Case Studies of Intimate Partner Violence,Immigration-Related Stress,and Legal Violence During Pregnancy in the U.S.-Mexico Border Region

Abstract

This article explores how experiences of intimate partner violence (IPV) combined with immigration-related stress shaped pregnancy and postnatal experiences among two immigrant women in the U.S.-Mexico border region of El Paso, TX. Enactment of U.S. immigration policies was changing rapidly during the period of data collection (2018–2019), generating a heightened sense of immigration-related insecurities for research participants. This context brought attention to how immigration law can exacerbate the potential for adverse health outcomes for pregnant and postnatal women caught in abusive relationships. This article presents the case studies of two women, Sara and Sofi, whose experiences reflected broader patterns documented in a larger qualitative study of the emotional experience of pregnancy among 35 first- and second-generation immigrant women in the U.S.-Mexico border region. Both women’s narratives highlight the ways U.S. immigration laws led to a sense of entrapment in abusive relationships during their pregnancies, which put them at heightened vulnerability. Further, the stress they experienced had the potential to lead to embodied health vulnerabilities. The case studies presented illustrate the ways the law can fuel processes that contribute to health risks, highlighting how U.S. immigration law can function as legal violence.

This article explores immigration-related stress and intimate partner violence (IPV) during pregnancy as experienced by two women in the U.S.-Mexico border region. In doing so, we analyze how legal violence generates harm via processes of embodiment and entrapment. Legal violence refers to how the law can have harmful effects for members of groups targeted by the law. Legal violence has been applied to analyze the health effects of draconian immigration laws characterized by deportation campaigns, workplace raids, and blocked access to public programs (Abrego & Menjívar, 2011; Menjívar & Abrego, 2012). Such tactics of immigration enforcement were becoming increasingly common during our data collection in 2018 and 2019.

Legal violence is related to other types of indirect violence, such as structural and symbolic violence, as the law can exacerbate conditions that limit agency and cause harm. Thus, resulting harm often occurs in subtle ways (Menjívar & Abrego, 2012). One challenge in using the term legal violence to advocate for policy change is that as a form of indirect violence it can be difficult to pinpoint the specific ways laws generate harm. As such, it is essential to analyze the pathways through which the law generates harm. Thus, we use two additional concepts—embodiment and entrapment—to identify and analyze how the law can generate harmful effects for pregnant immigrant women who have experienced IPV. Embodiment refers to the ways the social context translates into bodily experiences in ways that can contribute to health risks (Krieger, 2016). For example, precariously documented immigrants may have emotional and physiological responses to immigration enforcement tactics. This can include behavioral responses to feelings of fear and insecurity, resulting in hypervigilance and self-imposing limitations on movement (Kline, 2019; Lopez, 2019; Quesada, 2011) and activation of the stress response, with the long-term release of stress hormones being related to negative health outcomes (Thoits, 2010). Entrapment refers to how mechanisms of control and surveillance limit an individual’s ability to act (Núñez & Heyman, 2007). Immigration laws can be used to threaten and coerce victims, which can further entrap women in a relationship, continuing to put them at risk (Adams & Campbell, 2012; Salcido & Adelman, 2004). Pregnancy is a period of particular concern when examining the effects of embodiment and entrapment. Key maternal and infant health variables are stress-sensitive (Grote et al., 2010; Rondó et al., 2003; Vianna et al., 2011), reflecting the significance of focusing on embodied health risks. Pregnancy can also exacerbate feelings of insecurity, as it may be a time of greater emotional and financial vulnerability (Saltzman et al., 2003), compounding a woman’s sense of entrapment.

We use the experiences of two women to explore how immigration law constituted legal violence in their lives. We interviewed these women as a part of a larger qualitative study of the emotional experience of pregnancy among immigrant women. Within our larger project, 5 of 35 women (14%) reported IPV during their current or past pregnancy. While we did not initially intend to focus on experiences of IPV, we found that these women’s narratives provided profound insights into how immigration-related concerns can fuel emotional distress and other harmful effects during pregnancy. We focus on two women who were in the process of adjusting their immigration status using provisions under the Violence Against Women Act (VAWA). Their experiences show how the law contributed to processes of entrapment and embodiment, which generated maternal and infant health risks, illustrating how the law can be an integral component of processes that lead to harm. As embodiment focuses on bodily experience and entrapment attends to structural and contextual constraints, integrating these concepts shows how legal violence functions as a multilevel process; multiple processes spurred by the same legal context can intersect in ways that compound the potential harm caused by the law. The case study approach shows depth through these women’s experiences, which fosters a clearer understanding of the complexity of how the law can generate harm. Understanding these women’s experiences can inform various community programs that work with immigrant communities, survivors of IPV, and women’s reproductive health, as there is a need for more professional engagement in women’s experiences of emotional distress during pregnancy, birth, and the postpartum period (MacDougall, 2019).

