t an isolated incident. Medical repatriation, the act of “transferring” undocumented patients in need of chronic care to their country of origin without consulting a court, in effect deporting them, has been happening for years.
Concepcion told Rewire that her positive experience at Planned Parenthood might have to do with her varying degrees of privilege: She was already a recipient of Deferred Action for Childhood Arrivals (DACA), an immigration program then-President Barack Obama expanded in 2014 that enables certain undocumented immigrants who meet specific requirements to receive a work permit and reprieve from deportation, renewable every two years. If clinic staff had asked for documentation, she said, she could have provided them with her DACA paperwork. She was also in a major city, she acknowledged.
Planned Parenthood told Rewire in March 2016 that the health-care provider is serious about addressing the needs of the undocumented community, asserting that Planned Parenthood will provide health care no matter what, regardless of immigration, citizenship, or income status. However, services provided to undocumented women by Planned Parenthood differ across the country because of the legislative, political, and financial climate of states. As attacks on Planned Parenthood occur under Trump’s anti-choice administration, what’s offered from clinic to clinic could be limited or done away with altogether.
“Some states have harsher anti-immigration enforcement than others, which can stand in the way of undocumented people being able to access care at Planned Parenthood, or anywhere for that matter,” Gomez said. “In colonias, or border counties along the U.S. and Mexico border, for example, many immigrants live in medically underserved areas and lack public transportation, forcing them to go to tremendous lengths to access the care that they deserve.”
When you add Border Patrol checkpoints, increased funding to border militarization efforts, poverty, and lack of transportation to the mix, it becomes nearly impossible for many undocumented immigrants to access care because the risk of detainment and deportation becomes too great.
Despite living near a major city, Concepcion found transportation challenging as well. Concepcion grew up in the suburbs and didn’t learn to drive until her mid-20s. Getting to the city from her family home proved challenging.
“It might not sound like a real obstacle to a lot of people, but it really was for me and for a lot of people in our community. When I was a student, going to a medical space with family would have been challenging, especially for birth control. Especially if, like it was for me, a family member would be the only one who could drive me and then insist on going to the appointment. I didn’t want to share that because of trust issues, judgement, and shame,” she said.
But barriers to care don’t always have to be structural. For undocumented people, especially under this administration, there’s a lot to overcome—mentally, emotionally, and psychologically—Concepcion said.
“For a lot of us, it takes a lot to get to health care spaces like, emotionally …. The longer you’re undocumented, the more stigma there is. It’s like you’re ‘too undocumented’ for health care; you can’t afford it—not the time off, not the time away from earning, none of it,” Concepcion said.
Seeking any kind of medical care stirs fears for undocumented people, who do not “trust the system,” she said.
In light of Trump’s anti-immigrant executive orders and recent nationwide sweeps that resulted in the detainment of nearly 700 undocumented immigrants, “the community may lose confidence that information given to service providers, including health care organizations, will not be used for political purposes, including deportation proceedings,” the New England Journal of Medicine recently found.
“If no protections seem to apply to us, why would people in my family think they’re protected under HIPPA,” the federal privacy act securing personal medical information, Concepcion asked.
When few in the family have gained access to resources and are relatively isolated from a larger undocumented community—as Concepcion’s was—the “shame of being undocumented” drastically affects whether people seek out health care.
“My dad would always discourage us from [seeking health care] out of fear of being reported, but also because we had to be workers and can’t take time off,” Concepcion said. “It was kind of like, ‘Why do you think you have the right to go to the doctor?’ That was the notion in our family. Or like, what were you doing wrong, what was it about your behavior that warranted having to see a doctor? It’s self-blame for needing care.”
Concepcion told Rewire that these beliefs emerge frequently in undocumented and mixed-status families.
“My dad worked in a factory and often had two or three different jobs. He couldn’t wrap his mind around being sick, because being sick would have literally been a threat to our family’s survival,” she said.