Pregnant Immigrants Say They’ve Been Denied Medical Care in Detention Centers

According to Jennye Pagoada López, when she arrived on July 23 at the US-Mexico border, she was four months pregnant and bleeding. Seeking political asylum, Pagoada hoped to finally put an end to nearly 20 years of violence she and her family had suffered at the hands of the notorious gang Barrio 18—first in Honduras, then in El Salvador.

But instead of finding a new life in America, Pagoada was detained shortly after crossing the border and then sent to the Otay Mesa Detention Center in San Diego. Six days later, Pagoada says, she suffered a miscarriage, after being denied proper medical care. US Immigration and Customs Enforcement (ICE) claims she was never pregnant while in their custody.

The detention of pregnant women is a growing concern among immigrant rights groups. On September 26, a coalition of seven groups, including the American Civil Liberties Union and the Women’s Refugee Commission, filed a complaint with the Department of Homeland Security (DHS) regarding the treatment of pregnant immigrants. The complaint cites media reports that 292 pregnant women were detained by ICE in just the first four months of 2017, a 35 percent increase compared to the same period in 2016.

The signatories write that they are “gravely concerned” with the conditions reported by pregnant women detained across the country, and with “the lack of quality medical care” provided. “In several of the cases, there is concern that women are receiving inadequate and sub-standard medical care during and after miscarriage,” the complaint reads. “In every instance, the women express concern that the conditions of their detention and pressure of preparing for their legal cases in detention has had a harmful impact on their pregnancies.”

The groups argue that these detentions contradict ICE’s own policy. An August 2016 ICE memorandum authored by the current acting director of the agency, Thomas Homan, instructs that “pregnant women will generally not be detained” unless there are “extraordinary circumstances or the requirement of mandatory detention.”


When Pagoada turned herself in at the San Ysidro Port of Entry, she expected to be released in accordance with this policy. She was escorted to the border by Luis Guerra, a legal advocate with the United Farm Workers Foundation. Advocates say they have repeatedly witnessed Customs and Border Protection (CBP) telling immigrants that “political asylum doesn’t exist” and turning them away. As a result, immigrant rights groups were redoubling efforts to ensure that when people like Pagoada arrived, someone was present to help them obtain their legal right to claim asylum.

Guerra says that both he and Pagoada informed the CBP officers that she had a high-risk pregnancy and should receive immediate parole and access to medical care. Three days later, he learned that Pagoada was being held by ICE at Otay Mesa. Guerra and Allegra Love, an attorney with the Santa Fe Dreamers Project, asked that Pagoada be taken immediately to a hospital for prenatal treatment. She had continued complaining of vaginal bleeding as well as stomach and lower back pain. Love again cited the August 2016 ICE memorandum and said the facility was violating its own policy. “I sent the request to every officer who could possibly have influence on her case,” says Love. “I was ignored.”

Pagoada told her attorneys that on her sixth day at Otay Mesa the medical staff said she wasn’t pregnant. According to ICE spokeswoman Lauren Mack, “All of the appropriate protocols were followed and the medical tests did not support [Pagoada’s] claim that she was pregnant” while in the agency’s custody. Love disputes this assertion, noting that the test results were never communicated to counsel despite repeated instances of her and Guerra advocating for Pagoada’s prenatal care.

Pagoada’s case is among the ten included in the complaint filed with DHS, as are those of five women who were detained in the South Texas Family Residential Center (STFRC) in Dilley, Texas. Katy Murdza of the CARA Pro Bono Project has worked at STFRC as the advocacy coordinator for the past four months. Until recently, Murdza says, most pregnant women were released immediately at the border or within 24 hours, and would then receive a date to go before an immigration judge. This approach didn’t mean that the women got “a free pass to live in the US forever, or that they won asylum. It just meant they would go before an immigration court at a later date,” says Murdza. The majority of women who are released live with family or friends—a healthier environment than detention and also far less costly to taxpayers than detention.

In June, the Trump administration scrapped an Obama-era case management program offering alternatives to detention, which had a 99 percent compliance rate with immigration court appearances at a cost of about $36 a day per family. Since then, Murdza says, the number of pregnant immigrants detained at STFRC has risen. “Now we’re seeing about one pregnant person per day, and thirty since mid-August,” she says. “Almost none of these folks are paroled quickly anymore.”

