The intensification of U.S. immigration enforcement policies has raised concerns among health, social service, and legal assistance providers about unintended adverse effects on the use of services among Latinx and immigrant communities. Latinos and Latinas (referred to as Latinx) make up 18 percent of the U.S. population and are the country's largest ethnic minority (Lopez, Passel, & Rohal, 2015). We will study the effects of current policies on service utilization from the perspective of providers in a border community with a high proportion of Latinx and immigrant residents.
Immigration Policy and Enforcement Changes under the Current Federal Administration
U.S. immigration policy has prioritized border enforcement and interior deportation since the 1990s. This policy has hardened in the last two years. The Trump administration issued a series of executive orders in January 2017 to intensify immigration enforcement inside the United States, expand enforcement at the U.S.-Mexico border, and restrict entry to the United States for foreign nationals of seven Muslim-majority countries. These orders called for the hiring of 10,000 new Immigration and Customs Enforcement (ICE) officers and 5,000 new border patrol officers, deportation prioritization (fast tracking) of anyone in violation of immigration law, and expansion of expedited removals (National Immigration Law Center, 2017; White House Office of the Press Secretary, 2017). A U.S. Department of Homeland Security memorandum (2017) instructed immigration enforcement personnel to disregard mitigating factors for immigration enforcement used under previous administrations (prosecutorial discretion). Immigration and Customs Enforcement has reported a 30-percent increase in arrests of immigrants without documentation and a more than twofold increase in arrests of unauthorized immigrants without a criminal background (2017).
Significant policy shifts also occurred at the state level. State legislation related to immigration increased by 110 percent from 98 laws in 2016 to 206 laws in 2017. The largest category of new laws related to state budget allocations (25%), followed by law enforcement, including immigration enforcement (21%) (Morse, Pimienta, & Chan, 2018). For instance, the 2017 Texas Senate Bill 4 (SB 4) empowers Texas state and local police to inquire about immigration status during any law enforcement stop, to detain the people involved, and to turn them over to federal immigration authorities.
Effects of Immigration Enforcement Policies on Health and Service Utilization
Scholars have documented that fear of immigration enforcement and deportation, as well as political rhetoric fueling fear of and antipathy toward immigrants, heightens anxiety among the Latinx community in general and children in particular (Gonzalez, 2018; Martinez, Ruelas, & Granger, 2018; Roche, Vaquera, White, & Rivera, 2018). Fear of deportation increases parental stress among Latinx families (Berger Cardoso, Scott, Faulkner, & Barrios Lane, 2018). Anti-immigrant legislation and discourse have adverse effects on youth by weakening their sense of being American, lowering their self-esteem, reducing their acceptance of diversity (intolerance), and adversely impacting their self-efficacy (Santos, Menjivar, & Godfrey, 2013).
Restrictive immigration policies have been associated with adverse health outcomes and declines in service utilization among Latinx. For instance, the adoption of restrictive state immigration enforcement policies is linked to poorer self-rated health (Anderson & Finch, 2014) and mental health (Hatzenbuehler et al., 2017). Moreover, studies have found associations between immigration raids and poorer self-rated health and higher levels of immigration enforcement stress (Lopez et al., 2017) as well as higher proportions of low birth weight among Latina mothers (Novak, Geronimus, & Martinez-Cardoso, 2017). Research indicates that parental detention and deportation have negative material and psychological health effects on children including posttraumatic stress disorder and depression (Rojas-Flores, Clements, Hwang Koo, & London, 2017; Zayas, Aguilar-Gaxiola, Yoon, & Rey, 2015). Adverse effects on emotional well-being were found not solely among children of detained or deported parents, but also among children of parents who are at risk of deportation (Brabeck & Xu, 2010; Gulbas et al., 2016).
Research has uncovered associations between restrictive immigration policies and decreases in visits to county health (White, Blackburn, Manzella, Welty, & Menachemi, 2014), pediatric emergency (Beniflah, Little, Simon, & Sturm, 2013), and mental health departments (Fenton, Catalano, & Hargreaves, 1996). Similarly, Toomey and colleagues (2014) found a relationship between the enactment of Arizona's SB 1070, a law that enables local police to request proof of immigration status, and declines in public assistance utilization among Mexican mothers. Studies revealed links between strengthened enforcement and increased food insecurity in Mexican noncitizen households (Potochnick, Chen, & Perreira, 2017); lower participation in the Women, Infants, and Children Program in Mexican mixed-status households in particular (Vargas & Pirog, 2016); and lower Medicaid and other insurance coverage for children of noncitizen mothers (Watson, 2014).
Joanna Dreby's pyramid of immigration enforcement effects (2012) provides a theoretical basis for our study. According to this pyramid, the strongest but numerically smallest impacts are on children in households with individual members arrested, detained, or deported. In the middle are children in families who live in fear of deportation (families who mix legal and undocumented members). At the base of the pyramid are people who are not immediately at risk of arrest but who struggle with ambivalent identity because of overlaps between stigmatized social categories of illegal, immigrant, and Latinx, especially those of Mexican origin (Dreby, 2012). Although the pyramid depicts the effects of deportation policies on children, the hierarchy of impacts also applies to Latinx communities across age categories. The most significant but also least frequent effects are family dissolution and the corresponding material and emotional hardship. The middle category includes community members who live in fear of deportation for themselves and/or family members and friends. Finally, the largest group in the community, who are farthest removed from direct immigration policy effects, experience difficulties related to their identity based on societal conflations of ethnicity, race, immigration status, and illegality. The impacts at all levels of the pyramid, although to different extents, carry the potential to interfere with health, legal, and social service utilization among a predominantly Latinx and immigrant community in the border region.
Implications of Immigration Enforcement in the U.S.-Mexico Border Region
Questions about enforcement impacts on the well-being of immigrant and Latinx communities are particularly apt on the U.S.-Mexico border, given the history and social fabric of the region. On the U.S. side of the border, approximately half of the population is Hispanic and predominantly Mexican (Stepler & Lopez, 2016; United States-Mexico Border Health Commission, 2014). In El Paso County (the location of this study), 82 percent of the population is Hispanic, 25 percent foreign-born, and approximately 66,000 (of 835,000 total) are undocumented (Migration Policy Institute, 2014; U.S. Census Bureau, n.d.).
In addition to federal and state policy changes, specific enforcement activities in El Paso County and its surrounding region have sparked fears and behavioral changes in the community. For example, an ICE raid at a trailer park in nearby Las Cruces, New Mexico, in 2017 was followed by a 60-percent increase in...