American Journal of Epidemiology Vol. 188, No. 1 © The Author(s) 2018. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of DOI: 10.1093/aje/kwy218 Public Health. All rights reserved. For permissions, please e-mail: [email protected]. Advance Access publication: October 24, 2018

Original Contribution

Restrictive and Birth Outcomes of Immigrant Women Downloaded from https://academic.oup.com/aje/article-abstract/188/1/24/5144386 by Stanford Law Library user on 31 January 2019

Florencia Torche* and Catherine Sirois

* Correspondence to Dr. Florencia Torche, Department of Sociology, Stanford University, 450 Serra Mall, Stanford, CA 94305 (e-mail: [email protected]).

Initially submitted March 30, 2018; accepted for publication September 21, 2018.

Unauthorized immigration is one of the most contentious policy issues in the United States. In an attempt to curb unauthorized migration, many states have considered restrictive laws intended to make life so difficult for unautho- rized immigrants that they would choose to leave the country. ’s Senate Bill 1070, enacted in 2010, was a pioneering example of these efforts. Using population-level natality data and causal inference methods, we exam- ined the effect of SB1070 on infants exposed before birth in Arizona. Prenatal exposure to the bill resulted in lower birth weight among Latina immigrant women, but not among US-born white, black, or Latina women. The decline in birth weight resulted from exposure to the bill being signed into law, rather than from its (limited) implementation. The findings indicate that the threat of a punitive law, even in the absence of implementation, can have a harmful effect on the birth outcomes of the next generation. birth weight; immigrants; immigration policy; infant health; prenatal stress

Abbreviation: DID, difference-in-difference; SB1070, Senate Bill 1070.

Immigration is one of the most contentious policy issues in families, communities, and workplaces as their unauthorized the United States. There are currently about 11 million immi- peers (15–17). In contexts in which authorization status is con- grants without authorization living in the country, most of whom flated with ethnicity, those who speak the same language or share come from Mexico and Central America (1, 2). Facing a dead- physical similarities with the unauthorized could be the target of lock at the federal level, states have taken an increasingly active profiling and harassment or feel directly threatened by immigra- role in setting immigration policy. Some states have chosen an tion enforcement (18–22). inclusive approach, preventing law enforcement involvement in To date, the literature has focused on the consequences of immigration enforcement (“sanctuary cities”) and extending ben- immigration enforcement for adults and children (14). We shifted efits such as driver’s licenses to undocumented immigrants (3). attention to those exposed in utero, a less visible but relevant pop- Others have opted for a restrictive stance, expanding local ulation. Because the prenatal period is highly sensitive to the involvement in the enforcement of federal immigration environment and consequential for health and development, ex- law, mandating that employers verify work eligibility, and posures during pregnancy can have enduring consequences over blocking access to driver’s licenses, in-state tuition, and other thelifecourse(23, 24). benefits (4, 5). We examined the effect of Arizona’s Senate Bill 1070 These “internal ” measures have large implica- (SB1070), “Support Our Law Enforcement and Safe Neighbor- tions for the target undocumented population. Research suggests hoods Act,” on infant health among Latina immigrants. We focus they shape immigrants’ residential choices (6–8), labor force par- on birth weight, a critical measure of early health and well-being. ticipation (9, 10), health-care utilization (11, 12), and health and Signed into law in 2010, SB1070 is an omnibus bill intended to psychosocial well-being (13, 14). Their effects can expand achieve “attrition through enforcement” (25) by targeting all beyond intended targets, affecting authorized immigrants and undocumented immigrants and tying their legal status directly even co-ethnic citizens. Spillover effects could emerge from to law enforcement. The bill established that being an immi- proximity, given that many authorized immigrants and US- grant in Arizona without carrying registration documents was born co-ethnic persons live and work in the same mixed-status a state misdemeanor, prevented “” policies, and

