The National Association of Certified Professional Midwives (NACPM) issues this brief to articulate our opposition to proposals that would restrict or eliminate birthright citizenship in the United States. Such policies would have far-reaching and harmful consequences for maternal, infant, and family health, while placing untenable burdens on perinatal care systems and providers.
Birthright citizenship has long served as a stabilizing force for families and communities, ensuring that children born in the United States have access to legal identity, healthcare, and social support essential to health and well-being. A birthright citizenship ban would not only undermine long-standing constitutional principles but would also exacerbate existing disparities in access to perinatal care, worsen health outcomes, strain emergency and hospital systems, and deepen workforce challenges at a time when the United States is already facing a perinatal health crisis and widespread maternity care deserts.
Background and Context
Immigrants, regardless of documentation status, are an integral part of the U.S. perinatal population.(1;2) Pregnancy, birth, and postpartum needs do not change in response to immigration enforcement priorities, and families will continue to require timely, skilled care regardless of legal classification. Yet many immigrant families already face significant barriers to prenatal, intrapartum, and postpartum care, including limited insurance coverage, geographic isolation, language access gaps, and fear of legal consequences.(2) Proposals to restrict or eliminate birthright citizenship would compound these barriers in ways that directly harm perinatal and infant health.
Although attacks on birthright citizenship are often framed as narrowly targeting immigrant communities, the consequences of such policies would extend far beyond those families. Any system that conditions newborn status, eligibility, or access to services on documentation introduces new layers of administrative complexity into perinatal care. Midwives, birth centers, hospitals, public health agencies, and state Medicaid programs would be required to navigate verification processes that are costly, error-prone, and time-intensive, diverting resources away from direct clinical care and public health functions.(3;4)
The U.S. perinatal care system is already under acute strain. Maternal health outcomes in the United States rank among the worst of economically developed nations, and labor and delivery units are closing at an accelerating rate, particularly in rural and low-resource areas.(5) Many counties are now classified as maternity care deserts, requiring families to travel long distances to access care.(6) Community midwives and birth centers play a critical role in filling these gaps, often serving as the most accessible and trusted point of care when hospital systems are unavailable or overwhelmed.
Introducing verification-based eligibility requirements at birth would further destabilize this fragile system. Loss of automatic Medicaid eligibility for newborns would increase uncompensated care burdens on hospitals already operating on narrow margins, accelerating additional labor and delivery unit closures.(3) As facilities close, access worsens for all families, citizens, and non-citizens alike.(7)
Beyond financial strain, verification-based systems erode access to public health services. Citizens who do not have immediate access to standard identification may also delay or avoid care.(8) This can include individuals experiencing domestic violence or human trafficking, where identification documents are often withheld or controlled by an abusive party. It also includes individuals living on reservations who may possess only tribal identification that is not consistently accepted across systems and who face barriers to obtaining other forms of identification due to the lack of federally recognized residential addresses. Effective public health infrastructure is built on clarity, predictability, and community trust. Policies that introduce ambiguity at the moment of birth undermine these foundations.
Once established, the eligibility verification infrastructure also creates long-term structural risk.(9) Systems built to enforce one form of exclusion are easily expanded over time to encompass additional criteria, increasing surveillance and narrowing access across broader populations. This precedent threatens to normalize proof-contingent access to essential healthcare, further fragmenting an already disjointed perinatal system.
From a public health and systems perspective, birthright citizenship functions as a stabilizing mechanism, ensuring that every child born in the United States enters life with legal identity, access to care, and continuity within public health systems.(10) Undermining this stability does not merely harm immigrant families; it introduces inefficiency, inequity, and risk across perinatal care infrastructure nationwide, worsening outcomes, increasing costs, and weakening community resilience at a time when the system can least afford it.(3;4;5;10)
Increased Barriers to Care
A birthright citizenship ban would introduce new administrative and legal requirements into perinatal care, including pressure on healthcare providers and institutions to verify parental citizenship status.(3;4;9). These requirements would create delays, confusion, and fear at critical moments in pregnancy and birth.
In practical terms, such a policy would:
Delay or deter people from seeking prenatal and delivery care
Increase administrative burdens on midwives, hospitals, and clinics
Interrupt continuity of care during pregnancy and postpartum
Exclude newborns from Medicaid eligibility, shifting costs to hospitals and families
The loss of Medicaid coverage for newborns would impose significant financial strain on hospitals already operating under narrow margins, further accelerating the closure of labor units. As access shrinks, travel distances to the nearest obstetric facility increase for all families, citizens, and non-citizens alike, expanding the number of counties classified as maternity care deserts.(3;6;7;11)
Fear, Delayed Care, and Worsening Outcomes
Fear is a powerful determinant of health behavior. Immigrant families without legal status already face heightened anxiety related to surveillance, deportation, and legal repercussions. A birthright citizenship ban would intensify these fears, discouraging timely engagement in prenatal care and increasing the likelihood of delayed or avoided care. (4;9;10;12)
Delayed or absent prenatal care is associated with higher rates of:(12)
Preterm birth
Low birth weight
Hypertensive disorders and unmanaged chronic conditions
Preventable pregnancy and neonatal complications
In the United States, a significant proportion of pregnancies already receive inadequate prenatal care, with undocumented individuals among the least likely to receive timely and sufficient services(1). Policies that amplify fear and uncertainty will further erode access and worsen outcomes.