Background

U.S. Immigration Law and IPV

There is disagreement on the prevalence rate of IPV among immigrants in the United States. Some studies show the prevalence rate is particularly high among some immigrant populations in comparison to the U.S.-born population (Vaughn et al., 2015), while other studies show rates are similar or significantly lower within immigrant populations (Sabina et al., 2015; Wright & Benson, 2010). Despite a lack of clarity in overall rates, it is well established that restrictive immigration laws can exacerbate the effects of IPV and prevent women from seeking support (Erez & Harper, 2018). Abusive individuals may use their partner’s immigration status as a tool of control. For example, an abusive partner may threaten to call immigration authorities as a way to instill fear. When an abusive partner is a U.S. citizen or resident, that person can hypothetically petition for the U.S. residency of a spouse. The promise of legal residency often contributes to an abused partner staying in the relationship. Additionally, individuals with a precarious immigration status may lack the support networks and access to social services that could facilitate leaving a relationship (Erez & Harper, 2018; Menjívar & Salcido, 2002).

Given these patterns, activists have fought for protections for immigrant women under VAWA. VAWA initially passed with bipartisan support in 1994. However, funding for VAWA must be reauthorized every 5–6 years, and in recent years, reauthorization has involved intense political debate. In 2012, reauthorization stalled when Republican members of the House of Representatives wanted to roll back protections for vulnerable groups, including provisions that enable undocumented immigrants to apply for a visa. While VAWA was reauthorized in 2013, the next reauthorization again stalled in the Senate at the end of 2019. At the time of writing, VAWA reauthorization remains stalled and programs that receive federal funding have been left short of the funding needed to continue services. Under current VAWA provisions, a battered partner without authorized immigration status has two primary mechanisms for securing a visa. The first is through a self-petition for U.S. residency, which is an option only for women married to a U.S. citizen or permanent resident. This option requires applicants to produce documentation of the abuse and evidence of the marriage, both of which can be impossible tasks for some women. In some cases, women with immigration-related concerns may avoid reporting incidents and lack evidence in the form of police reports and medical records (Parson & Heckert, 2014). If a woman married in another country or has a common-law marriage (which is only recognized in some states), even proof of marriage may be a challenge (Kapur et al., 2017). Abused women who did not marry a U.S. citizen or permanent resident have even more limited options for protection. The primary route for doing so is through a U visa, which is designed to protect witnesses who assist in the investigation of a crime. However, there is a cap of 10,000 U visas issued annually, and to secure such a visa, the applicant needs a certificate of cooperation with law enforcement. When law enforcement officials are perceived of as being connected to immigration officials, fear can deter women from applying for this form of protection (Kapur et al., 2017). As such, intensified immigration enforcement is associated with a drop in U visa and VAWA self-petitions (Amuedo-Dorantes & Arenas-Arroyo, 2019). Further, for both applications, women need legal support to navigate what can be an overwhelming and confusing process. The demand for legal support is greater than the availability of services, often forcing service providers to make decisions about which cases to accept (Lakhani, 2019). Further limiting the potential protections available to immigrant women under VAWA is a 2018 change to U.S. Citizenship and Immigration Services (USCIS) policies that can lead self-petition applicants to be placed in deportation proceedings if their application is denied. This policy change will likely deter women already intimidated by the process of self-petitioning. Thus, despite the legal mechanisms available under VAWA, some aspects of applying for protections may further perpetuate feelings of insecurity. Existing laws may reinforce a sense of entrapment, as the requirements of VAWA can make a person feel they lack the evidence to have a successful case and contribute to a decision to stay in a relationship (Salcido & Adelman, 2004).

Legal Violence and Entrapment

Entrapment refers to the state of being trapped; immigration law and being in an abusive relationship can serve as compounding sources of entrapment. From a legal standpoint, entrapment describes a person being lured into a compromising act. Feminist legal scholars have argued that social circumstances that marginalize particular groups and constrain individual circumstances can force a person to make decisions that are not in their best interests, and at times, these decisions are criminalized (Richie, 1996). These decisions also have health risks (Núñez & Heyman, 2007). The effects of constraining circumstances are particularly profound for women, as society regulates a person’s behavior based on their gender, generating what Richie (1994) calls gender entrapment. The implications of gender entrapment can include limiting a person’s options for leaving an abusive relationship. Perpetrators of IPV rely on control and coercive methods to limit the agency and autonomy of victims, generating entrapment in the relationship (Herman, 1992). The effects are particularly profound when there are other aspects of that person’s social position that have marginalized her. As Richie (1996, p. 2) notes, the severity of consequences resulting from entrapment is “directly related to the degree of stigma, isolation, and marginalization imposed by a woman’s social position.” Thus, immigration concerns can be a powerful tool in limiting the agency of victims. For example, a woman’s legal status can potentially be contingent upon a partner who could sponsor her immigration application, making her legal status exploitable (Erez et al., 2009).