24 Am J Epidemiol. 2019;188(1):24–33 Restrictive Immigration Law and Birth Outcomes 25 imposed penalties for hiring or transporting unauthorized im- not become a major topic of public discussion until April migrants. Its most prominent provision, the so-called “show 2010, when it was signed into law. There is a sharp spike me your papers” component, required law enforcement agents in both Google searches and newspaper mentions immediately to determine individuals’ immigration status during lawful after the law’s passage until its (partial) implementation in July stops or arrests if there was reasonable suspicion that the 2010, followed by a marked drop. There is also a minor spike individual was an unauthorized immigrant. According to around June 2012 when the “show me your papers” provision critics, this provision induced profiling based on ethnicity, was upheld by the Supreme Court, but it is slight compared language, and skin tone (26). with the initial reaction. The spike in alertness and concern SB1070 was not an isolated event. Rather, it provided a blue- about the bill contrasts with the stability in deportations of unau- Downloaded from https://academic.oup.com/aje/article-abstract/188/1/24/5144386 by Stanford Law Library user on 31 January 2019 print for about a dozen states, which have introduced compara- thorized immigrants. Figure 2, based on the Secure Communi- ble enforcement bills (27) (see Web Figure 1, available at ties deportation program, shows no increase in fingerprints https://academic.oup.com/aje). More recently, federal immigra- submitted to federal authorities (Figure 2A) or in deportations tion policy has adopted a more restrictive and aggressive (Figure 2B) after the passage of SB1070. immigration enforcement approach similar to Arizona’sin Combined, these trends suggest that the bill induced con- communities across the country (28). cern and anxiety but did not result in an increase in detentions Recent research using natural experiments provides evidence or deportations of undocumented immigrants during or after of an effect of prenatal exposure to environmental stressors on the implementation of the law. Based on this evidence, we ex- birth weight, rendering our question plausible. To date, how- pected that Latina immigrants experienced the bill as a stressor ever, these studies have tended to focus on discrete events, such immediately after it was passed and before it was enjoined by as a land-mine explosion, a natural disaster, an immigration the courts, in the period between April and July of 2010. The raid, or the death of a family member (22, 29–31). In all these effect of prenatal exposure on birth weight, if any, should then cases, the event can be dated with accuracy. In contrast, the passage be most evident among births occurring in the second half of and implementation of immigration law is a process that unfolds 2010. The effects of the bill might have extended to US-born over time, making the timing of its impact an empirical question. Latinas, driven by proximity to the immigrant population and SB1070 was never fully implemented. The bill was signed vulnerability to ethnic profiling. into law in April 2010, and its constitutionality was immediately challenged in court. On July 28 of that year, the day before the METHODS bill was scheduled to come into effect, most of its provisions— including the “show me your papers” component—were We relied on natality microdata containing all US births enjoined, and a very partial version came into effect the between January 2007 and December 2012, obtained from the following day. The was upheld until June 2012, Centers for Disease Control and Prevention. Since 2005, when the US Supreme Court struck down the entire bill the public-use birth data sets excluded information on geography, with the exception of the “show me your papers” provi- so we obtained restricted-access data sets with location informa- sion. Even after the Supreme Court ruling, the application tion. Because birth records compiled by the Centers for Disease of the law was very limited, with authorities usually following Control and Prevention lack information on some variables for local ordinances rather than the new ones established by SB1070 Arizona, we obtained natality data from the Arizona Department (32, 33). In spite of its partial implementation, the passage of of Health Services and merged them with data for other states SB1070 is reported to have affected self-reported health (34), included in the analysis. fear and distress (35–37), and health-care utilization (38)among Latinos. Although the consequences appear to have been stron- Difference-in-difference model ger among undocumented immigrants, evidence suggests that the psychological distress might have extended to documented We used a difference-in-difference (DID) model, combining peers and even US-born Latinos (37). temporal and geographic variation in exposure to SB1070 to We examined indicators of awareness and concern about define a control population that would provide a counterfactual the bill to ascertain when it was experienced as a stressor. We to Arizona. For privacy reasons, these birth records did not include relied on Google Trends, a web tool that uses Google search precise information about day or week of birth, so it is not possible data to analyze how often a particular term is searched relative to calculate date of conception. Accordingly, we used a temporal to the total search volume in a particular locality and language. dimension that distinguished the following periods based on date We also analyzed mention counts of SB1070 from the 2 local of birth: t0 for January 2007 to June 2009; t1 forJulytoDecember newspapers with the highest circulation in Arizona. Figure 1 2009; t2 for January to June 2010; t3 for July to December 2010; t4 shows monthly trends in Google searches for “SB1070” in Ar- for January to June 2011; t5 for July to December 2011; and t6 for izona (Figure 1A), references to “SB1070” in the main local January to December 2012. The first 3 periods (t0–t2)capturepre- newspapers (Figure 1B), and Google searches for the Spanish treatment prenatal exposure, and the last 4 describe posttreatment words “ilegal” (illegal) and “derechos” (rights) in Arizona exposure, assuming a standard gestational length of 39 weeks. (Figure 1C). While the first 2 indicators capture awareness We hypothesized that the law had its strongest effect during the and concern about the law, the third reflects reactions by Ari- interval between its passage in April 2010 and its injunction in zona’s Spanish-speaking community, conceivably intended to July 2010 and that this would result in an effect on infants born evaluate risk and develop protective strategies. between July and December 2010 (t3). Although SB1070 was introduced to the Arizona legisla- Rather than arbitrarily selecting control states, we com- ture in January 2010, these indicators suggest that the bill did pared Arizona with a synthetic cohort of states that resemble

