Keeping Pregnant Patients Safe in the Setting of State-Sponsored Violence

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The latest updates, announcements, and clinical information from the Reproductive Health Hotline

Keeping Pregnant Patients Safe in the Setting of State-Sponsored Violence

ReproHH Staff

Keeping Pregnant Patients Safe in the Setting of State-Sponsored Violence Graphic

This is an expanded partner piece published in coordination with the Reproductive Health Access Project (RHAP). RHAP trains, supports, and mobilizes primary care clinicians to ensure equitable access to sexual and reproductive health care, filling critical gaps in clinical education and care delivery.

The Reproductive Health Hotline (ReproHH) received a call this winter from a clinician conducting a medication abortion telehealth follow-up visit with an 18-year-old undocumented patient in Minnesota. 

The patient had taken abortion medications six weeks earlier and was reporting persistent bleeding and a positive pregnancy test. She was afraid to leave her home to visit a clinic or urgent care because of the heavy presence of Immigration & Customs Enforcement (ICE) agents in her community. The clinician asked ReproHH what guidance she could offer.

As we witness the rise of ICE raids across immigrant communities, it is critical for reproductive health providers to recognize the impact of institutional violence on pregnant patients and their ability to access care.

The Chilling Effect

In 2025, the current administration rescinded a longstanding ICE policy that had previously restricted immigrant enforcement activities in “sensitive locations,” including hospitals and clinics.1 

Shortly afterward, one of the largest federal immigration enforcement deployments in recent history — “Operation Metro Surge” in Minnesota from February to March 2026 — involved ICE operations conducted at or near schools, healthcare facilities, childcare centers, courthouses, and places of worship. During that same period, a poll of more than 500 pregnant patients found that 20% delayed or avoided prenatal care because of fear related to ICE activity.

These raids, and the fear they generate, have occurred across the United States and have contributed to what researchers describe as the “chilling effect” — the avoidance of medical and social services due to fear of immigration enforcement.2

In prenatal care, the chilling effect refers to the phenomenon in which pregnant individuals avoid, delay, or discontinue essential pregnancy-related services because of fears related to immigration status, legal repercussions, or financial consequences. Studies have shown that anti-immigration rhetoric and policies are associated with significant delays in first prenatal visits and fewer total prenatal visits among Latina immigrants.3

How can clinicians provide safer prenatal care for immigrant communities?

In April 2026, the American College of Obstetricians and Gynecologists (ACOG) published Advocating for Safe and Equitable Obstetric and Gynecologic Care for Immigrants,4 which outlines several recommendations for clinicians and health systems:

  1. Do not seek or document immigration status unless it is clinically relevant to the patient’s care.
  2. Develop clear policies distinguishing public and private spaces within health care facilities. Institutions should use signage and written policies restricting public access — including access by federal agents — to private patient care areas. Examples of printable signage are available through Physicians for Reproductive Health.
  3. Practice immigration-informed care. Clinicians and staff should work with their institutions to create welcoming clinical environments for immigrant patients, including multilingual signage and patient-facing resources such as those available through the Immigrant Legal Resource Center.
  4. Provide trusted legal and community referrals. When patients express concerns related to immigration status, clinicians should connect them with reputable medical-legal resources or trusted community organizations. [see box 1 below]
  5. Prepare staff for interactions with law enforcement. Hospitals and clinics should proactively develop policies regarding interactions with immigration officials and law enforcement. Tools such as the The Badge Buddy Tool and online staff training programs can help clinicians and support staff understand their rights and responsibilities.
  6. Engage in advocacy efforts. Reproductive health providers can play an active role in local, state, and national advocacy efforts to improve access to care regardless of immigration status. Advocacy can include fundraising, signing petitions, writing op-eds, contacting legislators, participating in media interviews, and attending rallies or press conferences.
  7. Advocate for humane treatment of pregnant individuals in detention settings. Timely, evidence-based reproductive health care should be available to individuals held in immigration detention facilities, and pregnant people should not be targeted for immigration enforcement.