The effects of gender entrapment for precariously documented women are particularly relevant on the U.S. side of the U.S.-Mexico border, where there is intense immigration surveillance. For example, major transportation routes have fixed internal Border Patrol checkpoints where agents can request proof of residency or citizenship from vehicle passengers. Border Patrol also regularly sets up temporary checkpoints at unpredictable times and locations, creating a constant threat of encounters with immigration agents. One way precariously documented immigrants respond to this surveillance is by limiting their movement (Núñez & Heyman, 2007). These limitations on movement can prevent a person from leaving an abusive relationship, thus exposing them to further harm. Given this perpetuation of harm is rooted in the enactment of immigration law, the concept of legal violence is important for emphasizing the harmful effects the law (Menjívar & Abrego, 2012) via entrapment in an abusive relationship.

For some immigrants, families can serve as safe havens from the entrapment generated through immigration law by providing important forms of material and affective support. This may be especially true during pregnancy and shortly after the birth of a child (Fleuriet, 2009; Gálvez, 2011). Given that the United States has weak public safety net programs combined with no federal laws to guarantee paid maternity leave, pregnancy and the postpartum period have the potential to increase a woman’s sense of economic insecurity and need for familial support. However, needing to rely on familial support when there is abuse within that family unit has the potential to further entrap women in an abusive relationship (Parson & Heckert, 2014).

Legal Violence and Embodiment

Embodiment is another mechanism through which the law can have harmful effects. Embodiment posits that the sociopolitical context is central to generating biological patterns (Gravlee, 2009; Gustafsson & Hammarström, 2012; Krieger, 2016; Willen, 2007). Embodiment is a multilevel process that involves individual-level experience, social interactions, and social structures (Krieger, 2001). Thus, there are various lenses for understanding the processes that produce embodied health risks.

The stress response is one way the social world translates into health disparities (Thoits, 2010). Given that it is the social context that exposes individuals to stressors, the stress response links social experiences of inequity to health outcomes. Restrictive immigration policies can be a source of extreme emotional distress for immigrants (Hatzenbuehler et al., 2017; Lopez, 2019). Physiological responses resulting from this distress can be especially concerning during pregnancy, as key maternal and infant health variables are stress-sensitive. Low birth weight, preterm birth, and hypertensive conditions have particularly clear links to maternal stress and are among the leading causes of infant and maternal mortality and morbidity (Dunkel Schetter & Glynn, 2011; Grote et al., 2010; Rondó et al., 2003). Illustrating the association between immigration-related stress and birth outcomes, Novak et al. (2017) found a significant increase in the prevalence of low birth weight among infants born to Latinas following a major immigration raid in Pottsville, IA. Low birth weight is particularly significant, as it is associated with various future adverse health conditions (Kuzawa & Sweet, 2009). For immigrant women in abusive relationships, the effects of physical and emotional abuse compound immigration-related stress.

Beyond physiology, embodiment can be understood by examining the role of law, policies, and social structures in producing health inequity via patterns such as differential exposure to health risks, economic deprivation, and systematic exclusion from health services (Krieger, 2012). For example, dangerous jobs involving exposure to occupational health hazards are more likely to rely on undocumented immigrants to fill the workforce. Economic sectors that rely heavily upon immigrant labor, such as farmwork, meatpacking, and construction, expose workers to hazards such as pesticides, repetitive use injuries, heat illness, and other hazards (Cohen & Merino Chavez, 2013; Horton, 2016). Compounding higher exposure to health risks is a lack of access to affordable health care, as Medicaid policies and subsidies under the Affordable Care Act (ACA) exclude undocumented and some groups of documented immigrants (Castañeda, 2018). Thus, the social disadvantage produced through immigration law can produce embodied health inequities.

Embodiment also brings attention to how the social context can shape individual actions. For example, immigration policing can generate a sense of hypervigilance (Willen, 2007) and limit the utilization of health care resources (Kline, 2019; Quesada, 2011). These efforts of control can become self-regulating. For example, migrant farmworkers routinely avoid taking breaks, putting their health at risk because breaks could prevent them from meeting the minimum work requirements needed to keep a job (Holmes, 2013; Horton, 2016). Looking specifically at pregnancy, the term reproductive habitus refers to the ways that women respond to their pregnancies in relation to larger structures of power (Fleuriet & Sunil, 2015; Smith-Oka, 2012). While patterns such as not seeking prenatal care may be viewed as willful actions, the social context shapes these patterns. Overall, embodiment facilitates an understanding of how particular policies shape individual everyday experiences in ways that have health implications, making it an important concept for understanding how the law can contribute to harm.