Am J Epidemiol. 2019;188(1):24–33 26 Torche and Sirois

A) Downloaded from https://academic.oup.com/aje/article-abstract/188/1/24/5144386 by Stanford Law Library user on 31 January 2019 SB1070 Google Searches

Jan 2009 Dec 2014

B) SB1070 Newspaper Mentions SB1070 Newspaper Jan 2009 Dec 2014

C) Derechos Ilegal Arizona Google Searches

Jan 2009 Dec 2014

Figure 1. Monthly trends in awareness and concern about Senate Bill 1070 (SB1070) in Arizona, January 2009 to December 2014. A) Monthly trends in Google searches for “SB1070” in Arizona. B) References to “SB1070” in the main local newspapers. C) Google searches for the Spanish words “ilegal” (illegal) and “derechos” (rights) in Arizona. Google search data obtained from Google Trends. Trends normalized by coding the high- est frequency as 100. Newspaper-mention counts are from the 2 state newspapers with highest circulation, and Arizona Daily Star. The vertical line marks the signing into law of SB1070 in April 2010.

Arizona in terms of pretreatment trends (39). The synthetic points between January 2007 and December 2012, we com- cohort was empirically obtained by assigning weights to a pared each period with the first period, between January 2007 donor pool of states to minimize the difference between the and June 2009 (t0). This model is expressed in regression form treated and the control units. It is shaped as follows: as follows: (0.522), (0.168), New Mexico (0.177), and (0.133). Web Appendix 1 and Web Table 1 provide details on Yxxxist =β0 +βs s +βt t +βst st the construction of the synthetic cohort. The DID model captured the difference in mean birth weight where Y identifies the dependent variable, i indexes individual, between children of Latina immigrants in Arizona and children s indexes state (1 = Arizona, 0 = synthetic cohort), t indexes of Latina immigrants in the synthetic cohort of control states time of birth (t0 = January 2007 to December 2009, . . . , t6 = across periods of exposure. Because we considered 7 time January to December 2012), and the population was restricted

Am J Epidemiol. 2019;188(1):24–33 Restrictive Immigration Law and Birth Outcomes 27

A) Downloaded from https://academic.oup.com/aje/article-abstract/188/1/24/5144386 by Stanford Law Library user on 31 January 2019

B)

Figure 2. Monthly trends in fingerprint submissions and deportation via the program in Arizona, December 2009 to March 2014. Data obtained from the Department of Homeland Security (2014): A) fingerprint submissions; B) deportations. The vertical line marks the signing into law of SB1070 in April 2010.

to Latina immigrants. βs is a fixed state effect capturing time- an economic downturn or health-care reform, the DID estimates invariant differences in the outcome between treatment and would be biased. To address this possibility, we used a falsifica- control states (e.g., differences in population composition), tion approach and examined the effect of SB1070 on US-born and βt is a set of fixed period effects capturing temporal and non-Hispanic white and black women, a group for whom no seasonal trends shared across states (e.g., the economic cycle). effect from the bill was expected. The estimates identifying the effect of exposure to SB1070 on birth outcomes are βst, which capture changes in birth weight between the 2007 and 2009 pretreatment period and each sub- RESULTS sequent period among Latina immigrant women in Arizona compared with Latina immigrants in control states. All models Model 1 in Table 1 reports changes in mean birth weight for include county fixed effects and control for characteristics of Latina immigrants across periods of exposure. The main finding the mother (age, education, marital status) and the birth (sex, is a significant decline in birth weight of 15 g (P < 0.01) for im- parity, occurrence in state of residence). We fitted a similar migrants giving birth in the second half of 2010 (t3), who were model restricting the population to US-born Latinas to test the exposed to the passage of the law during gestation. No other sig- hypothesis of spillover effects onto this group. The dependent nificant effects for Latina immigrants were detected before or variables include birth weight (grams) and its 2 proximate deter- after the passage of the law. This finding suggests that the decline minants: gestational age (weeks) and intrauterine fetal growth in birth weight resulted from exposure to SB1070 becoming law (sex- and gestational age–specific weight percentile). rather than from its (partial) implementation. Model 2 examined the effect of the bill for US-born Latinas. No adverse effects are fi Falsification test detected for this group (and a signi cant increase in birth weight is found for infants born between July and December 2011). Nor The main threat to unbiasedness of the DID estimator is the are there negative effects of the bill for US-born black and white violation of the parallel-trend assumption—that counterfactual women, a “placebo” group for whom no effects were expected, trends in birth weight would be the same in Arizona and the and a small positive effect is detected for infants born between control states in the absence of the law. If Arizona had experi- January and June of 2010 (model 3). Figure 3 compares the effect enced a change coinciding with the passage of the bill, such as estimates obtained from Table 1 across different groups among