Murdza describes pregnant women struggling with various kinds of stress and trauma in detention. Some are in the US because they are fleeing torture, abuse, or rape (and in some cases learn in detention that their rape resulted in pregnancy); some are trying to care for their children who are also struggling with detention and recent trauma; some have miscarried in the past due to stress or depression, and now fear a repeat due to their current circumstances; and there is little rest since detainees are sharing rooms with so many people, many of whom are sick.

Then there is an overlying stress for all pregnant asylum seekers: they face an interview to determine if they have a “credible fear” of returning to their birth country. Flunk that test, and they can be deported to the country that they just escaped.


Pagoada’s credible fear interview occurred one week after her miscarriage, according to Love and Guerra. They claim that at the time of the interview, she still hadn’t received proper medical care, was severely depressed, and had had only one visit from a counselor—to determine if she was suicidal.

According to Guerra, Pagoada experienced numerous traumas prior to seeking protection from the United States; they include multiple sexual abuses, one perpetrated when she was an adolescent living in Honduras by her stepfather who had ties to Barrio 18, according to Guerra. At that time, the family reported Pagoada’s stepfather to the police but he escaped custody. Shortly thereafter the death threats began, and a cousin who shared her surname was kidnapped and murdered. Pagaoda and her mother fled to El Salvador, while her brother remained behind and worked.

In El Salvador, Guerra says, Pagoada received phone calls extorting her to pay protection money or she and her brother would be killed. Late last year, her brother joined Pagoada and their mother in El Salvador. Within a few days of his arrival, members of Barrio 18 tortured him and mutilated his body. Pagoada and her mother were only able to identify him by a tattoo of the mother’s name. After fleeing for Mexico, they were still unable to escape violence. Staying at a shelter, Pagoada was assaulted by a man that they feared also had ties to the gang. When she learned she was pregnant, Pagoada decided to seek asylum in the US, hoping she would finally rid her and the baby she was expecting of the violence that had long plagued her.

But the asylum officer declined to find that Pagoada had a “positive credible fear” of returning to her birth country, and so she was scheduled for “removal.” Guerra believes that determination was due to the fact that Pagoada focused only on her most recent trauma—her brother’s murder—in the interview. With just one day until her deportation, Guerra and Love successfully obtained a second interview for her, saying that she had not been fit “medically, physically, or emotionally” for the first interview, and that she had not been able to tell her entire story. This time Pagoada talked about her life in Honduras, and the officer determined she had a “positive credible fear” of returning there.

Guerra and Love argue that the determination—along with the fact that she isn’t a flight risk and doesn’t pose a threat to public safety—again suggest that Pagoada should be released under ICE’s own guidelines. But nearly three months since she came to the country seeking asylum, Pagoada remains in detention. Pagoada says that she still needs medical care—she is suffering from depression, frequent headaches and vomiting, and numbness in her face. According to Guerra, as of October 1, she still hadn’t seen a doctor outside of Otay Mesa, despite repeated assurances that she would be able to do so. ICE maintains that like every detainee, Pagoada received a screening by medical staff to determine medical, dental, and mental health status within the first 12 hours of arrival into the detention facility; according to ICE, detainees are referred to off-site specialists as determined by their on-site primary care providers.

An ICE spokesperson says the August 2016 memorandum stipulating that pregnant women will not be detained absent extraordinary circumstances remains current policy. But advocates see evidence of a new, brutal era in immigration enforcement. “This is about the Trump Administration making it as hard as possible for immigrants to come here, even for pregnant women seeking political asylum,” says Love.

The Department of Homeland Security’s Inspector General and Officer for Civil Rights and Civil Liberties are responsible for investigating the complaint filed on behalf of Pagoada and the nine other women. Regardless of the outcome, for Pagoada that investigation is too little, too late.

This article was produced in partnership with The Nation.

Correction: An earlier version of this article referred to “Barrio 18” as “MS-18.”



The Other Repeal and Replace Effort Taking Place in D.C.

When D.C.’s paid leave proposal passed into law earlier this year, it was widely regarded as one of the most generous packages of its kind. But now, some of the same legislators who passed the bill—known as the Universal Paid Leave Act (UPLA)—are attempting to overhaul it, jeopardizing its ability to deliver long-awaited benefits to D.C. workers.