Method

Research Context

We conducted this research in El Paso, TX, which shares an international border with Ciudad Juárez, Mexico. Roughly 25% of El Paso’s population is foreign-born (U.S. Census Bureau, 2013), while many others are second-generation immigrants. In part because the border has been the subject of sensational media coverage and political propaganda (Anderson & Bergmann, 2019; Heyman & Campbell, 2004), El Paso has been the experimental location for harsh immigration policies. For example, from March to November 2017, the El Paso Border Patrol Sector was a testing ground for separating children from their parents prior to this becoming standard practice in mid-2018 (Hope Border Institute, 2018). As Sabo and Lee (2015) point out, the mere anticipation of encounters with immigration officials creates intense stress for border residents. These patterns make it important to understand how the immigration climate is shaping health outcomes in the region.

Texas has the highest uninsured rate in the United States, with 16.6% of the population lacking health insurance. This is in part because the state did not expand access to Medicaid under the ACA (Texas Medical Association, 2016). Immigration status factors into Medicaid eligibility and subsidies under the ACA, leading to disparities in access to health care for immigrant populations. Texas’ Children’s Health Insurance Program (CHIP) perinatal program provides coverage for prenatal care and a hospital delivery regardless of immigration status, making pregnancy a temporary zone of inclusion for women otherwise excluded from health care resources (Andaya, 2018). Consequently, health conditions may go untreated until pregnancy, which can lead to higher risk pregnancies and deliveries. As primary health care services are one realm where women can be screened for IPV and offered access to interventions (Alvarez et al., 2017), the systematic exclusion of immigrant women from basic health services is a form of denying women access to interventions.

Data Collection

The University of Texas at El Paso institutional review board (IRB) approved our data collection procedures and all interviews involved informed consent, in accordance with U.S. Federal Policy for the Protection of Human Subjects. This article focuses on a subgroup of participants in a study that involved qualitative in-depth interviews with 35 first- and second-generation pregnant and postnatal immigrant women. We included second-generation immigrants as a way to explore the ripple effects of immigration policies. The women had a range of immigration statuses: U.S.-born citizens (n = 10); U.S.-born citizens who grew up outside of the United States, later to return (n = 1); foreign-born U.S. citizens (n = 1); naturalized citizens (n = 3); permanent residents (n = 9); holders of a temporary unexpired visa, such as a tourist visa (n = 5); in process of adjusting status (n = 2); and undocumented (n = 4). All but three of the foreign-born women were born in Mexico. The remaining three were born in South America (n = 1) and Africa (n = 2). All of the second-generation immigrants had at least one parent born in Mexico. Fifteen women were pregnant at the time of the interview, and 20 had given birth within the past year. To complement interviews with women, we conducted interviews with eight employees of community clinics and health-oriented community organizations. To protect confidentiality, we use pseudonyms and redacted from interview transcripts any information that could be used to identify a woman. In our presentation of women’s stories, we have intentionally kept certain details vague to minimize the risk that an individual could be identified.

We recruited using a combination of a site-based approach and snowball sampling. Our recruiting sites included community organizations that provide services to pregnant and postnatal women. These locations served as starting points, as initial participants often introduced us to other potential participants. We conducted interviews in a mutually agreed upon location, which was often the participant’s home. Interviews typically lasted 1–2 hr. Since all members of the research team are bilingual in Spanish and English, we conducted the interview in the language of preference of the participant. Twenty of the interviews were primarily in Spanish, while 15 were primarily in English, although some interviews included switching between languages, which is a common linguistic practice in the border region. We transcribed and coded transcripts in the language the interview was conducted in, rather than translating the transcriptions. However, we did translate into English direct quotes that we have used. Given that all members of the research team are bilingual, with some being English-dominant and others Spanish-dominant, we were able to discuss words and expressions that are more difficult to translate to ensure accurate translations.

Interview questions focused on experiences of emotional distress during the woman’s current or most recent pregnancy, the factors perceived of as contributing to emotional distress, experiences of being an immigrant and/or having immigrant family members, experiences seeking health care, and perceptions of the types of health and social support services that were utilized. The semistructured nature of the interviews enabled us to probe in-depth into issues that emerged within each interview. When women described issues as stressful, particularly as they related to immigration-related concerns, we followed up with questions of how women felt like those experiences impacted their overall health and their pregnancies. We also included questions asking women to describe the emotions they experienced during their pregnancy, following up with questions of what factors contributed to their emotional states. These questions were particularly important for allowing women to explain on their own terms what aspects of their social worlds were influencing their emotional well-being. For five women, experiences of IPV during pregnancy emerged as a central issue.

