The Bureaucratic Violence of the Health Care System for Pregnant Immigrants on the United States-Mexico Border

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.