Written by rachna vanjani, md

As we witness the rise of authoritarianism and state-sponsored violence, it is important for reproductive health clinicians to recognize forms of systemic oppression and how they affect care for pregnant people in our communities. State-sponsored violence against pregnant people uses legal, police, and institutional systems to control, punish, or force pregnancy outcomes, often separating families and violating human rights.

The various forms of state-sponsored violence that affect our communities include institutional violence, criminalization of pregnancy outcomes, forced gestation through abortion bans, and medical coercion and neglect. This insight focuses on institutional violence, and what clinicians can do to keep pregnant patients safe amid rising ICE raids in their communities. 

In 2025, the administration rescinded a longstanding U.S. Immigration and Customs Enforcement  (ICE) policy that previously restricted immigrant enforcement activities in “sensitive locations,” including hospitals and clinics.¹ Shortly afterward, one of the largest federal immigration enforcement deployments in recent history, Operation Metro Surge in Minnesota from February to March 2026, involved ICE operations conducted at or near schools, healthcare facilities, childcare centers, courthouses, and places of worship. These raids have a widespread chilling effect, leading people to avoid medical and social services in fear of immigration enforcement.²

How can you provide safer prenatal care for immigrant communities?

In April 2026, the American College of Obstetricians and Gynecologists (ACOG) published Advocating for Safe and Equitable Obstetric and Gynecologic Care for Immigrants, which outlines several recommendations for clinicians and health systems.⁴

1. Do not inquire about or document immigration status unless it is clinically relevant to the patient’s care.
2. Develop clear policies distinguishing public and private spaces within health care facilities. Institutions should use signage and written policies restricting public access — including access by federal agents — to private patient care areas. Consider changing the location of your waiting room to a designated private area separate from check-in. Examples of printable signage are available through the Physicians for Reproductive Health website.
3. Practice immigration-informed care. Clinicians and staff should work with their institutions to create welcoming clinical environments for immigrant patients, including multilingual signage and patient-facing resources such as those available through the Immigrant Legal Resource Center Website.
4. Provide trusted legal and community referrals. When patients express concerns related to immigration status, clinicians should connect them with reputable medical-legal resources or trusted community organizations. See partner resources below.
5. Prepare staff for interactions with law enforcement. Hospitals and clinics should proactively develop policies regarding interactions with immigration officials and law enforcement. Tools such as The Badge Buddy Tool and online staff training programs can help clinicians and support staff understand their rights and responsibilities.
6. Engage in advocacy efforts. Reproductive health providers can play an active role in local, state, and national advocacy efforts to improve access to care regardless of immigration status. Advocacy can include fundraising, signing petitions, writing op-eds, contacting legislators, participating in media interviews, and attending rallies or press conferences.
7. Advocate for humane treatment of pregnant individuals in detention settings. Timely, comprehensive reproductive health care should be available to individuals held in immigration detention facilities, and pregnant people should not be targeted for immigration enforcement.

These tools and strategies can support clinicians, institutions, and staff in providing safe and compassionate reproductive health care for immigrant communities.

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