Women and birthing people living in communities along the U.S.-Mexico border face persistent barriers to accessing the care they need, and the Trump Administration and Republican policymakers’ agenda is further exacerbating these challenges. Policies like border militarization and cuts to public health funding will worsen access to comprehensive care, including critical primary, maternal, and reproductive health care services.
Texas, New Mexico, Arizona, and California are home to 8 million people living in the 44 counties along the U.S.-Mexico border, with a majority of these counties located in Texas. In New Mexico, California, and Arizona, about half of the population in border counties is Latine, which rises to approximately three-quarters in Texas border counties. These communities also have a higher likelihood of being home to migrant and undocumented groups – leaving far too many women unable to get the care they need.
Barriers to Health Care Access for Women in Border Communities
A majority of counties along the Southern border are designated as medically underserved areas, lacking adequate primary care facilities and personnel to meet community needs. In both California and Texas especially, border counties experience a limited supply of key health providers, with Texas facing particularly severe shortages in primary care, obstetrics and gynecology, dentistry, and emergency medicine. This means that many women in border communities live in maternity care deserts. As a result, and due to its proximity, many border residents rely on Mexican health care systems as a more accessible and affordable alternative. However, the Trump Administration’s border militarization and increasingly hostile approach to the U.S.-Mexico border region could disrupt this alternative for comprehensive care.
Layered onto clinician shortages, border communities have disproportionately high rates of uninsured and low-income populations. Health insurance plays a key role in making care affordable and accessible for women, as those with coverage are more likely to receive necessary preventive, primary, and specialized care. Texas has the highest uninsured rates among border communities compared to those in California, Arizona, and New Mexico, largely due to Texas’ refusal to expand Medicaid under the Affordable Care Act. Due to a provision in the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, lawfully present immigrants must wait five years after obtaining qualified status (known as the five-year bar) before they are eligible for Medicaid or CHIP. Moreover, undocumented individuals are excluded from Medicaid entirely, compounding structural barriers to care and leading to greater delays in care, reliance on emergency departments, and health disparities.
Major gaps in access to culturally responsive care further complicate Latine border communities’ ability to obtain quality health care, especially for those with limited English proficiency. Many people with limited English proficiency are often deterred from seeking care out of fear of being misunderstood or mistreated. These challenges become even more severe for undocumented individuals, who may feel unsafe in medical settings, especially as the Trump administration has eliminated safe spaces and allowed immigration enforcement within hospitals.
For those with legal status, cross-border health care remains a practical alternative for more affordable and culturally congruent care. However, travel itself presents another barrier, especially when it comes to time-sensitive services like reproductive and maternal health care. While Mexico and telemedicine avenues can fill health care gaps, access in border counties remains highly dependent on mobility, legal status, and the ongoing political climate regarding reproductive and immigration policy.
Republican Agenda Harms Reproductive & Maternal Health
The political landscape across the four border states has resounding effects on access to comprehensive reproductive health care. While California, Arizona, and New Mexico have safeguarded abortion rights, Texas maintains one of the most restrictive abortion bans in the country, dangerously limiting access for women across the state. As a result, Texans are forced to travel out of state for abortion care. In 2023 alone, approximately 35,000 patients left Texas to obtain abortion care elsewhere. However, for those living in Texas border counties, the nearest clinic offering these services can be up to a twelve-hour drive away, making this option solely feasible to those with transportation access, financial resources, and the ability to take time off from work to travel.
For migrant individuals, the situation is even more dire. Border Patrol checkpoints scattered throughout these counties (due to U.S. Customs and Border Protection’s ability to conduct stops or searches within “reasonable distance” from the border) create significant physical barriers, effectively preventing their travel for abortion access. In response, Texans have turned to telemedicine but this too is under political threat, especially with mounting attacks on abortion pills. Given increasing restrictions on reproductive care and aggressive immigration enforcement, border communities face heightened surveillance and the risk of pregnancy criminalization.
Conditions for women and birthing people in border communities will worsen as this administration continues its attacks on reproductive health care, drastic cuts to funding for maternal health programs and research addressing health disparities, and warrantless raids and deportations by U.S. Immigration and Customs Enforcement. This Administration’s recent decision to withhold funding for family planning programs would completely eliminate Title X care in California and partially eliminate care in Texas. Additionally, proposed cuts to Medicaid further jeopardize women’s health care access. Medicaid usage tends to be higher in border counties and remains crucial in providing coverage for prenatal care, labor and delivery, and postpartum care. Despite some progress in increasing coverage, such as the expansion of Medicaid in California, Arizona, and New Mexico, structural gaps persist and must be addressed to improve maternal health in border communities.
A Call For Change
For too long, the U.S.-Mexico border and its communities have served as a political headline for the Trump administration, while residents and their health care needs have been overlooked and left behind. We need Congress to pass the Health Equity and Access under Law (HEAL) for Immigrant Families Act, which removes harmful and unnecessary barriers to health care for immigrants; the Protecting Sensitive Locations Act, which prohibits immigration enforcement actions near health care facilities; and the LIFT the Bar Act, which removes the five year bar on immigrants’ eligibility for federal programs. We also need federal and state policymakers to increase investments in community-based maternal health solutions and safety-net programs, among other policies. It is time to end the longstanding neglect of the health care of border communities and eliminate roadblocks to care for people living along the border and immigrants of all statuses.
The author would like to thank Ashley Emery, Amani Echols, Kiera Peoples, Jaclyn Dean, and Erin Mackay for their contributions.