We had not anticipated focusing on experiences of IPV, but when this issue emerged as a part of women’s experiences, we probed into questions of how women perceived the abuse as shaping their emotional health and pregnancy experiences. Elsewhere (Heckert, 2020), we focus on other themes from the overall project. However, given the ways IPV intersected with immigration-related concerns and presented a distinct set of stressors and barriers for women in ways they perceived as impacting their pregnancies, we find it important to explore their particular experiences.

Data Analysis

All interview transcripts were analyzed using Atlas.ti version 8.1 qualitative data analysis software. As a starting point for analysis, we developed a codebook aimed at coding themes related to our central research questions. Using inductive reasoning, we added additional codes based on themes that emerged. We coded transcripts using a line-by-line process, which also gave attention to how themes overlapped. In analyzing the themes that emerged, we found that experiences and memories of violence were much more salient than we expected when we began the research. While some women referenced past experiences of emotional distress and insecurity related to narcoviolence in Mexico, it was IPV that women described as creating a pervasive, lasting source of emotional distress, even when they had left the relationship. The five women who reported IPV expressed similar immigration-related concerns to the other women we interviewed. However, the ways that IPV exacerbated immigration-related concerns, and the ways women felt like these experiences adversely affected their health, bring attention to the extent to which immigration law can function as a form of legal violence. To interrogate the processes linking legal violence to harmful health effects, we applied principles from grounded theory (Strauss & Corbin, 1997). Doing so enabled us to conceptually explore the relationships between IPV, immigration law, and pregnancy outcomes. In all five interviews, we found that embodiment and entrapment offered conceptual links for understanding the processes through which women felt legal violence adversely shaped their pregnancies and births. Sara and Sofi’s narratives provide particularly salient examples of these patterns, in part because both were in the process of self-petitioning under VAWA during their most recent pregnancy and described how this legal process affected them. Thus, rather than focusing on all five women, we use a case study approach, which facilitates depth for understanding lived experiences (Linde, 1993).

Results

Sara: Pervasive Hypervigilance and Compounding Sources of Entrapment

At the time of our interview, Sara was a 36-year-old mother of four children, including a 6-month-old baby. She relocated to El Paso from Juárez 3 years earlier, after her U.S. citizen husband convinced her to move. They had been in a cross-border relationship the previous 6 years, with the exception of a year they spent living together in the United States early in their relationship. After Sara’s husband had a legal incident, he was put on probation and unable to cross the border. In order to see her husband, Sara decided to come to the United States on a tourist visa, which granted her permission to stay in the country for 6 months. Her husband promised to sponsor her application for U.S. residency after the move, but he never did. Instead, he became physically and emotionally abusive and used Sara’s undocumented status against her. At one point, Sara’s husband badly injured their son. She said, “I felt like he wouldn’t do anything to the kids, but that was always my worry. Well, sooner or later, it was going to happen.” Sara had wanted to take her son to the emergency room, but her husband’s insistence that the police would arrest him deterred her from doing so. Instead, a school nurse noticed the injuries and called Sara to the school. From there, Sara and her son went to the hospital and the police showed up. This initiated a process that linked Sara to a local family violence organization. At the time of the interview, Sara had left the relationship and was in the process of adjusting her immigration status under VAWA. While intervention from law enforcement facilitated Sara’s ability to leave the abusive relationship, her process of seeking support reflects how the law also generated embodied vulnerabilities and perpetuated compounding forms of entrapment.

The combination of immigration law, insufficient protections for victims of IPV, and the process of applying for residency under VAWA produced multiple sources of entrapment for Sara. After the police visited her at the hospital, Sara attempted to leave the relationship. However, she experienced difficulties collecting the documentation required by VAWA. The burden of evidence required by a VAWA self-petition can be a barrier to utilizing legal provisions intended to protect women and can contribute to women’s continued sense of entrapment in an abusive relationship (Parson & Heckert, 2014). Further, her immigration status when she first attempted to collect the documentation required for a self-petition constrained her ability to seek employment, which reinforced economic dependence on her husband. This economic dependence became especially pronounced during her pregnancy. Previously, Sara had been able to work in the informal economy cleaning houses, but she was physically unable to continue her work late in her pregnancy. These intersecting factors contributed to her returning to the relationship 3 times before she left for good. Thus, challenges navigating legal procedures intended to provide protection contributed to Sara’s decision to return to the abusive relationship, highlighting the ways the law can perpetuate what Richie (1996) describes as gender entrapment for women with multiple sources of social marginalization. With the support of a nonprofit organization, Sara eventually collected the hospital report, police report, and witness testimonies that enabled her VAWA application to proceed. The organization also secured Sara housing support, easing her economic concerns. It is important to consider the limitations of such organizations in assisting women in similar circumstances. Community organizations that assist victims of IPV may have funding constraints that limit their abilities to provide support to all individuals in need (Lakhani, 2019); thus, it is necessary to advocate for legal changes that consider the ways current laws are limited if they do not address the ways a victim’s agency may be constrained.