The bill passed by the D.C. Council goes into effect in 2020, granting eligible workers eight weeks of paid leave per year for a new child, six weeks toward care for an ill relative, and two weeks to attend to a temporary disability. It is the product of a two-year battle between advocates, who originally proposed 16 weeks of paid leave funded through a payroll tax, and a business lobby that fought for half as much leave with unclear funding mechanisms.

But since the UPLA became law in April—without the signature of Mayor Muriel Bowser, who cited concerns about the tax it imposes and the fact that it creates a new bureaucracy—four Council members have come forward with proposals to overhaul how the program is administered. Although the bills that have gained the most traction don’t reduce the length of paid leave or the wage replacement rate, they introduce new systems that threaten to compromise workers’ ability to actually access their benefits.

Under the current law, benefits will be funded by a 0.62 percent payroll tax paid by employers. The D.C. government will administer the program in its entirety, meaning that workers will submit paid leave requests to and receive benefits from a government agency instead of negotiating them with their employers. This model is a boon to workers, many of whom have seen requests for paid leave denied by managers.

But, at the behest of business and trade associations, multiple D.C. Council members have introduced alternatives to the UPLA that replace the centralized system in current law with one that gives control to individual employers––in many cases, the same employers who opposed the paid leave bill in the first place. Under the bulk of these proposals—there are five in total—employers pay significantly less in payroll taxes (in some cases a rate of just .1 percent), and instead either pay for paid leave benefits out of pocket or purchase private insurance.

This system—termed the employer mandate—replaces the predictable payroll tax with an unknown, and likely very volatile, cost to employers, who will have to pay for paid leave out of pocket, and can’t predict when employees will need to access their benefits. Because businesses’ profit margins are on the line, it creates a powerful incentive for employers to discriminate against the workers who are most likely to need to take time off from work. Currently, it isn’t uncommon for employers to pay these workers less, fire them, or just not hire them in the first place, rather than provide them paid leave. For low-wage earners, who are more often subject to intimidation by employers, the stakes are especially high.

In the United States, paid family leave is uniquely difficult to come by—unlike in literally every other industrialized country, where it’s guaranteed to workers. Only a handful of states (and now D.C.) have such laws on the books, and the majority of the nation’s employees are faced with untenable decisions between a paycheck and critical time off to care for themselves, a relative, or a newborn. On the flipside, when people have access to paid leave, their labor force participation rates improve, alongside their economic security and their health outcomes.

D.C. workers had been promised one of the nation’s strongest paid leave programs, and a full 82 percent of D.C. residents––who also, after all, live in one of the nation’s most progressive hubs––support it. But under these new proposals, some of the workers who need those benefits the most may never receive them.



How Hurricane Response Efforts Are Sorting People into Deserving and Undeserving Poor

Hurricanes Irma and Harvey delivered a devastating one-two punch to Texas and Florida, forcing millions to evacuate and leaving thousands displaced. Now, as emergency responders try to help hurricane victims cope with the aftermath of the storm, previously homeless residents are taking a particularly hard hit.

In Florida, as officials rushed to open emergency shelters for those forced from their homes by Irma, some residents who had been homeless before the hurricane were forced to wear bright yellow bracelets to mark their status. In St. Augustine, previously homeless people reported that they were not only forced to wear wristbands, but that authorities warned newly homeless hurricane victims to stay away from people with the yellow bracelets because they were criminals, thieves, and drug users. One woman described her experience to a local service provider this way: “They treated me like I was non-human, insulted me and others … [They] separated us from other people.”

In New Smyrna Beach, Florida, a community volunteer said that previously homeless people—including some in wheelchairs—were turned away from hurricane shelters and later directed to the Volusia County Fairgrounds, which served as a segregated shelter for pre-hurricane homeless people. A homeless man in Daytona Beach said, “[We] were treated like animals … like we got a disease or something.”

The unequal treatment of “pre-hurricane homeless” people versus “hurricane homeless” people was not unique to Florida. One Houston service provider told me, “There was definitely a treatment of people who had been homeless prior to the storm that was different … [they were] told that they needed to go to agencies that are part of the city homeless service system, rather than receive services within the [hurricane] shelter.”  They were then de-prioritized for assistance too, as a spokeswoman for the Federal Emergency Management Agency wrote in an email to Reuters: “If an individual was homeless pre-disaster, they may not be considered for Housing Assistance and Other Needs Assistance, which both require successful verification of pre-disaster occupancy.”