Am J Epidemiol. 2019;188(1):24–33 28 Downloaded fromhttps://academic.oup.com/aje/article-abstract/188/1/24/5144386byStanfordLawLibraryuseron31January2019 Table 1. Difference-in-Difference Estimates of the Impact of Senate Bill 1070 on Birth Weight for Latina Immigrant Mothers, US-Born Black and White Mothers, and US-Born Latina Mothers in Sirois and Torche Arizona, and on Gestational Age and Intrauterine Fetal Growth for Latina Immigrant Mothers in Arizona, 2007–2012a

Model 3: US-Born Black and Model 1: Latina Immigrant Model 2: US-Born Latina Latina Immigrant White Model 5: Intrauterine Model 4: Gestational Age b Birth Weight (n = 1,444,541 Birth Weight (n = 1,504,561 Birth Weight (n = 2,403,044 Growth (n = 1,444,541 Variable (n = 1,444,541 Observations), g Observations), g Observations), g Observations), Observations), weeks Percentilec Estimate 95% CI Estimate 95% CI Estimate 95% CI Estimate 95% CI Estimate 95% CI Time period

t0: January 2007 to June 2009 0 Referent 0 Referent 0 Referent 0 Referent 0 Referent d d t1: July 2009 to December 2009 −14.2 −21.1, −7.3 −4.7 −11.4, 2.1 −2.6 −9.1, 3.8 0.008 −0.016, 0.032 −1.24 0.86, 1.61 e d t2: January 2010 to June 2010 −5.4 −11.2, 0.4 −1.9 −10.86, 7.07 −6.4 −16.3, 3.5 0.010 −0.012, 0.032 −0.57 −0.89, −0.25 f f f d t3: July 2010 to December 2010 −6.9 −12.8, −1.0 −7.6 −14.7, −0.5 −2.5 −4.6, 1.9 0.026 0.004, 0.05 −1.08 −1.46, −0.70 f g t4: January 2011 to June 2011 −8.3 −15.3, −1.4 −3.7 −9.4, 2.0 0.7 −4.3, 5.7 −0.006 −0.033, 0.021 −0.60 −1.00, −0.19 e d e d t5: July 2011 to December 2011 −8.0 −17.1, 1.1 −12.6 −19.7, −5.5 3.2 7.0, 2.2 0.032 −0.01, 0.065 −1.08 −1.54, −0.62 f e f f d t6: January to December 2012 −8.7 −14.0, −3.4 −5.3 −11.1, 0.5 7.3 2.4, 12.3 0.028 0.001, 0.055 −0.95 −1.32, −0.59 Treatment group × time period

Arizona × t0 0 Referent 0 Referent 0 Referent 0 Referent 0 Referent

Arizona × t1 −3.0 −11.8, 5.8 1.3 −15.4, 18.0 −1.7 −10.11, 6.8 −0.007 −0.037, 0.037 −0.08 −0.48, 0.32 e f Arizona × t2 −8.1 −17.3, 1.2 −3.4 −16.5, 9.8 11.6 0.8, 22.4 −0.022 −0.061, 0.021 −0.29 −0.80, 0.22 g e f Arizona × t3 −14.9 −25.6, −4.1 11.3 −0.6, 23.2 −0.7 −6.2, 4.7 −0.019 −0.051, 0.031 −0.68 −1.28, −0.09

