Prenatal Care, Immigration and the Welfare State: A Comparative of the Hispaniola and US-Mexico Dynamics

This thesis examines the problems that occur when the politics and practices of social services, specifically maternal and prenatal care, are guided by a distorted understanding of immigration. It compares the politics and practice of this care across two international borders: the U.S.-Mexico and that within Hispaniola. In an ideal world, care would be extended to all individuals regardless of citizenship. However, since every welfare state has its limits at the national border, citizenship matters to both federal governments and medical professionals. Government-provided resources play an integral role in the current immigration debate, as these programs are a collective investment in which all individuals contribute in order to sustain it. The United States developed the welfare state in order to provide necessary resources to those who could not afford it. Its creators did not view these services as a handout, rather as a support for the future workforce of the country. However, health care was and still is not provided on this model of economic and social citizenship. Current U.S. healthcare policy dictates that no one can be turned away in an emergency situation because someone cannot pay their medical bill, including undocumented immigrants. But for immigrant mothers carrying children across the border, maternal and prenatal care does not qualify as an emergency and the federal government aid typically does not extend to them them as citizens. When care is extended to undocumented immigrants in the United States at all, it typically is provided to the child through Medicaid, who is by dint of the Fourteenth Amendment considered a citizen after birth. The relation between the Dominican Republic and Haiti offers a more complex situation, as the idea of birthright citizenship has recently been revoked. Following the Haitian Earthquake in 2010, the only healthcare to which many Haitians had access was across the Hispaniola border. Haitian women who give birth to children in the Dominican Republic are often not evaluated by a doctor until they are entering the delivery process, and even then health-care is complicated by or denied because of racial prejudice and unclear legal situation. In September of 2013, the Constitutional Court of the Dominican Republic issues a new ruling which declared that any immigrant born between 1929 and 2010 without documentation of their own or of their ancestors does not have citizenship, rendering many Haitians born in the Dominican Republic essentially stateless. To be born to a non-citizen mother typically means the child will likely be born with little or no prenatal care, and the mother will receive poor or inadequate care. Prenatal care is one of the most inexpensive elements of a care-model that carries huge returns relative to its costs. All governments would benefit from improved access to maternal and prenatal care because its future citizens who receive such care would be born healthier and have fewer expensive chronic illnesses. Fewer chronic illness among a population would have huge returns on the welfare state because fewer people would be utilizing it for expensive medical treatments. Though most medical professionals condemn the extreme act of denying care to pregnant women or infants (documented or not), the Dominican Republic and the United States have a popular politics that embraces this cruelty, despite the fact that both pride themselves on a multi-ethnic population. It is easy for policymakers to incriminate undocumented immigrants and claim that they are responsible for an illegitimate share of the consumption of the country's resources. Therefore, it seems likely that the host country's perceptions of immigrant natality and maternity help construct a negative image of the immigration "problem" in such a way that laws and policies are designed without accurate rationale. This thesis examines how the United States and the Dominican Republic might improve the relationship between the culture of healthcare and the role of the legal system for immigrants and their children. It seeks to understand the reasons, motivations, and consequences for denying immigrants services on the account of their citizenship status. The social, economic, and health consequences of being an undocumented citizen will be examined. Current legal policy and what political roadblocks and cultural prejudices must be overcome in order to implement a successful policy will be reviewed. Finally, the best practices prenatal care as a national investment will be discussed, as will the problem of cross-cultural perception of natality, maternity, and immigration.