Ethical and Workforce Impacts on Perinatal Care Providers
At a time when the U.S. faces critical shortages of perinatal care providers, policies that destabilize and demoralize the workforce pose serious public health risks. A birthright citizenship ban would place midwives, nurses, and physicians in untenable ethical and legal positions. Perinatal care providers are bound by professional and ethical obligations to provide nonjudgmental, timely, and evidence-based care. Policies that criminalize or surveil immigrant families risk forcing providers into roles that conflict with these obligations. (10;13)
Such conditions would:
Increase moral distress and legal risk for providers
Accelerate burnout in an already strained workforce
Discourage providers from practicing in high-need communities
Further reduce access to perinatal care services
Strain on Emergency and Neonatal Systems
When families are unable or unwilling to access prenatal care, more births occur without appropriate clinical or public health support. This increases the likelihood of preventable emergencies, resulting in:
Higher reliance on emergency medical services (EMS)
Increased high-risk transports during labor
Greater demand on neonatal intensive care units (NICUs)
Lower vaccination rates of children
Preventable complications are more costly, more traumatic, and more dangerous than well-supported, planned care. Additionally, the financial and emotional stress associated with restricted access to care may contribute to broader community harms, including increased rates of family stress and interpersonal violence, further endangering parents and infants.
NACPM’s Position and Call to Action
NACPM strongly opposes any effort to restrict or eliminate birthright citizenship. Such policies would harm pregnancy and infant health, destabilize perinatal care systems, and place healthcare providers in ethically untenable positions.
We call on policymakers to:
Invest in community-based midwifery and integrated perinatal systems
Reject proposals that undermine access to care based on citizenship status
Protect the ability of all families to seek timely, culturally-responsive perinatal care
Strengthen, rather than erode, the perinatal care safety net
Every baby born in the United States deserves access to care, security, and a healthy start in life. Policies that undermine these foundations threaten not only individual families but the health and future of the nation as a whole.
Sources:
Zhu, C. (2023). Barriers and challenges of immigrant women's access to and experience of optimal maternity care. Columbia University Journal of Global Health, 13(1). https://doi.org/10.52214/cujgh.v13i1.10690
Janevic, T., Weber, E., Howell, F. M., Steelman, M., Krishnamoorthi, M., & Fox, A. (2022). Analysis of state Medicaid expansion and access to timely prenatal care among women who were immigrant vs US born. JAMA Network Open, 5(10), e2239264. https://doi.org/10.1001/jamanetworkopen.2022.39264
Reese, A., Edwardson, N., Ruyak, S., & Tinkle, M. B. (2026). Federal policy changes endanger Medicaid's critical role in perinatal care and health equity. Journal of Obstetric, Gynecologic & Neonatal Nursing, 55(2), 130–142
Félix Beltrán, L., Vargas Bustamante, A., et al. (2025). Born into uncertainty: The health and social costs of ending birthright citizenship. UCLA Latino Policy & Politics Institute
Hoyert, D. L. (2025). Maternal mortality rates in the United States, 2023 (NCHS Health E-Stat 100). Centers for Disease Control and Prevention
March of Dimes. (2024). Nowhere to go: Maternity care deserts across the U.S. March of Dimes
Blavin, F., Buettgens, M., & Simpson, M. (2025, March 1). Hospital revenue losses and increased uncompensated care if Medicaid funding is cut. Robert Wood Johnson Foundation / Urban Institute
Ng, A. E., Adjaye-Gbewonyo, D., & Dahlhamer, J. M. (2024). Sociodemographic differences in nonfinancial access barriers to health care among adults: United States, 2022 (NCHS Health Statistics Report No. 207). Centers for Disease Control and Prevention
Papageorgiou, V., Wharton-Smith, A., Campos-Matos, I., & Ward, H. (2020). Patient data-sharing for immigration enforcement: A qualitative study of healthcare providers in England. BMJ Open, 10(2), e033202. https://doi.org/10.1136/bmjopen-2019-033202
Fabi, R. E., Santos, P. M. G., Sommers, B. D., & Cervantes, L. (2026). Stateless at birth — Birthright citizenship and the safeguarding of immigrant maternal and child health. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-025-10117-4
Fontenot, J., Brigance, C., Lucas, R., & Stoneburner, A. (2024). Navigating geographical disparities: Access to obstetric hospitals in maternity care deserts and across the United States. BMC Pregnancy and Childbirth, 24(1), 350. https://doi.org/10.1186/s12884-024-06535-7
Molina, R. L., Beecroft, A., Pazos Herencia, Y., Bazan, M., Wade, C., DiMeo, A., Sprankle, J., & Sullivan, M. M. (2024). Pregnancy care utilization, experiences, and outcomes among undocumented immigrants in the United States: A scoping review. Women's Health Issues, 34(4), 370–380. https://doi.org/10.1016/j.whi.2024.02.001
Abernethy, J., Norvell, M., & Page, K. R. (2025). The cost of caring: Moral injury and treating immigrant patients. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-025-09934-4