Prenatal Care for Undocumented Immigrants: Implications for Policy, Practice, and Ethics

Nearly 250,000 babies are born each year to undocumented immigrant parents in the U.S. These babies are U.S. citizens, but undocumented immigrants are ineligible for most public insurance, making it difficult for them to access prenatal care. This research brief describes restrictive policies related to prenatal care for undocumented immigrants and discusses how these policies affect health care providers and the care they are able to offer pregnant immigrant women

Determining the Number of Refugees to Be Resettled in the United States: An Ethical and Policy Analysis of Policy-Level Stakeholder Views

Through engagement with key informants and review of ethical theories applicable to refugee policy, this paper examines the ethical and policy considerations that policy-level stakeholders believe should factor into setting the refugee resettlement ceiling. We find that the ceiling traditionally has been influenced by policy goals, underlying values, and practical considerations. These factors map onto several ethical approaches to resettlement. There is significant alignment between U.S. policy interests and ethical obligations toward refugees. We argue that the refugee ceiling should be restored to historical norms, and that there exists a corresponding obligation to counter negative public perceptions about refugees and the costs of resettlement

Publicly Funded Prenatal Care for Undocumented Immigrants: A Comparative Case Study in Policy, Practice, and Ethics

There are over 11 million undocumented immigrants living in the United States and nearly 8% of births each year are to at least one undocumented parent. Under the 14th Amendment to the U.S. Constitution, all children born within the borders of the United States are legal citizens regardless of their parents’ immigration status. Many undocumented immigrants are unable to access adequate prenatal care. Nineteen states have implemented one of two policies intended to provide undocumented immigrants with insurance coverage during pregnancy. This dissertation explores the policy, practice, and ethics of these policies through three aims. Aim 1 examines the relationship between the policy narratives, policy requirements, and the use of moral and prudential reasons by legislatures and courts in state policies that provide publicly-funded prenatal care to undocumented immigrants. The legislative histories of prenatal policies in three case states: Nebraska, California, and New York are reviewed and analyzed. The findings of this analysis include that policymakers and others appeal to moral reasons based on different conceptions of the principles of Respect for Persons and Justice, as well as prudential reasons related to the health and economic benefits of prenatal care for U.S. citizens and legal residents. Aim 2 describes the professional norms and practices of health care workers who serve undocumented pregnant immigrants in states with different prenatal policies or prenatal policy implementations (Nebraska, California, New York, and Maryland) and the ethical tensions they encounter when providing or facilitating care under policy restrictions that limit the benefits available to undocumented immigrants. In-depth interviews were conducted with purposively sampled health care workers at safety net clinics in each state. Findings include the attitude and professional practice norms held by health care workers who see pregnant patients as well as the ethical tensions they encounter when policy or institutional constraints prevented them from living up to professional norms. Aim 3 applies three normative accounts of distributive justice regarding a society’s obligations to non-citizen residents to the duty of the public to provide care to pregnant undocumented immigrants and locate an overlapping consensus across accounts. This paper explores the moral space that this issue occupies, and the results suggests that real moral progress can be achieved through the consistent application of shared values

Publicly Funded Prenatal Care for Undocumented Immigrants: A Comparative Case Study in Policy, Practice, and Ethics

There are over 11 million undocumented immigrants living in the United States and nearly 8% of births each year are to at least one undocumented parent. Under the 14th Amendment to the U.S. Constitution, all children born within the borders of the United States are legal citizens regardless of their parents’ immigration status. Many undocumented immigrants are unable to access adequate prenatal care. Nineteen states have implemented one of two policies intended to provide undocumented immigrants with insurance coverage during pregnancy. This dissertation explores the policy, practice, and ethics of these policies through three aims. Aim 1 examines the relationship between the policy narratives, policy requirements, and the use of moral and prudential reasons by legislatures and courts in state policies that provide publicly-funded prenatal care to undocumented immigrants. The legislative histories of prenatal policies in three case states: Nebraska, California, and New York are reviewed and analyzed. The findings of this analysis include that policymakers and others appeal to moral reasons based on different conceptions of the principles of Respect for Persons and Justice, as well as prudential reasons related to the health and economic benefits of prenatal care for U.S. citizens and legal residents. Aim 2 describes the professional norms and practices of health care workers who serve undocumented pregnant immigrants in states with different prenatal policies or prenatal policy implementations (Nebraska, California, New York, and Maryland) and the ethical tensions they encounter when providing or facilitating care under policy restrictions that limit the benefits available to undocumented immigrants. In-depth interviews were conducted with purposively sampled health care workers at safety net clinics in each state. Findings include the attitude and professional practice norms held by health care workers who see pregnant patients as well as the ethical tensions they encounter when policy or institutional constraints prevented them from living up to professional norms. Aim 3 applies three normative accounts of distributive justice regarding a society’s obligations to non-citizen residents to the duty of the public to provide care to pregnant undocumented immigrants and locate an overlapping consensus across accounts. This paper explores the moral space that this issue occupies, and the results suggests that real moral progress can be achieved through the consistent application of shared values

Determining the Number of Refugees to Be Resettled in the United States: An Ethical and Policy Analysis of Policy-Level Stakeholder Views

Through engagement with key informants and review of ethical theories applicable to refugee policy, this paper examines the ethical and policy considerations that policy-level stakeholders believe should factor into setting the refugee resettlement ceiling. We find that the ceiling traditionally has been influenced by policy goals, underlying values, and practical considerations. These factors map onto several ethical approaches to resettlement. There is significant alignment between U.S. policy interests and ethical obligations toward refugees. We argue that the refugee ceiling should be restored to historical norms, and that there exists a corresponding obligation to counter negative public perceptions about refugees and the costs of resettlement