Arizona × t4 10.6 −11.2, 12.4 5.2 −4.7, 15.1 0.6 −9.0, 10.2 0.011 −0.02, 0.042 0.28 −0.34, 0.90 d e Arizona × t5 −1.3 −14.8, 12.3 29.8 21.3, 38.3 3.7 −5.5, 13.1 −0.045 −0.096, 0.006 0.51 −0.25, 1.27 f e e Arizona × t6 6.1 −5.9, 18.0 10.8 1.8, 19.7 9.7 −0.9, 20.4 −0.021 −0.065, 0.025 0.54 −0.07, 1.15 Female sex −95.4d −97.8, −93.0 −95.9d −101.2, −90.4 −117.6d −119.6, −114.4 0.145d 0.133, 0.157 0.40d 0.28, 0.51 Educational level Less than HS 0 Referent 0 Referent 0 Referent 0 Referent 0 Referent d f d mJEpidemiol. J Am Some HS 10.7 6.8, 14.6 1.4 −16.1, 18.9 15.1 0.9, 29.3 −0.005 −0.016, 0.016 0.64 0.35, 0.92 HS graduate 4.6 −2.8, 12.0 24.5f 3.1, 45.9 80.5d 65.7, 95.3 −0.015 −0.030, 0.010 0.39e −0.06, 0.84 Some college 11.8g 4.0, 19.6 35.4g 12.3, 58.6 115.5d 99.0, 131.9 −0.007 −0.033, 0.039 0.78d 0.34, 1.21 College graduate 12.9f 1.0, 24.8 64.0d 32.7, 95.2 161.3d 142.2, 180.2 0.074d 0.039, 0.109 −0.21 −0.99, 0.57 Birth order

2019;188(1):24 1 0 Referent 0 Referent 0 Referent 0 Referent 0 Referent 2–3 75.8d 69.8, 81.9 55.0d 50.4, 59.5 46.3d 41.2, 51.4 −0.162d −0.178, −0.142 5.63d 5.30, 5.96 4–5 98.4d 90.5, 106.3 52.2d 45.6, 58.8 27.6d 17.7, 37.5 −0.229d −0.256, −0.202 7.59d 7.15, 8.03 ≥6 100.3d 89.4, 111.2 27.0d 16.4, 37.7 −3.3 −10.8, 13.1 −0.314d −0.349, −0.279 8.50d 8.00, 9.00 Table continues – 33 Restrictive Immigration Law and Birth Outcomes 29

infants born in the second half of 2010 (t3), who were in utero during the period between the bill’s passage and par- 0.01

− tial implementation. c 1,444,541 1.00, 1.32 0.31, 0.70 3.74, 7.86 0.02, = 19.08, 23.60 − n Proximate determinants of birth weight d d d d d Percentile Observations), Models4and5inTable1 examined the effects of the bill on 0.02 Model 5: Intrauterine Growth ( − the 2 proximate determinants of birth weight, gestational age Downloaded from https://academic.oup.com/aje/article-abstract/188/1/24/5144386 by Stanford Law Library user on 31 January 2019 and fetal growth, among Latina immigrants. Evidence indicated a decline in both measures among infants born in the second

0.002 half of 2010 (t ), but the decline is significant only for fetal − 3 Latina Immigrant growth, and it reaches 0.7 percentage points. The population-level impact of exposure to SB1070 is simi- 0.090, 0.122 1.16 0.014, 0.0620.944, 1.278 0.50 5.80 0.002, 36.251, 36.789 21.34 1,444,541 − lar to the effect of exposure to other environmental stressors dis- = n d d d d d

( cussed in the literature. For example, a study found a decline in birth weight of approximately 8 g resulting from prenatal expo- Observations), weeks Model 4: Gestational Age 0.002 sure to a land-mine explosion in the municipality of mother’s − values are for 2-tailed tests. residence (29). Early-pregnancy exposure to an earthquake re- P sulted in a decline in birth weight of 50 g (30), and the effect of the death of one of the mother’s parents during pregnancy was 0.2

− found to reach approximately 20 g (31). While these studies vary 2,403,044 =

0.3, methodologically, the negative effect of exposure to SB1070 on 10.3, 14.996.8, 112.6 0.106 32.1, 243.3 0.038 1.111 − n birth weight is within the range defined by the studies capturing White 2,738.3, 2,953.7 36.523 the effect of major environmental stressors. d d d f d Observations), g 0.2 − Birth Weight (

