Unaccompanied and pregnant: The challenges of finding health services

This article was produced as a project for the California Health Journalism Fellowship, a program of theCenter for Health Journalism at the USC Annenberg School for Communication and Journalism.

Other stories in the series include:

Unaccompanied minors and their harrowing journey to safety

At 14-years-old, Valentina Fernandez* didn’t expect to be a mother, let alone as the result of a rape. Soon after celebrating her son’s first birthday at their home in Guatemala, the young mother and her son joined the nearly 70,000 unaccompanied minors who made the long journey to the United States in 2014, seeking asylum from the rampant violence and extreme poverty of Central America’s Northern Triangle, which has been likened to a war zone.

Fernandez said she didn’t come to the U.S. willingly, but the circumstances she faced in her country forced her to leave. Fernandez and her son, Jordan, arrived at a detention center in 2014, where they received physical and mental health care, but she didn’t expect the challenges she would face when accessing health care for herself and Jordan once they were released to family members in Los Angeles. And the challenges grew even greater when she became pregnant with her second child.

Nearly 40,000 unaccompanied minors have continued to flood the southwestern border each year since the surge of 2014, the majority coming from Guatemala, Honduras and El Salvador. Most of the unaccompanied minors that come to the U.S. are teenage boys, but in 2015, nearly one-third of the 33,000 unaccompanied minors referred to the Department of Health and Human Services were girls. In some cases, the girls are fleeing their country because they were victims of sexual assault. Some girls are raped on their journey to the U.S. and don’t learn of their pregnancies until undergoing medical screenings while in U.S. custody.

“We are seeing a very high percentage of unaccompanied minors that have been victims of rape or sexual abuse, especially rape by gangs,” said Judy London, directing attorney of Public Counsel’s Immigrants’ Rights Project. The United Nations Office of Human Rights has recognized rape as a weapon of war, and is often used by gangs during turf wars to express their dominance.

More than 1,123 cases of rape were registered with El Salvador’s National Civil Police in the first 8 months of 2015. 597 of the cases reported were cases where a minor or handicapped person was raped. Women’s rights advocates say that a large number of sexual assault cases go unreported, especially in countries where rape and violence against women occur with impunity.

In 2014, there was a total of 726 pregnant unaccompanied minors in the care of the Department of Health and Human Services, Office of Refugee Resettlement (ORR), the number decreased to 456 in 2015 and 367 year-to-date. Customs and Border Protection agents picked up about 21,000 family units in the months of May, June and July, although it is unclear how many of those mothers are under the age of 18.

While the ORR locates family members of unaccompanied minors to take them in, the majority of the children are cared for through a network of about 100 state licensed ORR-funded facilities, some of which are shelters with specialized expertise in caring for pregnant or parenting unaccompanied minors, said Victoria Palmer, public affairs specialist for the Department of Health and Human Services, in an email.

Immigrant Respite Center Aids Families Seeking Asylum In U.S. | Photo: John Moore/Getty Images

Immigrant Respite Center Aids Families Seeking Asylum In U.S. | Photo: John Moore/Getty Images

“There are huge challenges for a young mother to find herself terrified of deportation in a new country with absolutely no support provided by our government while their asylum claims are pending. The children may have access to therapy and medical care while in the care of ORR, but once they’re released the government obligation tends to end,” said London. 

“The government is not recognizing a right to counsel for unaccompanied minors, so it’s extremely difficult for a child to find a lawyer. Then you add the challenge of a child who is herself a young mother and the baby is also put in removal proceedings, there’s challenges everywhere you look. All unaccompanied minors are vulnerable, but the pregnant girls are so much more vulnerable,” said London.

Before being released to the care of family members in Los Angeles, Fernandez received an address to a clinic from officers at the detention center where she could take her son to get health care. She wasn’t able to make an appointment for a check-up because while their asylum cases were pending, they remained undocumented and prior to the passing of Senate Bill 75 in May, undocumented children were only eligible for emergency medical services.

“When we were in [the detention center in] Texas we got to see the doctor and when we got to Los Angeles I thought it would be the same, but it wasn’t. It made me feel bad to take my son to the doctor and see him get denied care. He couldn't see the dentist either and like all kids, he should be able to see the dentist and get a check up,” said Fernandez in Spanish.

The first year was the hardest for the two, said Fernandez’s attorney, Lucero Chavez, a staff attorney with Public Counsel’s Immigrants’ Rights Project. She would help Fernandez make appointments with different social services agencies to get her assistance with services like therapy and housing, but Fernandez was often denied because she was undocumented.

“She also didn't have time to go to many appointments because she was working and she would've needed to get a babysitter to go and she didn't have money for a babysitter, so it made it harder,” said Chavez.