These tools and strategies can support clinicians, institutions, and staff in continuing to provide safe and compassionate reproductive health care for immigrant communities. 

In the case of the patient in Minnesota, ReproHH followed this outline for safer care, working with the clinician to create a responsive care plan that minimized the risk of engagement with federal agents. The patient ultimately received a home visit and was prescribed additional misoprostol to help manage her symptoms safely.

Additional Resources (from ACOG Guide)

Doctors for Immigrants (https://doctorsforimmigrants.com/)

“Welcoming and Protecting Immigrants in Healthcare Settings: A Toolkit Developed from a Multi-State Study” (https://doctorsforimmigrants.com/wp-content/uploads/2020/01/WelcomingProtectingImmigrants-toolkit-3.pdf) provides actions to implement change at the institutional, clinician, and patient levels, including training strategies and educational tips plus sample policies and scripts.

National Immigration Law Center (NILC) (https://www.nilc.org/)

The NILC provides information for health care professionals on how to prepare for and respond to enforcement actions by immigration officials and interactions with law enforcement, including “Health Care Providers and Immigration Enforcement: Know Your Rights, Know Your Patients' Rights” (https://www.nilc.org/resources/healthcare-provider-and-patients-rights-imm-enf/).

American Civil Liberties Union (ACLU) (https://www.aclu.org/)

The ACLU provides information (https://www.aclu.org/documents/health-care-providers-guide-best-practices-protecting-your-rights-and-your-patients-rights) for hospitals, medical centers, community health centers, other health care facilities, health care professionals, medical associations, and advocates on how to prepare for and respond to enforcement actions by immigration officials, interactions with law enforcement that could result in immigration consequences for their patients, and law enforcement presence that deters access to care.

Immigrant Legal Resource Center (ILRC) (https://www.ilrc.org/)

The ILRC offers a variety of resources, including Red Cards/Tarjetas Rojas (https://www.ilrc.org/red-cards-tarjetas-rojas) that provide examples of people's rights and protections under the U.S. Constitution regardless of immigration status and a fillable and printable “Step-by-Step Family Preparedness Plan” (https://www.ilrc.org/resources/step-step-family-preparedness-plan).

Health Begins (https://healthbegins.org/immigration-enforcement-in-healthcare-settings-how-to-prepare-and-respond/)

This site provides resources and guidance to address how health care partners can prepare for potential U.S. Immigration and Customs Enforcement encounters on their premises and respond in the interim to concerns among patients and staff.

If you have questions about providing reproductive health care for immigrant communities, call us at the Reproductive Health Hotline | 1-844-ReproHH (844-737-7644) after reading our Terms of Service.

References:

  1. Rubin R. US Patients Getting ICEd-Out of Health Care. JAMA. 2026;335(10):835–837. doi:10.1001/jama.2026.1067
  2. Montoya-Williams D, Barreto A, Laguna-Torres A, Worsley D, Wallis K, Peña MM, Palladino L, Salva N, Levine L, Rivera A, Hernandez R, Fuentes-Afflick E, Yun K, Lorch S, Virudachalam S. Philadelphia Latine Immigrant Birthing People's Perspectives on Mitigating the Chilling Effect on Prenatal Care Utilization. Med Care. 2024 Jun 1;62(6):404-415. doi: 10.1097/MLR.0000000000002002. Epub 2024 Apr 26. Erratum in: Med Care. 2025 Apr 1;63(4):316. doi: 10.1097/MLR.0000000000002136. PMID: 38728679; PMCID: PMC11090453
  3. Nwadiuko J, German J, Chapla K, et al. Changes in Health Care Use Among Undocumented Patients, 2014-2018. JAMA Netw Open. 2021;4(3):e210763. doi:10.1001/jamanetworkopen.2021.0763
  4. ACOG Committee Statement No. 25: Advocating for Safe and Equitable Obstetric and Gynecologic Care for Immigrants. Obstetrics & Gynecology 147(4):p 598-607, April 2026. | DOI: 10.1097/AOG.0000000000006213