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Using the concept bureaucratic violence, this article explores how health care bureaucracy contributes to harm for pregnant immigrants on the United States-Mexico border. The term bureaucratic violence captures how even when laws and health policies are not targeting a specific group, bureaucracy can do this work instead, causing systematic harm. Prenatal care in the United States captures this dynamic. In many states, prenatal coverage is available for low-income women regardless of immigration status. Yet, the bureaucratic routes for gaining access to coverage create latent forms of exclusion and fear, leading women to delay or not seek prenatal care or to experience anxieties over seeking care. In-depth interviews with pregnant and postnatal immigrant women revealed that threats of changes to bureaucratic procedures via the likely public charge rule was shaping the use of pregnancy-related public benefits. Even when women applied for these programs, they faced bureaucratic barriers and described bureaucratic monitoring as a source of emotional distress. These patterns can have detrimental effects on maternal and infant health outcomes. Bringing attention to bureaucratic violence can emphasize to health practitioners the struggles immigrants face in seeking prenatal care and the need for additional measures to support pregnant immigrants.
Key words: United States-Mexico border, immigration, maternal health, health care policy, bureaucratic violence
Introduction
I met Zahra in El Paso, Texas, in late 2018, four years after she had left Kenya for the United States. The previous month, she had given birth to her second child, just after moving from Dallas. The pregnancy was challenging, as she was homeless and unable to access prenatal care. She explained, "In Dallas, we lost a lot. You know, life just went downhill. So, we thought, 'Maybe if we go far away, that might change things.'" Prior to relocating to El Paso, Zahra's family was living out of their car when Zahra discovered she was five months pregnant. A community clinic instructed her to apply for CHIP Perinatal, which would cover prenatal care through the Children's Health Insurance Program (CHIP). Although Zahra had secured permanent residency through her mother, she had not been a resident long enough to qualify for Medicaid, which requires permanent residency for at least five years. Texas offers publicly-funded prenatal care for low-income women regardless of immigration status...