After settling in at her family’s home in Los Angeles, Fernandez started attending high school as a sophomore. She would leave her son with a babysitter while she went to school and her part-time job after school at a hair salon.

Because she was told Jordan couldn't receive health care services because he was undocumented, Fernandez feared they would be denied other social services and dropped out of school to start working full-time at the salon.

Fernandez was able to receive food vouchers through Women, Infants and Children (WIC) Supplemental Nutrition Program, which doesn’t have restrictions on an applicant’s immigration status.

Unaccompanied Minors - Health Service. | Photo: Lucy Guanuna

Unaccompanied Minors - Health Service. | Photo: Lucy Guanuna

“WIC helped with certain things, but I didn't want to use it because our asylum case was pending at the time and I was worried it could affect the case,” said Fernandez.

When Fernandez became pregnant with her second child in 2015, she didn’t know she was eligible for pregnancy-related services, until an employee at a WIC office referred her to a clinic for care.

“I didn’t know how I would pay for the doctor. After I started going to the doctor for prenatal visits, they explained how Medi-Cal would cover everything,” said Fernandez. Medi-Cal does not have immigrant eligibility restrictions for pregnancy-related services.

“Them being pregnant adds more to the difficulty of everything they have to do. These pregnant unaccompanied minors don’t understand how the health care system works. It’s expensive and hard for them to navigate and I don’t think their families or sponsors know either,” said Patricia Ortiz, program director at Esperanza Immigrant Rights Project.

Undocumented immigrants can be apprehensive about trying to take advantage of services and programs available to them for fear of deportation.

“The people in my family don't know too much about social services. They told me don't try to get it because if I was denied services, [ICE] would deport me immediately. They said I would be putting myself in danger. They also said not to put their address down because if immigration came to deport me, they could be deported too. They didn't help me out of fear of getting themselves in trouble,” said Fernandez.

Fernandez lived in Texas a few months during her pregnancy, where a lack of access to public transportation sometimes prevented her from seeing a doctor.

“It was sometimes a problem when trying to get to prenatal visits because sometimes the buses would take over an hour or an hour and a half. It would worry me because I lived far from the clinic and if I arrived late, they wouldn’t see me and I would have to reschedule to come on another day,” said Fernandez.

Transportation can be one of the greatest barriers when trying to access pregnancy-related services because many teens don’t have jobs or consistent employment, so they don’t always have money to use public transportation, said Stacey Hodgkinson, a psychologist at Children’s National Health System and coauthor of the report “Addressing the Mental Health Needs of Pregnant and Parenting Adolescents”.

“It would be nice if there were quality health care in every community, but that’s not always the case, so we have teens travel pretty great distances. A lot of times health care providers and facilities that take insurance for low income families just aren't conveniently located,” said Hodgkinson.

Reproductive rights advocates say the pregnant unaccompanied minors who might want to terminate their pregnancy, may not be given the proper information on how and where to access these services.

The staff at ORR care facilities are only required to provide services for pregnancy prevention, STD testing and mental health services for sexual abuse victims to unaccompanied minors that have been sexually abused in ORR care.

Unaccompanied Minors - Family. | Photo: Lucy Guanuna

Unaccompanied Minors - Family. | Photo: Lucy Guanuna

“For those who come to the U.S. pregnant and who may want to terminate a pregnancy that’s the result of a rape, they don’t know what services are available and more often than not, the information is not being relayed to them. If they’re pregnant and considering terminating their pregnancy, another issue that may prevent them is that often in their home country abortion is illegal, so it might not be an option that they even consider,” said Ena Valladares, research director for the California Latinas for Reproductive Justice.

Fernandez moved back to Los Angeles with Jordan and her daughter, Natalia and recently started a new job cleaning houses Monday through Friday. As soon as she and Jordan were granted asylum, Fernandez enrolled herself and her children in Medi-Cal, although she said she has been waiting months to receive the Medi-Cal cards.

“It took one whole day to sign up the first time and now I am worried I will have to miss work to go back to ask them why the cards haven’t come yet,” said Fernandez. 

“For my kids, I don't want them to suffer what I suffered. I want them to have the opportunity to have what I didn't have. What mother wouldn't want to see their kids on a stage getting their diploma? I want that to be my kids,” said Fernandez. 

Fernandez plans on going back to school to get her high school diploma and learn English.

“I not only want to finish high school, but also the university because I want my kids to be proud of me when they get older,” said Fernandez. “I want to say that this is for all the women that have come or that want to come – although it seems difficult one day, tomorrow you see the fruits of your labor.”

[This story was originally published by KCET.]

*Name changed for privacy.