Sara felt her family could have provided her support that she needed to leave the relationship. Although she lived geographically close to her family, they were separated by an international border that none of them could cross without significant risk. In this case, immigration law further exacerbated her sense of entrapment and limited her options for seeking support. At the time of our interview, Sara had secured a work permit, which is typically granted while an application for residency is under review. However, her lawyer advised her not to travel anywhere that would require her to pass through Border Patrol checkpoints including internal checkpoints located on highways throughout the border region. This continued to trap Sara in El Paso as she awaited the decision on her self-petition. Sara explained her interpretation of the lawyer’s advice: “The lawyer told us that we cannot go to Juárez because, because when they check the visas that it will appear that I was on CHIP and then they would not let me enter.” Texas’ CHIP Perinatal program covers the cost of prenatal care and delivery regardless of a woman’s immigration status. An October 2018 announcement from the Trump Administration of planned changes to the “likely public charge” rule when considering immigration applications likely triggered the lawyer’s concern. The category of likely public charge can be used to deny immigration applications if there is concern the applicant will be reliant on publicly funded programs. From 1996 to 2018, USCIS guidelines stated that the use of noncash benefits would not be used to label an applicant a likely public charge. The October 2018 announcement generated concerns that the use of CHIP Perinatal would be considered grounds for denying a petition for residency. The final guidelines on the likely public charge rule that were released in August 2019 backtracked on CHIP Perinatal, specifically stating that pregnant women could use this program without being labeled a likely public charge. However, we interviewed Sara during a period of uncertainty over what proposed changes might entail. Mere threats of proposed policy changes generated anxieties around utilizing public programs intended to provide prenatal support. Even though Sara was on a path to adjusting her status, she had new concerns over how changes in immigration law could be used to deny her application. This fear over how the law could be executed continued to limit her movement. This highlights that when interrogating how the law can cause harm, it is important to go beyond identifying how the law is worded and executed to also examine the fears it generates. Beyond immigration law as a source of entrapment, Sara found that legal protections for victims of IPV were insufficient for ensuring a feeling of security. Specifically, she said of the restraining order against her husband, “It expired after 2 months, but I endured him for 9 years.”

For Sara, various aspects of the law perpetuated entrapment and made it harder to leave an abusive relationship, putting her at continued risk. The law also contributed to embodied vulnerability via a sense of hypervigilance and constant stress. In response to feeling trapped in El Paso where she fears her ex will find her, she described how she responds to always being on guard:

When I take the kids out or something, first I go here, then I go over there, and then somewhere else. I go in circles so that he can’t follow me and so that he doesn’t know where we live.

The stress of being an immigrant exacerbates this hypervigilance. Sara said, “Well, it does affect you because one sometimes is super stressed and you want to do a lot of things, but sometimes you are like tied by the hands no, no, no, you just can’t. One just stresses.” As past research shows, such emotions can trigger physiological responses associated with negative maternal and infant health outcomes (Dunkel Schetter & Glynn, 2011; Grote et al., 2010; Rondó et al., 2003). Although Sara described a relatively healthy pregnancy and delivery, stress also has long-term health risks including increased lifetime risk for diabetes, cardiovascular disease, and major depression (Thoits, 2010). As embodiment theory goes beyond physiology, Sara’s hypervigilance is also a reflection of how she has internalized her social world. Her hypervigilance has the potential to take a toll on her emotional well-being and limit her agency in other aspects of her life. Other women felt like experiences of intense stress were a direct cause of adverse birth outcomes, as was the case for Sofi.

Sofi: Emotional Distress and Embodied Health Vulnerabilities

Sofi is originally from West Africa and has been trying to obtain U.S. residency for 19 years. She was 35 years old and pregnant with her third child at the time of our interview. When Sofi was a toddler, her mother migrated to the United States. As a teenager, Sofi came to the United States on a tourist visa. Since Sofi’s mother had obtained U.S. residency via marriage, she was able to petition for her daughter. According to Sofi, immigration kept sending her paperwork to an old address, so she never received her residency. In 2011, Sofi married a U.S. citizen, but he never petitioned for her residency. For a short period beginning in 2012, she had a work permit under Deferred Action for Childhood Arrivals (DACA). DACA enables undocumented immigrants who came to the United States before the age of 16 to receive a temporary work permit if they have continually resided in the United States since 2007, among other criteria. However, DACA does not provide the full protection of legal residency, it must be renewed every 2 years, and protections expire once an individual turns 31. Since 2016, the Trump Administration has made constant threats to end this program. In 2016, after her DACA status expired, Sofi left her abusive husband. Since that time, she has been in the process of adjusting her status under VAWA. She has started a new relationship and was pregnant at the time of the interview, yet she felt haunted by the past and frustrated by the long process of waiting for the approval of her residency. Like Sara, Sofi’s process of leaving an abusive relationship shows how immigration law perpetuated harm via embodiment and entrapment.

