American College of Obstetricians and Gynecologists, and the American Academy of Family Physicians. In a 2018 press release, the AAP stated that “the condi- tions in (DHS) facilities are not appro- priate for pregnant women and children.” It’s not hard to see why. A 2024 study published by the Journal of Perinatology noted that “incarcerated individuals have a greater likelihood of negative birth outcomes,” including higher rates of premature birth. A 2022 study in the American Journal of Public Health found that incarceration “jeopardizes maternal and fetal health,” with pregnant incarcer- ated women “enduring high levels of addi- tional stressors and lower access to health care.” FLIP-FLOPPING DHS once agreed that imprisoning pregnant women was a bad idea. In 2014, under President Barack Obama, Homeland Security Secretary Jeh Johnson issued a memorandum stating that “absent extraordinary circumstances,” ICE “should not expend detention resources” on pregnant aliens or anyone else “whose detention is otherwise not in the public interest.” Reportedly, the policy extended as far back as 2011. None other than Tom Homan, now Trump’s tough-talking “border czar,” affirmed that stance in August 2016. Then serving as the executive associate director of ICE under Obama, Homan authored a memo promising that “pregnant women will generally not be detained by ICE.” But when Trump arrived and appointed Homan as acting ICE director, Homan clicked his heels and acted accordingly. In a December 2017 memo — the same month Morales-Alfaro entered the country and ICE custody — Homan ended the presumptive release of expectant mothers. The New York Times reported that from 2016 to 2021, ICE “arrested undocu- mented pregnant immigrants more than 4,000 times.” In 2019, an ICE spokes- person told the Times that between Oct. 1, 2016, and Aug. 31, 2018, 28 women “may have experienced a miscarriage just prior to, or while in ICE custody.” Tellingly, given the Trump administration’s sanctity- of-life rhetoric, the same spokesman said that “for investigative and reporting purposes, a stillbirth is not considered an in-custody death.” In 2021, the Biden administration reversed that reversal, reinstituting the practice of generally not taking pregnant women into custody. Under Trump 2.0, has the policy on detaining pregnant women been officially re-re-reversed to the 2017 standard? Asked several times via email to answer this question, an ICE spokesperson repeatedly dodged it, instead sending Phoenix New Times the 2025 version of its National Detention Standards, which states that a pregnant woman “shall not be restrained absent truly extraordinary circumstances.” The standards say nothing about not detaining expectant mothers. Notwithstanding ICE’s own guidelines regarding the restraint of pregnant women, Morales-Alfaro said she was shackled or cuffed more than once. In court filings, the federal government formally denied the claim. It says Morales-Alfaro would not have been shackled according to detention guidelines. Interestingly, a 2022 survey of U.S. prison practices published by the Maternal and Child Health Journal found that, despite a patchwork quilt of laws and policies against the practice, the shackling of pregnant and postpartum women persisted. The unnecessary shackling of pregnant women, whether in civil or criminal deten- tion, has received nearly universal condemnation. A study published last year in the Journal of Obstetric, Gynecologic and NeoNatal Nursing found that “placing a pregnant woman in shackles leads to an increased risk of falling and subsequent potential negative outcomes,” such as increased blood loss, stillbirth, and “placental abruption,” which is when the placenta prematurely separates from the inner uterine wall. In 2018, after a Buzzfeed News exposé about miscarriages in immigration deten- tion, Sen. Patty Murray introduced a bill to keep pregnant detainees out of handcuffs. The Washington state Democrat’s “Stop Shackling and Detaining Pregnant Women Act” would codify the presumption of release for pregnant women in immigrant detention and prohibit DHS from using physical restraints during and after preg- nancy. Murray has called the act of restraining expectant mothers a “barbaric practice” with “no justifiable reason.” Murray reintroduced the bill earlier this year. Seven years after she first pushed it, it still lacks enough support to pass. ‘DELIBERATIVELY PUNITIVE’ Several times while in ICE custody, Morales-Alfaro asked for medical attention. She knew something was wrong. She eventually was able to