By Lucie Arvallo, Hannah Liu, Suma Setty, Priya Pandey, and Salen Andrews National Latina Institute for Reproductive Justice and the Center for Law and Social Policy

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Introduction

Due to enduring xenophobic and racist policies, the United States has a long history of limiting abortion access in im/migrant communities.* Im/migrants must overcome deeply embedded systemic barriers in order to access abortion care. The 2022 Supreme Court decision in Dobbs v. Jackson Women’s Health Organization exacerbated these barriers, striking down federal protections on the right to an abortion granted in Roe v. Wade and created unprecedented harm by allowing states to pass outright bans on abortion. The ruling had devastating consequences for bodily autonomy, economic mobility, and freedom for im/migrants, people in detention, pregnant people, transgender and gender-non-conforming people, and women of reproductive age. State abortion bans and restrictions disproportionately harm communities who already face significant barriers to accessing health care, including Black, Indigenous, Latina/x, Asian, and Pacific Islander communities; communities living with low incomes; individuals with disabilities; individuals with Limited English Proficiency (LEP); and people living in rural areas.

Im/migrants, especially those who are undocumented and those in mixed-status families, are particularly vulnerable to the harmful impacts of abortion bans due to the barriers they face in accessing health care and the increased risk of criminalization based on immigration status. These barriers and risks include arbitrary Customs and Border Protection (CBP) checkpoints, a five-year waiting period for legal permanent residents to enroll in public health insurance programs, agreements between local law enforcement and federal immigration authorities, and increasing anti-immigrant state policies. Individuals in immigration detention face additional threats to their reproductive health and overall well-being, including medically unnecessary gynecological procedures like forced hysterectomies and denial of abortion care. This fact sheet highlights how Dobbs compounded pre-existing barriers to abortion care for im/migrants. We propose a set of concrete recommendations for Congress and the administration to support im/migrant access to abortion.

The Impact of the Dobbs Decision On Immigrants

I. Abortion bans put the health and well-being of im/migrants at risk.

Since the Dobbs ruling, abortion access has been severely restricted in 22 states. Many of those states are also home to a high number of im/migrant and mixed status families, such as Texas, Arizona, and Florida. As of June 2024, at least 1.9 million undocumented female im/migrants live in a state that either bans abortion completely or by the 18th week of gestation.

Since 2022, at least 65 abortion clinics have closed, increasing the burden on those remaining; the number of women served per facility has grown 29 percent. Moreover, southern border communities, home to many mixed-status families, are already considered medically underserved areas, disproportionately impacting certain populations. For instance, more than one-third of Afro Latinas and 44 percent of multiracial Black women live in states that have banned or are likely to ban abortion after Dobbs. Additionally, nearly 6.7 million Latinas, 38 percent of whom were born outside of the United States, live in states that have banned or are likely to ban abortion. Barriers to access continue to cause widespread confusion among both patients and providers about abortion access and coverage due to variation in laws from one state to the next as well as vaguely written bans.

Abortion bans don’t just restrict access to abortion care. They also threaten all types of pregnancy and reproductive care, including access to contraception. Patients are having a hard time getting important pregnancy care, or are being denied the care they need, including treatment for miscarriages and ectopic pregnancies. The majority of OBGYNs feel the Dobbs decision has worsened their ability to manage pregnancy-related emergencies, increased pregnancy-related mortality, furthered inequities, and damaged the prospects of attracting new providers to the field. A study of 54 OBGYNs in 13 states with abortion restrictions found that providers believed post Dobbs bans had negative impacts on their work, including clinically inappropriate delays in essential patient care, fears of legal ramifications, mental health effects, and planned or actual moves to practice in other states. In some places, the rising cost of providing care and the dearth of providers have forced maternity clinics and wards to close, contributing to “maternity-care deserts.”

Dr. Jessica Rubino, Medical Director at Meadow Reproductive Health and Wellness, told the Latina Institute that interstate travel was often the only recourse she could suggest for patients who needed an abortion while she was practicing in Austin, Texas. But for many patients, that wasn’t possible:

“I had one patient who looked at me like I had three heads when I suggested traveling out of state for an abortion. It turned out that she couldn’t drive safely on the roads due to her immigration status. I’ve dedicated my life to helping people access care, and I cannot tell another patient to get in a car or on a plane to go to another state. It’s unethical, and it’s a form of violence.”

— Dr. Jessica Rubino, Medical Director, Meadow Reproductive Health and Wellness

II. Abortion bans further criminalize immigrant communities.

Even before the Dobbs decision, im/migrants faced significant barriers to accessing an abortion. Policies like Texas’ S.B. 8, which banned abortion care after six weeks and invited anti-abortion vigilantes to sue those “aiding and abetting” abortion, made seeking an abortion for im/migrants living along the southern border nearly impossible almost a year before Dobbs was decided. At the time S.B. 8 was implemented, Texas already had the largest number of U.S. cities classified as “abortion deserts,” defined as areas where residents need to travel 100 miles or more to reach a provider, of any state. Texas currently has some of the most restrictive abortion policies in the country, including a complete abortion ban with very limited exceptions, meaning people living in the state must travel to obtain abortion care. In 2023, more than 35,000 Texans traveled to another state to get an abortion, compared to just 2,400 in 2019.