Model 3: US-Born Black and Behavioral responses and population composition xed effects. fi Among Latina immigrants, behavioral responses to the threat posed by the law, such as outmigration or fertility postponement,

0.3 could have altered the population of births exposed to the bill. −

1,504,561 For example, if highly educated immigrants had left Arizona to 0.4, = 19.6, 26.028.7, 44.9 12.6 104.8 − avoid exposure, the negative effect attributed to the bill could be n 142.3, 260.5 137.7

2,644.9, 2,807.1 2,846.6 an artifact of population sorting inducing negative selectivity. To assess compositional change of the exposed population, d d d d d Observations), g we tested for changes in the birth rate of Latina immigrants in 0.4

− Arizona in the second half of 2010 (t3)comparedwithLatina Birth Weight ( immigrants in control states using DID models (see Web Table 2 for reports of the full models). Figure 4A shows a significant decline of 2.72 births per thousand population. This decline is

0.6 much larger than the one experienced by US-born black and −

1,444,541 white women, suggesting that Latina immigrants might have = 9.0, 16.5 36.8 0.5, reduced their fertility, voluntarily or involuntarily, as the bill 27.7, 33.5 22.8 − n 201.6, 266.0 201.4 was being signed into law. Figure 4B–D (and Web Table 3) 2,570.0, 2,684.0 2,726.1 shows changes in sociodemographic characteristics of women d d d d d Observations), g that are known to be correlated with birth outcomes, including

0.5 – −

Model 1: Latina Immigrant Model 2: US-Born Latina age, marital status, and education (40 43). Latina immigrants Birth Weight (

Estimate 95% CI Estimate 95% CI Estimate 95% CI Estimateexposed 95% CI to SB1070 Estimate 95% CI during pregnancy were less likely to be c weight percentile.

fi teens (P < 0.001)andlesslikelytobesingle(P < 0.001). The decline in the proportion of immigrants with low education is speci

– not significantly different from zero (P = 0.80). However, for

dence interval; HS, high school. all 3 sociodemographic markers, these declines are much fi

b larger than those experienced by US-born black and white women.

2 Attributing trends in population composition solely to the Variable passage of SB1070 would be inaccurate. The changes preceded Continued s age s age 30.6 ’ ’ ’ the law s passage and persisted afterward (Web Tables 2 and 3), 0.001. 0.01. 0.10. 0.05.

< < < likely driven by the impact of the Great Recession (starting in < Difference-in-difference models compare trends in Arizona withIndicator trends for in the a treatment synthetic group cohort (Arizona) of dropped control because states of (see perfect text collinearity for with details). theP county P P Sex- and gestational age P Abbreviations: CI, con a b c d e f g 2008) and by prior immigration enforcement regulation in Arizo- Mother Birth in state of residenceConstant 233.8 2,627.0 Mother was married 12.7 Mother

Table 1. na (44, 45). Regardless of their causes, this analysis indicates

Am J Epidemiol. 2019;188(1):24–33 30 Torche and Sirois

Ethnicity and Nativity EE (95% CI) Downloaded from https://academic.oup.com/aje/article-abstract/188/1/24/5144386 by Stanford Law Library user on 31 January 2019

Figure 3. Comparison of effect estimates (EEs) associated with exposure to the signing of SB1070 into law in the first half of pregnancy for differ- ent groups of women defined by ethnicity and nativity, Arizona, December 2009 to March 2014. Confidence intervals (CIs) based on tests for the null hypothesis that the parameter estimate is different from zero at the 0.05 confidence level.