The reality is, none of the people who were homeless before the storms were living “pre-disaster” lives. Before the hurricanes struck, they had already fallen victim to more routine disasters: a lost job, eviction, health crisis, domestic violence, untreated addiction, or mental illness. Any of these can lead to homelessness because of the manmade disaster that is the biggest driving cause of homelessness today: the crisis in affordable housing.

After decades of cuts to federal housing programs—which shrank as a share of gross domestic product by 30 percent between 1996 and 2016—only 1 in 4 of those who are poor enough to qualify for housing assistance currently receive it. At the same time, as many cities experience luxury development booms, lower-income people are being displaced from the private housing market. As inequality deepens, poorer Americans must crash with families and friends, live in their cars, seek refuge in emergency shelters, or try to survive on the streets.

Some of us are both more vulnerable and more likely to be excluded from help and human decency.

For those living in public, there is also the risk of being fined, arrested, and even jailed. Increasingly, cities across the country are passing and enforcing laws that make it a crime to sit, sleep, and even eat in public places. Over the past ten years, such laws have increased dramatically the throughout country—including in some of the same cities that rushed to the aid of hurricane victims.

In Houston, some 6,000 people were homeless pre-Harvey, and emergency shelters had long been full. But instead of helping homeless residents, the city passed a new law just before the storm making it a crime to sleep on the street—punishable by fine, arrest, and incarceration.

The slew of storms will now worsen the already tight housing market—the destruction of millions of properties will increase demand and drive rents higher. This will likely hit low-income people particularly hard, since they are more likely to live in flood-prone areas or in shoddy, unsafe housing, making their residences particularly vulnerable to ruin. Not surprisingly, these disasters disproportionately affect people of color, who are not only more likely to be poor, but also more likely to be homeless. Those unable to receive housing assistance will be left to fight for space in overflowing emergency shelters or to live on the streets.

People often come together with generosity in the face of natural disasters, as they can remind us that we are all vulnerable to nature. But as Harvey, Irma, Jose, and now Maria have shown, the reality is that some of us are both more vulnerable and more likely to be excluded from help and human decency.

A coalition of organizations is now advocating for new policies to ensure a fair and just recovery—and to prevent those who are most vulnerable from being stigmatized, excluded, and tagged with special bracelets during future natural disasters. Responses to natural disasters must be equitable, both during and after the crisis. They must recognize the needs—and humanity—of those made homeless by natural disasters and those made homeless by manmade disasters.

Editor’s Note: This article was produced in collaboration with the Economic Hardship Reporting Project.



The House Budget Shows Us That Poverty Is a Choice

This week, Speaker Paul Ryan will finally bring the House budget to the floor for a vote. It passed out of the Budget Committee back in July, but far-right lawmakers wouldn’t support a floor vote until they received more details on President Trump’s long-touted tax “reform.”

A tax framework was released last week, so House Republicans are now primed to vote on the budget and set the budget reconciliation process in motion, which, if successful, will allow Republicans in both chambers to pass a joint budget by simple majority, thus skirting the threat of a Democratic filibuster. As confusing as all that may be for non-wonks (explainers here, here, and here), it’s all technically permissible under legislative procedure.

Though it seems to have satisfied the Freedom Caucus (temporarily), there is considerable disagreement as to whether or not the White House’s nine-page framing document on taxes actually clarified much of anything. Trump and his various surrogates have done an awful lot of lying in the meantime—about who benefits, who doesn’t, and by how much—and no one seems to know how, exactly, the Congressional majority intends to pay for the trillions of dollars in tax cuts for which they’re calling. It seems to involve a fair amount of magical thinking.

Well, magical thinking, and shanking the poor. That much was clarified: The poor will, of course, be shanked.

Tax brackets, tax breaks, and just how the rich will become richer are all important details, no doubt, but among those details runs a single, shining through-line, a unifying message: Some people are worth investing in. Other people are not.

Every budget answers a question: Given a finite amount of treasure, on whom is it best spent? Should we, as a society, give $125 a month in food to people who can’t find a job, work in poorly-paid industries, or have fallen ill, or put an extra $129,000 into the pockets of people who make three-quarters of a million dollars a year? What’s better: Putting money into education initiatives and loan forgiveness programs that give those in poverty a tool with which to try to escape poverty, or helping the wealthy protect their wealth in off-shore tax havens?

