Undocumented Motherhood: Gender, Maternal Identity, and the Politics of Health Care

ABSTRACT

Undocumented Mexican immigrants have had to regularly confront a prohibiting health care system despite alienation, marginalization, and the threat of deportation. In this article, I explore the impact of political exclusion and alienating discourses on the health habitus of undocumented Mexican mothers through the narrative of one mother, Marta Garza, who finds herself at the painful intersection of political and medical alienation. Marta’s narrative reflects an analytical framework that centers undocumented motherhood as a space of necessary resilience and strain, wherein she is forced to advocate for her children’s health despite prohibitive barriers and dangerous potential consequences.

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KEYWORDS:

• Health access
• illness narratives
• immigrant health
• Latino/a health
• undocumented Mexican women

Supplemental data

Supplemental data for this article can be accessed on the publisher’s website.

Acknowledgments

This research counted on support from the Center for Mexican American Studies (CMAS) at the University of Houston, first through a visiting scholar position in 2015 and then through a Faculty Seed Grant in 2016. Several Latino faculty at the University of Houston offered critical feedback that ultimately helped this article come together. I would like to thank Drs. Christina Sisk, Amanda Ellis, and Tatcho Mindiola for engaging this work and offering important comments. I am also grateful to Jessica Jerome and Alejandro Cerón for their invitation to participate in this special issue and for their critical feedback on this article. Finally, I am thankful to the editorial labor and insights of the three anonymous reviewers that reviewed this article for the journal.

Notes

1. The clinics I visited were all Federally Qualified Health Centers. Clinic names are excluded and referred to instead as “community health center” to protect patient privacy and to protect the services that they provide to undocumented immigrants. Before I began interviewing undocumented immigrants, I needed to understand the larger public health structure in Houston. I interviewed physicians and community health workers (CHWs). I underwent a 160-hour community health worker training to learn the public health practices and discourses that community health centers used to interact with uninsured and undocumented patients. Through training, I met health care representatives across the city, including representatives from the Texas Health and Human Services Commission: Center for Elimination of Disproportionality and Disparities, the Mexican Consulate’s Ventanilla de Salud, and the National Latina Institute of Reproductive Health (NLIRH) in Texas (see also n. 15). In addition to conversations and observations in clinics, I organized community forums through a centrally located church to discuss these issues outside of a clinic setting.

2. Marta was recruited for this study at a health center. At each health center, I was given a space to speak with patients after they were screened for financial eligibility by the eligibility specialist (also community health worker). This space was a small office where I could explain the research, introduce myself, and ask for informed consent.

3. CHIP is a federal insurance program administered at the state level. Children in Texas without health insurance may be eligible for low cost or free health coverage, either from CHIP or Children’s Medicaid. Both programs cover office visits, prescription drugs, dental care, eye exams, glasses, etc. See: https://chipmedicaid.org/en/About.

4. It was renamed the Harris Health Financial Assistance Program (FAP) when the system discontinued the use of actual gold cards. County officials found that cards wrongly encouraged people to think of the program as health insurance, causing considerable confusion. The HHFAP is not insurance and it can only be used in the two Harris county hospitals and the Harris Health clinics. Only families that live in Harris County and who meet the income requirements are eligible for the discount program.

5. Mayo Clinic. Turner Syndrome: Symptoms and Causes. https://www.mayoclinic.org/diseases-conditions/turner-syndrome/symptoms-causes/syc-20360782.

6. In 2012, the Pew Research Center estimated that four million undocumented immigrant parents, or 38% of adults in this population, lived with their US-born children, either minors or adults. In 2012, undocumented immigrant parents of US-born children had been living in the United States for a median of 15 years.

7. Mexican immigrants primarily come to the US for employment and not for social services, and undocumented families actually use very few health care services, even community clinics and other resources for which they may be eligible (Berk et al. 2000:49; Gálvez 2011; Horton 2014).

8. Lawful permanent residents, who have lived in the US less than five years, and legal residents on temporary visas, such as work and student visas, were excluded from the ACA and Patient Protection Act. When these immigrants are added to the undocumented population, a total of 22.1 million immigrants (Nwosu, Batalova, and Auclair 2014) were excluded from the 2010 health care reforms.

9. Kaiser Commission Key Facts Report on Health Coverage for the Hispanic Population Today and Under the Affordable Care Act. April 09, 2013. https://www.kff.org/disparities-policy/report/health-coverage-for-the-hispanic-population-today-and-under-the-affordable-care-act/.

10. Texas Medical Association. “The Uninsured in Texas.” https://www.texmed.org/Uninsured_in_Texas/.

11. Markian Hawryluk 2015. “Ben Taub ‘Under Assault’ as Funds from Many Sources Cut, Threatened.” Houston Chronicle. http://www.houstonchronicle.com/news/health/article/Ben-Taub-under-assault-as-funds-from-many-6310020.php.

12. Undocumented immigrants can be detained and imprisoned in detention centers for any reason and for an indeterminate amount of time. The recorded human rights abuses in detention centers are numerous because the rule of law is suspended. See n. 6.

13. In a 78-page Human Rights Watch Report, “Detained and Dismissed: Women’s Struggles to Obtain Health Care in United States Immigration Detention,” Human Rights Watch details violations such as “shackling pregnant detainees or failing to follow up on signs of breast and cervical cancer, as well as basic affronts to their dignity.” The same technologies of control and surveillance that allowed for the violent medical treatment of Latinas over generations continues to be visible in the unregulated detention center of the US.

14. Planned Parenthood 2017. “Press Release: Texas Governor Greg Abbott Signs Two Extreme Abortion Restrictions.” https://www.plannedparenthoodaction.org/pressroom/texas-governor-greg-abbott-signs-two-extreme-abortion-restrictions.

15. The National Latina Institute for Reproductive Health. NLIRH Gulf Coast operates in Texas through the Texas Latina Advocacy Network (TX LAN). http://latinainstitute.org/en.

16. Emerging data in syndemics may be interesting to consider here, especially in thinking about the real physiological and mental health impact of social and environmental factors (see Mendenhall 2017:889–891; Mendenhall 2012).

17. Obama’s Health Care Speech to Congress. New York Times. September 9, 2009. http://www.nytimes.com/2009/09/10/us/politics/10obama.text.html.

Additional information

Funding

This research counted on support from the Center for Mexican American Studies (CMAS) at the University of Houston, first through a visiting scholar position in 2015 and then through a Faculty Seed Grant in 2016.

Notes on contributors

Elizabeth Farfán-Santos

Elizabeth Farfán-Santos is assistant professor of Anthropology at the University of Houston and author of Black Bodies, Black Rights: The Politics of Quilombolismo in Contemporary Brazil (2016).