Analysis Law and Policy

It’s Getting Even Harder for Refugees to Access Health Care

Hannah Harris Green

The Trump administration's policies have likely exacerbated these problems, both for women struggling with access in their home countries and for those who eventually flee to the United States.

After fleeing from Iraq to Jordan and then waiting for years, Zainab and her family were finally granted political asylum in the United States.

As soon as they were resettled in a small Midwestern town, they had trouble finding work, and were unable to get health-care access through Medicaid because of administrative problems. Zainab—who requested that Rewire not use her real name or other identifying details—and her husband were barely able to make ends meet for themselves and their children, studying to qualify in the United States for the jobs they’d been doing for years at home. And on top of all the strain, Zainab became unexpectedly pregnant.

Zainab knew she wanted to get an abortion, but didn’t know where to go. She was new to the country, and had no community to turn to. She says her English was still rough at the time. So she went online, and found a place she says claimed to offer abortions.

When she got there, she realized very quickly that she was in the wrong place. The staff informed her that they didn’t perform abortions, and told her that her decision was wrong—that she would be destroying a life. Still, Zainab agreed to an ultrasound, just so she could find out for sure if she was pregnant. One staffer pressured Zainab to join her in a prayer, and when Zainab refused, began to pray loudly over her. Zainab said she did not pray; she told the woman she had once been a Muslim but had privately become an atheist.

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“She laughed, and she laughed so hard,” Zainab told Rewire. “What I thought the situation is, is, ‘Well you deserve this because you’re an atheist, so God is punishing you for not believing in him.'”

Abortion clinics in the state where Zainab settled are few and far between and require patients to jump through certain hoops, including a waiting period between the consultation and the appointment—which can be trying for those who live far from the clinic. In the end, Zainab never got her abortion. She did have a miscarriage, which may have been related to the stress she was experiencing. But Zainab was grateful. “Thank goodness,” she said.

Zainab wasn’t alone. For refugees, accessing reproductive health care is especially arduous. Many of these women lack the community connections to know where to access an abortion, and also face barriers to health care, like lack of insurance. Some women also don’t know that contraception is available because they never learned about it; others come from communities where contraception is stigmatized. That means crisis pregnancy centers, like the one where Zainab wound up, can step in to fill the gap—frequently giving would-be abortion patients misinformation even as the centers receive state and federal funding. Zainab has refugee status in the United States, but many undocumented women are also seeking refuge in the country. So in addition to these barriers, they may be afraid that attempts to access health care could expose them.

And for women seeking refuge from conflict zones, the struggle for reproductive health-care access often begins before they even had the chance to flee. According to a Guttmacher Institute report on refugee reproductive rights, “Women’s needs do not suddenly stop or diminish during an emergency—in fact, they may become greater.” Sexual violence is more common in conflict zones, so women are more likely to become pregnant as a consequence of rape, and less likely to get the support they need from the health care system. As the report states, “The dissolution of public infrastructure often includes the health system. Consequently, the increased threats to sexual and reproductive health, in particular, expose women and adolescent girls to unwanted pregnancy, unsafe abortion, STIs including HIV, and maternal illness and death.” Sexual assault also occurs frequently during escape from conflict zones—so frequently, in fact, that some migrant women take birth control specifically to prevent pregnancy from rape.

The Trump administration’s policies have likely exacerbated these problems, both for women struggling with reproductive health-care access in their home countries and for those who eventually flee to the United States. The “global gag rule,” first established during Reagan’s presidency, forbids organizations that receive U.S. Agency for International Development (USAID) funding from providing or even discussing abortion. The rule was suspended under the Obama administration, but the Trump administration reinstated and expanded it to include organizations that fight malaria and HIV. This expansion has restricted USAID funding more than tenfold; while before it affected about $600 million of funding, it now affects about $9 billion.

Meanwhile, in addition to other barriers to insurance coverage, the Hyde Amendment in the United States bans federal funding from being used for the majority of abortions. Only 17 states have Medicaid programs that allow coverage for abortion care. This means that an asylum seeker could be unable to find a safe abortion in their home country, and then seek refuge in the United States, where they will continue to seek obstacles to finding an abortion.

For undocumented women, those obstacles can also include being housed in detention. Scott Lloyd, head of the Office of Refugee Resettlement, went to great lengths to prevent Jane Doe from getting an abortion when she became pregnant after a rape, and has done the same with other minors in immigrant detention. Lloyd justified his intervention partially based on the fact that Doe was a minor, but other policies threaten to severely restrict abortion for all women in detention centers. The Aderholdt Amendment, which the House passed in 2015, would forbid immigration detention centers from using their funding to “facilitate” abortion, and could even allow immigration detention center employees to refuse to transport detained women to get abortions, including those who can pay for the procedure themselves. An appendix to Trump’s budget proposes something similar. Meanwhile, even pregnant women who don’t want abortions are denied health care in immigration detention centers, which is dangerous for both mother and fetus.

The political tides seem unlikely to change in favor of reproductive rights for undocumented women. The anti-choice Alex Azar, who was appointed secretary of Health and Human Services (HHS) at the end of January, will likely bolster Lloyd’s efforts to keep undocumented migrants, including asylum seekers who have experienced sexual violence, from getting abortions. Other HHS staff believe that contraceptive methods like the morning after pill and IUDs actually cause abortions.

As anti-choice politicians continue to fill Trump’s health-care cabinet, as state leaders feel empowered to continue enacting restrictions, and as abortion and reproductive health services become harder to access abroad due to Trump’s policies, women seeking asylum—who are some of the most vulnerable to sexual violence—will face increasing global barriers to the reproductive health care they need.

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