Deterrence-based asylum policies exacerbate health inequities among women and children seeking safety at the US–Mexico border

The past decade has seen a global spike in racist, anti-immigrant rhetoric. In the USA, intensifying militarization and restrictive asylum policies have created a public health emergency at the southern border. Years of policies explicitly designed to deter border crossings (e.g., Title 42, Migration Protection Protocols) have stranded asylum-seekers in Mexico, leaving families to wait indefinitely under inhumane conditions for limited opportunities to seek protection in the USA. Human rights organizations have documented at least 13,500 violent attacks¹ and 1085 missing or dead migrants between 2021–22;² and 4,000 children were separated from their families by border officials from 2017-2021.³ Title 42–a policy used to effectively close the US-Mexico border during the COVID-19 pandemic–expired on May 11, 2023. Unfortunately, new restrictions have been implemented in its place, which disqualify migrants from claiming asylum who do not request protection in transit countries (e.g., Mexico) or cross between ports of entry; migrants who do not adhere to these restrictions face “expedited removal” and are banned from re-entry to the USA for five years. These xenophobic deterrence policies violate the internationally protected right to seek asylum in safety, increase the criminalization of migration, and have been widely condemned by public health and legal experts.⁴ The continued use of deterrence-based immigration policies will further perpetuate human suffering, felt most keenly by reproductive-aged women and their children.

Globally, forced displacement continues to rise at unprecedented rates. As of 2021, criminal and political violence, poverty, and climate emergencies have forced nearly six million people to flee the Northern Triangle, Cuba, and Haiti. Over the past five years, increasing proportions of women, trans, and other gender minorities have sought asylum globally. The USA has seen growing encounters along its southern border, with 535,000 children and families apprehended in 2022.⁵ In recent years, migrants who reach the US–Mexico border have encountered highly restricted options for requesting asylum, with thousands of families forced to wait in Mexico for an average of 17 months to enter, before beginning the years-long process of petitioning for safety.⁶

While waiting to apply for asylum, women and children in Mexican border cities have typically been housed in overextended shelters or encampments, where overcrowding, insufficient heating and ventilation, contaminated water, and limited sanitation infrastructure pose major health and safety risks.⁷ These conditions have contributed to an increased risk of malnutrition, dehydration, and infectious disease transmission, including diarrheal, dermatological, and respiratory infections.^7,8 Under asylum deterrence policies, women face deeply gendered security risks, with alarmingly high report rates of sexual and physical violence, harassment, torture, extortion, femicide, and other rights violations perpetrated by organized crime groups, US and Mexican officials, and intimate partners.⁷ Such violence amplifies pre-existing traumas endured before and during forced migration, contributing to heightened rates of posttraumatic stress, suicidality, anxiety, and postpartum depression.^7,8 Xenophobia, racism, and transphobia further drive stigma, abuse, and violence against LBGTQI+, Black, and Indigenous asylum seekers.⁹

Lack of access to prenatal and obstetric care, maternal malnutrition, and chronic stress contribute to an increased risk of preventable pregnancy-related complications. Humanitarian organizations at the US–Mexico border have documented a high prevalence of miscarriage, anaemia, preeclampsia, preterm births, and fetal and maternal mortality.^9,10 Such adverse outcomes have life-long consequences for the health and development of women, infants, and families.⁷ Finally, asylum deterrence policies pose grave consequences for the broader health and social wellbeing of children; 71% of young migrants living in Tijuana in 2021 had not attended school since fleeing their home country. Under the confluence of these conditions, some families have made the unthinkable decision to send their unaccompanied children across the border to unite with family in the USA, to spare them from the life-threatening conditions and dangers caused by US asylum deterrence policies. The implications of family separation on children's long-term mental health are devastating.⁷

Asylum deterrence policies violate national non-refoulement obligations grounded in two international treaties to which the US is a signatory: the Convention against Torture and the 1951 Refugee Convention. These policies further violate US law (Title 8, Section 1225, US Code) granting migrants the right to seek asylum on arrival in the US. The US government has demonstrated its capacity to process asylum-seekers in a timely and dignified way in its rapid processing of Ukrainian refugees in 2022. Community-based immigrant support organizations at the US–Mexico border—such as Al Otro Lado, Haitian Bridge Alliance, Espacio Migrante, and Human Rights First—have spent years supporting migrants and documenting these egregious human rights violations. As public health and legal scholars, we echo these calls and request that the Biden Administration immediately withdraw all asylum deterrence policies and uphold its international obligations to respect the fundamental human and reproductive rights of all persons, regardless of race, ethnicity, or country of origin. To curb this humanitarian disaster, humane reception structures, full access to asylum at all ports of entry, and trauma-informed medical and humanitarian aid must be implemented.

Contributors

ESC: Conceptualization, writing - original draft; NR: Conceptualization, writing - review and editing; SG: Conceptualization, writing - review and editing, supervision.

Declaration of interests

ESC is a member of the Welcome to Canada Campaign expert working group; NER is the director of the Border Rights Project at the non-governmental organization Al Otro Lado.