Even for Trump and Congress, the calculus on who makes the cut is complex. It’s informed by race, by gender, by existing wealth, by proximity to power, by actual power. It’s informed by pettiness and greed. But at the end of the day—at the end of every single day—we still have a choice. The divide between poverty and wealth is a choice made by Americans who have arrived at a judgement about the fundamental worthiness of the lives of other Americans.

Poverty is a direct outcome of how humans with power choose to relate to other humans.

Contrary to how we usually discuss it, poverty is not a condition—it’s not dandruff, or cancer. Poverty doesn’t just appear at random, nor is it part of the natural order. Poverty is a choice, a series of choices, made and compounded across generations, by human beings. And as that choice is made by one group of people about another group of people, poverty is ultimately a relationship.  It is a direct outcome of how humans with power choose to relate to other humans.

The Ryan budget and Trump tax plan are blunt instruments with which to cement and extend the existing relationship between the extremes in American society—and the extremes are already more extreme than they’ve been in generations.

About a week before Trump unveiled his tax plan, the founder and chairman of Bridgewater Associates, the largest hedge fund in the world, made a startlingly frank comment about income inequality: At a fundraiser for Grameen America, Ray Dalio said that the United States effectively has two separate economies, and “the greatest issue of our time is the disparity of wealth and the problems that exist for the lower 40 percent of the population.”

Just days after Dalio made his comments, the Federal Reserve released a report about that very disparity, finding that the top 10 percent of American wealth holders already control 77 percent of the nation’s wealth. The top 1 percent of families control 38.5 percent.

Much of human suffering is beyond human control: Hurricanes and heartbreak will always come, no matter what we do. But poverty is a human relationship, in which humans decide who to value, and in whom to invest. Humans decide if the rich are going to get richer as the poor get poorer.

For all the commotion and legislative jargon currently swirling around the Congressional budget and tax plans, it’s important to remember that the poverty enshrined in both isn’t inevitable. It’s just that the wealthiest and most powerful people in America are doing all they can to ensure that people in poverty stay in their place.



The Bipartisan Attack on People with Disabilities: ‘If This Passes, My Children Will Have a Tougher Life Than I Had’

Editor’s note: This interview was edited for clarity and length.  To listen to the full interview or read the full transcript, visit the Off-Kilter podcast page on Medium.

While all eyes were focused on the latest effort by conservatives to take away your health care, Congress quietly advanced a bill that would roll back the civil rights of people with disabilities by exactly 27 years—to a time before the Americans with Disabilities Act. The ADA Education and Reform Act of 2017 would create onerous red tape for people with disabilities attempting to enforce their rights under Title III the ADA (the part of the statute that applies to places of public accommodation). It would not only shift the burden of compliance from business owners to people with disabilities, but would allow businesses to delay compliance with a decades-old civil rights law for months—if not years.

I spoke with Rebecca Cokley, a Senior Fellow at the Center for American Progress and the former Executive Director of the National Council on Disability, about the stakes of this fight for people with disabilities and allies.

Rebecca  Vallas: So the bill is misleadingly titled “The ADA Education and Reform Act of 2017”. It should probably be called the “Let’s throw the ADA in the sewer and stomp on it with really high sharp heels bill of 2017”. Is that a fair characterization and what would the bill do?

Rebecca Cokley: I think that’s more than fair—and after we step on it with some high heels we’re going to stick it in a paper shredder and then use that to line a bird cage. The bill itself would actually push back requirements around accessibility and accommodations. [The Americans with Disabilities Act] has been the law for 27 years. We’ve had whole generations grow up that have never understood life before it. And what this would do is: a) it would put the onus much more on people with disabilities to prove discrimination in very tedious ways, and b) it would then allow business even more time, a minimum of an additional six months after a complaint is filed, not even to remedy the barrier but to “make substantial progress.” So that could mean instead of having an actual ramp so people could access a place,  somebody could come out and tell them what the ramp would cost.

RV: So say you are a person who uses a power wheelchair, and you get to a building and you find you can’t get inside. And you want to enforce your rights under the ADA.  What new hoops would you have to jump through under this proposal?