see ICE nurses in CoreCivic’s facility, according to her legal complaint. During those visits, she related that she’d had a miscarriage before entering the U.S. several months earlier, had been kicked by a Border Patrol agent after her arrest, and was experi- encing abdominal pain. “Can you see if my baby is OK?” she asked one nurse. “I can’t eat and I feel sick to my stomach all the time. I think I need iron pills and vita- mins.” To another nurse, Morales-Alfaro reported that she was experiencing “pain of a ‘9’ on a scale of 0 to 10.” On Jan. 2, 2018, after nearly two weeks in detention, Morales-Alfaro reported vaginal bleeding to a nurse. She was given Tylenol and sent away. About a week later, Morales-Alfaro collapsed. She was put in chains and taken to a hospital, where her pregnancy ended. During her deposition, which was conducted in 2022, Morales- Alfaro said she asked the doctor why her baby’s heart had stopped. In his answer, the doctor noted her incarceration and “the conditions in which I had been.” Morales-Alfaro was released in March 2018 and currently lives in Arkansas. She is still fighting to remain in the country on an asylum claim, though in Trump’s America, that’s a tough claim to make these days, one likely made tougher for Morales-Alfaro due to her pleading guilty to a forgery and minor theft charge in Arkansas in 2021, for which she received a suspended sentence and had to pay a $3,000 fine. Another uphill battle: her fight for justice for how she was treated in ICE custody. In 2020, Morales-Alfaro filed her lawsuit, seeking unspecified damages for the miscarriage and for the emotional trauma it wrought. She alleged that the treatment she endured was part of ICE’s policy to make the conditions for asylum seekers — especially those from Central America — “deliberately punitive.” A government witness testified that the conditions she faced — including the use of restraints and a lack of adequate sunlight, feminine hygiene products and proper clothing — “had no effect on her preg- nancy.” Despite an ultrasound to the contrary, government attorneys argued that Morales-Alfaro was never pregnant to begin with; the baby growing inside her was instead a “blighted ovum” that would eventually be absorbed back into the womb. A federal district court judge in California ultimately ruled in favor of ICE and CoreCivic, in large part because Morales-Alfaro could not conclusively demonstrate that her miscarriage was a result of the government’s and CoreCivic’s negligence. “Even if a triable issue exists as to whether Morales-Alfaro was afforded proper care,” the judge wrote, “she fails to establish causation, an essential element of the claim.” A three-judge Court of Appeals panel upheld the lower court’s ruling in early June. Scottsdale lawyer Joy Bertrand, who is representing Morales-Alfaro in the case, said she will ask the Ninth Circuit to recon- sider its decision. Then she might seek a review of the case by a larger panel of appellate judges. “It’s important to note that the govern- ment doesn’t deny that they failed to give her proper care,” Bertrand told New Times. (Morales-Alfaro declined an inter- view through the attorney.) “They simply say, ‘Who cares? It was the first trimester.’ In my reply brief on the appeal, I said if you agree with that, you’re giving them a free pass to provide no care in the first trimester.” (Though CoreCivic has denied all of Morales-Alfaro’s accusations, including her claims of being chained upon trans- port, its answering brief on appeal is careful to point out that it contracts with a third party “to provide supervision and escort” outside the Otay Mesa facility. Food services there are handled by another company. And, of course, ICE provides medical services at Otay Mesa.) No doubt nativists would opine that the fate of Morales-Alfaro’s unborn child was her own fault. If she’d just stayed put in El Salvador, all would have been well. But that stance dodges the obvious: that America is perfectly capable of ensuring that the whims of ICE staffers don’t threaten the lives of babies and mothers. In 2019 — no longer in El Salvador or in some ICE slammer, and able to adequately look after herself — Morales-Alfaro Under Donald Trump and border czar Tom Homan, the United States has flip-flopped on whether detaining and chaining pregnant immigrant women is within policy. (Gage Skidmore/Flickr/CC BY-SA 2.0) >> p 14 Rubia Morales-Alfaro claims she was mistreated while detained at the Otay Mesa facility run by CoreCivic, leading to her miscarriage. (JasonDoiy/Getty Images)