In Sofi’s case, health policies tied to her immigration status shaped her reproductive habitus (Flueriet & Sunil, 2015) or actions in response to her pregnancies. These actions are one way that a woman’s social world contributes to embodied health risks. During Sofi’s first pregnancy in 2008, she lived in a state where she had access to CHIP Perinatal. However, for her second pregnancy in 2011, she was living in a state where she had no way of qualifying for prenatal care because of her immigration status. That is when she decided to marry her partner, so she could gain coverage under his insurance plan. Five days after they married, when she was 5 months pregnant with their second child, she said, “He beat me until my face was unrecognizable.” While Sofi had hoped her husband would petition for her U.S. residency and solve her immigration issues, he never did. Instead, the abuse escalated. When their daughter was 3 months old, Sofi left the relationship and went to live with family members. She then sought the advice of an immigration lawyer. Rather than advising Sofi on how to self-petition under VAWA, the lawyer suggested that Sofi return to her husband. According to Sofi, the lawyer said, “Since he is a United States citizen, you should get back with him so that you can get your papers, so that he can file for you. Within 3 months you will get it.” Sofi left the consultation believing the only way to get her residency was by returning to her abuser, so that is what she did. Sofi’s understanding of immigration law, in part based on problematic legal advice, made her feel trapped in an abusive relationship, highlighting the ways immigration law can exacerbate gender entrapment by further limiting a sense of agency. Sofi’s decisions in relation to constraints imposed by immigration law continued to put her and her children at risk of harm. In 2016, after Sofi and her family moved to Texas, an episode of violence led her to leave the relationship. After her husband beat her with a fire extinguisher, and at one point missed and hit their son, Sofi called the police. From there, her husband was arrested and Sofi was connected with a family violence agency.

The emotional distress that Sofi experienced in relation to the abuse and her immigration status contributed to embodied health vulnerabilities. Highlighting the role of stress physiology in producing embodied health vulnerabilities, there is a strong relationship between maternal stress and low birth weight (Grote et al., 2010). Both Sofi’s children were low birth weight. Given Sofi’s West African origins, it is important to consider the role of race in patterns of low birth weight, as research shows a relationship between the everyday experience of institutionalized and interpersonal racism in the United States and higher rates of adverse birth and maternal health outcomes for African American women and their infants (Davis, 2019; Mullings & Wali, 2001). The experience of being an undocumented black women involves multiple levels of everyday stress. Mentally, Sofi also suffered. This emotional distress shaped her actions in ways that had potentially life or death consequences. In 2014, she hit a low point when her DACA was about to expire and she had no money to renew it. Her partner was not providing economic support and she was facing an eviction notice. That is when she took an entire bottle of Aspirin to attempt suicide. She said, “I was just stressed out. I think I cried for three days straight just to ease the pain, and I couldn’t take it.”

Since leaving the abusive relationship, Sofi describes herself as more at ease. She was in a new relationship and was pregnant during the time of our interview. She described the pregnancy as much healthier than her previous ones, which she attributes to her emotional state. However, she still felt anxiety over waiting for the approval of her residency, fearful that something could go wrong. She said, “If I get deported, what is going to happen to my kids? Their father is not going to take care of them.” Thus, the continued threat of deportation was continuing to harm her emotional well-being. This continued emotional distress produced by immigration law could result in physiological responses that have implications for her most recent pregnancy.

Discussion

The term legal violence has been used to highlight the harm, including health vulnerabilities, produced by the legal system (Abrego & Menjívar, 2011). To effectively advocate for policy change, it is important to interrogate the pathways through which the law leads to harm. As Sofi and Sara’s narratives show, these pathways were often indirect. The concepts of embodiment and entrapment highlight the links between the law and adverse health outcomes.

Sara and Sofi’s narratives show potential ways immigration law can produce harm by generating intersecting forms of insecurities that reinforce entrapment. The insecurity both women felt as a result of their precarious immigration statuses limited their ability to leave their relationships. In Sofi’s case, economic insecurity and the fear of not being able to afford her medical bills as a consequence of her immigration status contributed to her decision to marry her abuser so that she could gain health insurance coverage. Once married, her continued immigration-related fears contributed to her decision to stay in the relationship and return to her abuser after her first attempt to leave. In Sara’s case, immigration law constrained her ability to achieve economic security, which was a key factor that led her to return to her abuser multiple times. Immigration law also prevented her from receiving support from family members living in close proximity, yet on the other side of the international border. Sara and Sofi’s insecurities also produced embodied health risks. The combination of immigration law and abuse led to states of fear and emotional distress for both women. In response to the threats that produced this distress, Sara responded with hypervigilance. Further, stress physiology helps explain how fear marks bodily physiology and contributes to adverse health outcomes, such as the low birth weight of Sofi’s children.