a reduction in fertility in a positively selected group of Latina of restrictive immigration law on birth weight. The literature immigrants exposed to SB1070 during pregnancy. suggests several pathways through which prenatal exposure to environmental stressors can affect birth outcomes. These include the mother’s physiological, neuroendocrine, and immune stress DISCUSSION responses, which could affect the developing fetus, and the mother’s behavioral responses to anxiety, such as reducing Existing literature suggests that the passage of a restrictive prenatal care use or consuming alcohol or cigarettes (49–51). immigration bill in Arizona had a negative effect on health-care The fact that the effect of exposure to the bill’s passage was utilization, psychological well-being, and self-rated health discrete and short-term is consistent with an acute stress response among Latino immigrants (34–38). Here we examined a less among immigrant mothers. A plausible mechanism for the visible but still relevant outcome: the effect of restrictive immi- observed effect on intrauterine growth is a stress-induced gration law on infants exposed before birth. We found that ex- increase in levels of placental corticotropin-releasing hormone, re- posure to the bill’s passage had a negative effect on birth weight sulting in decreased uteroplacental flow and hypoxemia restric- among Latina immigrant women, which was driven largely by a tion, which are well-known risk factors for fetal growth restriction decline in intrauterine fetal growth. Web Appendix 1 offers a (52). Our ancillary analysis of prenatal care utilization and smok- battery of robustness checks and shows that the findings are ing as potential behavioral mechanisms (Web Tables 8 and 9) robust to alternative specifications and significance calculations suggests that these behavioral pathways did not play a significant (Web Tables 4–7). This effect was not observed among US- role in this setting. There are, however, several other plausi- born Latinas or US-born black and white women, and its magni- ble pathways—such as economic hardship, change in diet, tude is comparable to the effect of major environmental stressors and decline in the quality of health care—that call for further documented by the literature. This finding should be interpreted investigation (14). in the context of the birth outcomes of Latina immigrants, which We found no evidence that the effect of the bill on birth weight compare favorably to those of US-born white women despite extended to US-born Latinas, departing from other research re- immigrants’ lower levels of education, income, and health insur- porting a negative impact of restrictive immigration policy on ance (46–48). Even if the decline in birth weight resulting from this population (22). We can only speculate about the sources of exposure to SB1070 has limited clinical impact at the individual divergence. It is possible that the absence of a spillover effect in level, its consequences at the aggregate level erode part of the this case resulted from contextual factors. In the context of a large health advantages of an already vulnerable population. and established Latino population in Arizona, the differences We also detected a decline in fertility and a reduction in the between immigrant and US-born Latinos in terms of economic proportion of teen, low-education, and single mothers among standing, language, and demeanor might be more pronounced Latina immigrants exposed to the immigration bill. These and visible than in contexts with a smaller and more homogeneous changes suggest that more disadvantaged Latina immigrants Latino population. Alternatively, it has been established that Latino might have reduced their fertility in the face of the bill. Even if immigrants lose their health advantage in birth outcomes across these sociodemographic factors are controlled for in our mod- generations, plausibly because subsequent generations are more els, if they are correlated with unobserved sources of maternal exposed to and more aware of racialized exclusion than recent selectivity, they could result in an underestimate of the true effect immigrants (53). As a result, a novel shock such as a restrictive of the law’s passage on birth weight that would have been immigration law might be less consequential for a population observed had the composition of the group (Latina immigrants already accustomed to racialized exclusion. giving birth) not changed. It is important to note that the effect captured in this analysis is An important question that we cannot address with the avail- an “intent to treat” outcome measured among all Latina immigrant able data is the mechanism(s) accounting for the negative effect women exposed to the bill, regardless of immigration status and

Am J Epidemiol. 2019;188(1):24–33 Restrictive Immigration Law and Birth Outcomes 31

A) Ethnicity and Nativity EE (95% CI) Downloaded from https://academic.oup.com/aje/article-abstract/188/1/24/5144386 by Stanford Law Library user on 31 January 2019

Effect Estimate

B) Ethnicity and Nativity EE (95% CI)

Effect Estimate

C) Ethnicity and Nativity EE (95% CI)

Effect Estimate

D) Ethnicity and Nativity EE (95% CI)

Effect Estimate

Figure 4. Indicators of change in the composition of births occurring in the second half of the year for different groups of women defined by ethnic- ity and nativity, Arizona, 2010. Measures are: A) births per thousand population; B) proportion of mothers aged 19 years or younger; C) proportion of mothers who were single; and D) proportion of mothers with a high-school diploma or less. CI, confidence interval; EE, effect estimate.

socioeconomic advantage. It is likely, however, that the effect attainment, distinguishing immigrants with an educational varied within the population. For those interested in overall popu- level of high-school diploma or less from those with some lation well-being, the intent-to-treat effect is a central result. If the college or more. Prenatal exposure to the bill’s passage resulted focus is on mitigation and compensation policies, identifying the in a decline in birth weight of 12 g (P = 0.04) among immigrants women most affected is critical. Ancillary analysis offered with low education and 29 g (P = 0.05) among immigrants with in Web Table 10 examines heterogeneity in SB1070’s effect higher levels of education (while these estimates differ in magni- among Latina immigrants based on mother’s educational tude, they are statistically indistinguishable (P = 0.29)). The

