The Cost of Medical Marginalization: Undocumented Mothers and Health Access in the Time of COVID-19

May 5, 2020
4:34 PM

“Mother” by Ibraim Nascimento

HOUSTON — In the last few weeks we have learned that more Latinx and African Americans have died from medical marginalization and exclusion after contracting the coronavirus than any other ethno-racial group. The truth is that in the United States health care is a privilege, and the devastating impact of racism and xenophobia on the health and wellbeing of communities of color is well documented but still largely ignored. Never has this been clearer than now as political leaders weaponize demographic health data, using it to blame communities of color for their own marginalization, while simultaneously instituting policies that continue to put these lives at risk.

“Are you going to get tested,” I asked Marta Garza, an undocumented mother in Houston?

“Depende,” she said. “If I got really sick, I would because I don’t want my family to get sick too. But I worry because if I got sick and I had to go to the hospital, how would we pay for that and who would take care of my kids? And now there are free tests, but have you seen those lines? It’s complicated to be in that line. What if immigration shows up? It’s a big risk for me.”

I called Marta and a few other mothers I have been working with over the past few years for my research on undocumented motherhood and health care access to see how they were doing. Like many parents right now, Marta was overwhelmed trying to balance the added rituals of keeping her children and husband healthy while also navigating online schooling and the demands of running a household on her own.

Marta’s husband works in construction, and despite everything, she was grateful that he still had a job. For many immigrant families, men are still working outside of the home during most of the day. Many of these men work in designated essential jobs such as construction and sanitation, while others continue their work in lawn care and home contracting. Marta has three children, one of whom has Turner Syndrome, a genetic disorder that requires additional treatment and regular therapies. Even before COVID-19, Marta had already shared with me her distrust in the public health care system, a system that made her feel undeserving of care.

Still, I knew that Marta was very careful about the health of her family, especially her kids—taking them to the doctor regularly as needed despite all the barriers and fears. When it came to her own health, however, Marta was more cautious and only went to the doctor if it was very serious. In my research, I found that undocumented mothers put a great deal of pressure on themselves and on their healthy bodies to support the needs of their families with very few resources. These women assume the role of health mediators and navigators who bridge the gap in health access for their families as they regularly confront a prohibiting health care system despite marginalization and the fear of deportation. But being a bridge in a system with a lot of cracks is a lot to bear.

“The worst part is that the people in our communities with the most need, are the ones that rarely ask for help,” Nataly Negrete, Associate Pastor at St. Paul’s United Methodist Church, explained. “It takes a lot. It has to really weigh on them for them to ask for anything.”

Even though the church was doing weekly online services, Nataly was reaching out to immigrant communities in person, calling families regularly to see how they were doing. She noted that a lot of women were calling her for prayer and comfort. Some women had even recommended the pastor to their family members in Mexico. In times like these, communities turn to each other for help, and immigrant communities have a long tradition of supporting each other through the most difficult situations. It didn’t surprise me, or the pastor, that women were the ones reaching out to her for comfort.

“Women carry the emotional structure of the whole family,” Nataly sighed. “We don’t always have the luxury of being sad, because we have a family to take care of, but it’s not easy.”

For Marta, being undocumented and uninsured while caring for three children —including a daughter with a chronic ailment— was already difficult even before the pandemic. Other women I spoke with were experiencing multiple job losses and some were single moms who were just trying to get through each day.

“Everyone is feeling the weight now, and the mothers are doing little things here and there to survive but it’s not enough. They are so humble and they say they’re O.K., that they have enough beans and maizena to make it, but I know they need help,” Nataly emphasized.

Access to quality health care for undocumented Latinas is a major problem across the U.S., but in Texas the situation is compounded by pervasive conservative state policies on health and immigration. Historically, health care polices have been combined with immigration policies and restrictions that have left undocumented immigrants and their families locked out of care. For example, the 1996 immigration (IIRIRA) and welfare (PRWORA) reforms —and most recently the Affordable Care Act and the Public Charge Rule— have restricted public health resources for all immigrants in the effort to exclude those that are undocumented.

The government is now using the coronavirus pandemic to further restrict immigration and public resources for immigrants. Excluding undocumented immigrants and their families from the CARES Act further compromises the health of these communities who, in the absence of public resources, rely heavily on their incomes to pay for health care. Contrary to mainstream belief, undocumented immigrants largely pay for health services out of pocket and in cash, a practice that often leaves them vulnerable to exploitation.

For generations, anti-immigrant policies have hurt the Latinx population. Across the United States now, Latinx communities are overrepresented among the uninsured and underinsured, especially in Texas, where Medicaid was not expanded and where public hospitals and community clinics still struggle to meet the demands of a large excluded population without additional federal aid. Undocumented immigrants, like Marta Garza, and their families pay millions of dollars in federal and state taxes every year, taxes that support our local medical services and schools, and are essential to the U.S. economy and workforce.

But undocumented immigrants deserve health access and protection not for their labor but for their humanity. In my work with undocumented mothers, I learned that these women will rise to the occasion. They will keep their families safe despite all barriers as they have been doing for generations, but at what cost?

Undocumented mothers are bridging the gap in care for their families, but they shouldn’t have to do it alone. Although there are some community health resources where undocumented immigrants can access primary care at little to no cost, there are many more barriers. Policies that actively undermine the health of immigrants are the biggest barriers of all. Health care providers, including mental health providers, from private and public sectors need to step up their political advocacy for undocumented communities. Community resources in Texas will need substantial support as the coronavirus progresses and forever changes the landscape of public health. This is the time for radical inclusion in health care and for disrupting the cycle of public policies that undermine health access for all.


Elizabeth Farfán-Santos, Ph.D. is a professor of anthropology at the University of Houston. She is a medical anthropologist, race scholar, and expert in the social, cultural, and political factors that impact health and illness. Her current research focuses on the medical alienation and exclusion of undocumented immigrant communities and the health of undocumented mothers. She tweets from @ChicanaAnthropo.