For both Sofi and Sara, the policies under VAWA aimed at providing support were insufficient for addressing their experiences of entrapment. For Sara in particular, her initial attempt to self-petition led her to feel overwhelmed by the burden of evidence she needed to produce. Sofi on the other hand was initially unaware of the provisions under VAWA and at one point felt compelled to return to her abuser as her only means of gaining legal status. Particularly concerning is the 2018 USCIS policy change that could result in victims being deported if their VAWA self-petitions are denied. This change will likely further entrap women in abusive relationships by deterring them from using VAWA, especially when they feel overwhelmed by the evidence necessary to have a successful case and fear the implications of a denied petition.

Interrogations of the pathways through which legal violence causes harm can also inform critical trauma studies. Critical trauma research seeks to move away from biomedical approaches to trauma that focus on individual pathology, instead of viewing trauma as a social object produced within a particular social context (Fassin & Rechtman, 2009; Tseris, 2013). Attention to embodiment in particular shows how the social context of immigration law results in harmful health outcomes. Embodiment can also help bridge trauma theory with biomedical paradigms, as embodiment focuses on how the inequities that characterize a given social context produce physical symptoms and psychological trauma resulting from this context (Krieger, 2001).

Implications for Social Work

This research can inform interventions at the interpersonal and structural levels. At the interpersonal level, women’s experiences of legal violence demonstrate the centrality of legal support in enabling a person to leave a relationship. For individuals and organizations that provide legal support for victims of IPV with precarious immigration status, Sara and Sofi’s experiences show how the legal process can be a deterrent for seeking support. Thus, there is a continued need for programs that can assist women in navigating legal challenges. For providers who regularly serve immigrant victims of IPV, and particularly those working in the legal realm, the specific needs of this population may be well known. However, social workers outside of the legal realm or who less frequently work with immigrant populations may find themselves in a position where it is important to connect women with legal services that can offer support in navigating VAWA petitions. There are a number of resources available to social workers and other victim advocates to better understand their clients’ needs and barriers. VAWnet, developed by the National Resource Center on Domestic Violence, is a website that includes training materials and webinars for victim advocates. Their special collections include materials tailored for providers serving immigrant and refugee survivors of IPV. They also have materials aimed at helping providers understand and communicate the legal protections available for this population. Casa de Esperanza is another organization that provides training and tool kits for providers and their organizations. Further, they engage in policy research and policy advocacy, in line with the mission of challenging political and social structures that contribute to harm. For providers needing to make referrals for legal services, Immigration Direct is an online directory of free and low-cost nonprofit immigration and legal services in the United States.

At the structural level, social workers are in a position to advocate for policy changes that are necessary for improving social care (Beresford, 2011). While this task may seem daunting, as structural changes require a sustained effort over time, social workers have effectively advocated for changes to immigration policies and IPV-related laws. For example, when the Trump Administration announced proposed changes to the likely public charge rule in 2018, the initial proposal had a 60-day period for public comment. The over 210,000 comments included a statement from the National Association of Social Workers outlining the potential harm that could result from this policy shift. Although the new rule still went into effect, public comments helped protect CHIP Perinatal and the Women, Infancts, and Children (WIC) nutrition program for pregnant women. Additionally, social workers are in a position where they can document the harm caused by policies, which can be used for advocating for policy changes through working with policy makers and developing policy reports.

Limitations and Future Research

A strength of focusing on two women is that this approach enabled us to give attention to complexity. While Sofi and Sara’s experiences reflected broader patterns of immigration-related emotional distress we identified in a larger study, the broader project did not specifically focus on women who had experienced IPV. Thus, future research could further explore broader patterns of how the law facilitates harm via embodiment and entrapment. Additionally, Sofi and Sara had both left abusive relationships. While it is more difficult to establish relationships with pregnant and postnatal immigrant women still in abusive relationships, this would be important for future research. Given that anti-immigrant sentiment is contributing to shifts in immigration policies in various settings, cross-cultural research on how these policies are shaping experiences of pregnancy among immigrant women who have experienced abuse would be important to show both the particularities and common trends across different contexts.

Conclusion

Sofi and Sara’s experiences reflect the ways the law constituted integral components of processes of embodiment and entrapment, contributing to health risks. Thus, the ways the law is a part of pathways that contribute to harm highlight how U.S. immigration law can act as legal violence. Although we have focused on the particularities of U.S. immigration law and the unique experiences of women who experienced IPV during pregnancy, thinking more broadly about how the law can produce entrapment and embodiment, thus resulting in harm, can be useful in advocating for policy changes.