Due to increasing restrictions and facility closures, more people than ever must travel long distances to receive abortion care in the U.S. Nationally, the number of people who crossed state lines to obtain abortion care more than doubled, with 17 percent of abortions in 2023 obtained by patients traveling from out of state, as opposed to only 9 percent in 2020. But im/migrants who do not have the necessary documentation, such as a driver’s license, often feel unsafe traveling due to fear of being pulled over, detained, or deported. This fear is only exacerbated by increasing state and local initiatives that attempt to restrict travel for abortion care. Additionally, im/migrants living in southern border states must often travel farther than others. For example, some Texans must travel 36 times farther than someone in Connecticut for abortion care. This can be prohibitively expensive, especially if they must miss work, arrange childcare, and/or do not have access to reliable transportation.

Immigration enforcement activity and the continued chilling effects of policies like public charge make it less likely that im/migrants will seek insurance coverage or health care altogether, and abortion restrictions exacerbate the fear of criminalization in immigrant communities. As of 2023, 50% of likely undocumented and 18% of lawfully present im/migrant adults reported being uninsured compared to 6% naturalized and 8% U.S. born citizens. Approximately 27% of undocumented and 8% of lawfully present im/migrants reported avoiding applying for food, housing, or health care assistance in the past year due to immigration-related fears. Moreover, polling conducted in 2018 found one in four Latina/o voters (24 percent) had a close family member or friend delay or avoid health care because of fear related to discriminatory immigration policies, and one in five (19 percent) said the same about reproductive health care.

“The rise in criminalization of abortion care also affects immigrant communities who may also be facing criminalization around documentation status… I know that, for the handful of patients who are able to travel to see me, there are dozen[s] who are unable to.”

— Dr. Gopika Krishna, OB-GYN, New York abortion provider, and Physicians for Reproductive Health Fellow

Im/migrants living in border states have a heightened fear of encountering enforcement because many state and local police in these states have official agreements with Immigration and Customs Enforcement (ICE) to arrest im/ migrants. In 2022, CBP operated immigration checkpoints at 129 locations, generally located within 25 to 100 miles inland from the Southwest and Northern borders, which impede travel for im/migrants living within the 100 mile border zone. While abortion care is available in New Mexico and California, it is banned at 15 weeks in Arizona and completely banned in Texas with few exceptions.

In 2023, Texas passed S.B. 4, a bill aimed at dramatically increasing the surveillance, racial profiling, and policing of im/migrant communities. S.B. 4 and similar bills further limit the ability of im/migrants to travel for abortion care. Since then, nine more states have pursued copycat legislation to adopt similar policies.

On June 13, 2024, the U.S. Supreme Court unanimously ruled that a group of anti-abortion physicians did not have standing to challenge the FDA’s actions related to the approval of mifepristone, which is used in medication abortions. Mifepristone will remain on the market and accessible in states where abortion is legal.

However, this attack on medication abortion could continue. The case will be sent back down to federal district court judge Matthew Kacsmaryk, who has already allowed the states of Kansas, Missouri, and Idaho to intervene in the case. Access to medication abortion is critical for im/ migrant communities, with the procedure accounting for 63 percent of all abortions nationwide in 2023.

Mifepristone provides individuals seeking an abortion a safe, discrete, and accessible way to get the care that they need. The consequences of not being able to access medication abortion disproportionately impact people of color, individuals with low incomes, im/migrants, and LGBTQ+ communities. For im/migrants that live in states with restrictive abortion bans and for whom traveling across state lines is not an option, protecting mifepristone access is crucial.

III. Abortion bans make it more difficult for people in immigration detention to receive timely reproductive health care.

Additional restrictions make accessing an abortion even harder for people in detention. While the Biden-Harris Administration adopted a general policy to not detain pregnant people, some still are due to strict mandatory detention laws. Because of a lack of reported data, however, it is unclear how many pregnant people have been detained, have requested an abortion, or have been granted their request.

Im/migrants who make the journey to the U.S. face significant risks of sexual assault, and therefore are at increased risk of unwanted pregnancy as a result of rape. Underreporting due to stigma, fear, and lack of access to care makes measuring sexual violence among migrants difficult. In 2023, Doctors Without Borders reported treating nearly 400 sexual violence cases in the Darién Gap alone. Older reports estimate that between 60 percent and 80 percent of female migrants, including teenagers and children, are sexually assaulted on their journey through Mexico. Once in the United States, pregnant minors are often limited in their choices when they are placed in Office of Refugee Resettlement (ORR) custody. Although the Biden-Harris Administration reaffirmed a policy of noninterference with minors attempting to access care, without permanent legislative protections, this policy will always be at risk.

In 2020, more than half of ORR-funded shelters serving children were located in states that now have restrictive abortion policies. Following Texas’ abortion ban and the Dobbs decision, the Biden-Harris Administration put forth guidance that prioritizes placement of pregnant minors in states without abortion bans and outlines a transfer policy under which unaccompanied minors who request abortion care in a state where abortion is illegal are transferred to a facility in a state where they are able to receive care. Although this is an improvement on previous guidance, stronger, more permanent protections are still needed. Moving unaccompanied minors between facilities makes it more difficult for them to stay in touch with their family, legal advisors, and health care providers. In addition, the time it takes to transfer a young person between states often leads to delays in care, making it more expensive and burdensome to receive services. Finally, this transfer policy and other policies that aim to protect the rights and health of unaccompanied minors are at risk of being rescinded under a future administration, as previous administrations have attempted to limit access to abortion for unaccompanied minors.

Recommendations

Congress must pass legislation that supports a universal right to access abortion and protects the reproductive rights of all people residing within our borders.**

*Note: The use of the term “im/migrant” is to recognize all persons and communities that are living in the U.S. who come from different countries or have migrated from different territories, whether temporarily or permanently