RC: The way the complaint process will actually shift is it will require such technical language that the average person with a disability is not going to feel qualified or empowered enough to even understand where in the law their particular situation might fit.

RV: So is what we expect to happen basically the lack of enforcement of a law that’s been the law of the land for 27 years? Is that eventually where this heads?

RC: I think there’s no other destination for it to head than that.

RV: You are a member of what’s often called the ADA generation and I would love for you to paint a picture of what life looked like before 1990—and before the ADA was in place.

RC: I’m part of the 20 percent of people with disabilities that grew up with parents with the same disability that they had. My dad became paralyzed when I was a year and a half and both my parents were little people. I remember my mom being denied tenure because she could only use the bottom six inches of a chalkboard. That was actually used to deny her tenure at the college that she had worked for decades. I remember wanting to go places with my dad who used a wheelchair and not being able to enter buildings. I remember my dad wanting to go vote and them having to bring the ballot out to his car and him getting really upset. He had been very active in voting rights issues in the south and was upset that in 1988 he couldn’t vote for the presidential election the same way that everybody in his family could.

RV: So how did the ADA change things?

RC: I think for so many people with disabilities you don’t even think about it anymore. And people without disabilities don’t even think about it anymore. You’re walking down the street managing your luggage and you take it down a curb cut, which is typically the example people tend to use. Or trying to get suitcases up a flight of stairs and there’s a ramp. The ADA really did a number of different things that were historic, the first of which was laying out a definition of disability that was not based on an inability to work or a requirement for health care. It was really talking about having a condition that affected the activities of daily living.

So let’s say you are a burn victim, and it doesn’t impact your ability to do your job but you are still discriminated against because you’re perceived as a person with a disability. Or you have a history of impairment—if you’re an individual who had a substance abuse addiction and were in rehab and had come through recovery, you still have that past history that qualifies you as a person with a disability. So it really cast a net that included millions of individuals with similar experiences tied to being historically discriminated against.

RV: Attacks on the ADA are nothing new, but this latest wave is actually gaining steam in Congress. This comes on the heels of a 60 Minutes piece that alleges widespread so-called frivolous lawsuits—people with disabilities who didn’t actually face discrimination but are just trying to milk the system and maybe even get money out of it.   Don’t we need to rein in frivolous lawsuits?

RC: Even in the original statute, there is means for dealing with frivolous lawsuits. State courts and state bar associations can punish attorneys who are filing lawsuits that are proved to be frivolous.

RV: So who is behind this bill and what’s really going on here?

'At what point are they going to have to comply with the law?'

RC: It’s important to note that both Democrats and Republicans are behind this bill. We continue to talk about disability rights being a bipartisan issue, but we’re also under bipartisan attack. You know we continue to hear that business feels attacked because they’ve been asked to comply with the ADA every year for the last 27 years. But the idea that after 27 years they should have even more time and then still refuse to be accessible—at what point are they going to have to comply with the law? Or are we just going to keep creating a slippery and slipperier and slipperiest slope—but actually not a slope because we’re not about accessibility, so a staircase.

RV: The 60 Minutes piece is part of a pattern of media coverage of pretty much only knowing, with very few exceptions, how to paint people with disabilities as takers or abusers of a system that they see a way to take advantage of. Am I off base here?

RC: Not at all.  I think there really is a myth that people with disabilities are collecting monetary damages off of this. It is not like you have a bunch of disabled veterans swimming in Scrooge McDuck’s money bin based on ADA lawsuits. People cannot collect monetary damages on these claims. All you can do—the only remedy that’s available—is having that place made accessible.

RV: Attorney’s fees and some [compensation] for their time, but that was intentionally done to enable people to find lawyers who are willing to take those cases.

RC: Exactly. The disability community is a poor community— 50 percent of people with disabilities live at or below the poverty level.

RV: So is the fight that people with disabilities are facing in 2017 categorically different from what other groups that face discrimination are [fighting] at this point in time?

RC: In some ways yes, in some ways no. I think I can connect it most easily with how several of our allies in communities of color felt about the rollback of affirmative action programs. You want your children to have a better future than you. You want your children to have better access to services, to programs, to school, to the world. And if this passes, my children are going to have a tougher life than I had, and that just doesn’t seem right.

RV: And it doesn’t seem very American.

RC: No, not at all.