Am J Epidemiol. 2019;188(1):24–33 32 Torche and Sirois negative effect among highly educated immigrants, most of whom 2. Passell J, Cohn D. Overall Number of Unauthorized are authorized, suggests that the detrimental effect of restrictive Immigrants Holds Steady since 2009. Pew Res. Center, Sept. immigration law might have extended to documented immigrants. 2016; http://www.pewhispanic.org/2016/09/20/overall- We found that the effect on infant health resulted only number-of-u-s-unauthorized-immigrants-holds-steady-since- from exposure to the signing of the bill into law rather than 2009/. Accessed February 9, 2017. 3. Lueders H, Hainmueller J, Lawrence D. Providing driver’s from its (partial) implementation. This suggests that it is not licenses to unauthorized immigrants in California improves necessary for a proposed institutional change to become the traffic safety. Proc Natl Acad Sci U S A. 2017;114(16): law of the land to have harmful consequences. This finding 4111–4116. is noteworthy given the recent proliferation of restrictive 4. Karoly LA, Perez-Arce F. A Cost-Benefit Framework for Downloaded from https://academic.oup.com/aje/article-abstract/188/1/24/5144386 by Stanford Law Library user on 31 January 2019 immigration enforcement initiatives at the state and, more Analyzing the Economic and Fiscal Impacts of State-Level recently, federal level. Even though most of these proposals have Immigration Policies. Santa Monica, CA: 2016. https://www. been blocked by the legislative or judicial systems and have not rand.org/pubs/research_reports/RR1397.html. Accessed been implemented, our findings indicate that the threat might be January 13, 2017. sufficient to alter birth outcomes among vulnerable populations. 5. Waters M, Pineau M. The Integration of Immigrants into While the Arizona bill did not increase deportations, nor does it American Society. , DC: National Academies Press; 2015. http://www.nap.edu/catalog/21746. Accessed appear to have achieved a substantial reduction in the unautho- May 24, 2018. rized population (54, 55), it affected the birth outcomes of infants 6. Bohn S, Pugatch T. US border enforcement and Mexican born to Latina immigrants who were exposed during pregnancy. immigrant location choice. Demography. 2015;52(5): The infants affected will most likely become the next generation 1543–1570. of students, workers, and taxpayers. To the extent that birth 7. Leerkes A, Leach M, Bachmeier J. Borders behind the border: weight predicts later health, development, and achievement, an exploration of state-level differences in migration control these infants could be scarred by an institutional shock experi- and their effects on US migration patterns. J Ethn Migr Stud. enced before birth. 2012;38(1):111–129. 8. Watson T. Enforcement and Immigrant Location Choice. NBER Work. Pap. 19626. 2013; http://www.nber.org/papers/ w19626.pdf. Accessed April 8, 2017. ACKNOWLEDGMENTS 9. Amuedo-Dorantes C, Bansak C. The labor market impact of mandated employment verification systems. Am Econ Rev. Author affiliations: Department of Sociology, Stanford 2012;102(3):543–548. University, Stanford, California (Florencia Torche, 10. Lofstrom M, Bohn S, Raphael S. Lessons from the 2007 Legal Catherine Sirois). Arizona Workers Act. Work. Pap. Public Policy Inst. Calif. We thank Dr. Asad Asad, Dr. Raj Chetty, Ramona 2011; http://www.ppic.org/content/pubs/report/R_311MLR. pdf. Accessed April 30, 2017. Corrales, Dr. Jason Fletcher, Dr. Matthew Gentzkow, Lydia 11. Rhodes SD, Mann L, Simán FM, et al. The impact of local Guzman, Dr. Guido Imbens, Dr. Cecilia Menjivar, Dr. Juan immigration enforcement policies on the health of immigrant Pedroza, Robert Warren, and the Center for Migration hispanics/latinos in the United States. Am J Public Health. Studies for sharing their extremely valuable insights and data 2015;105(2):329–337. with us, and participants of the conferences, colloquia, and 12. White K, Yeager VA, Menachemi N, et al. Impact of workshops where this research has been presented for their Alabama’s immigration law on access to health care among useful feedback. We also thank Christopher Maggio and Latina immigrants and children: implications for national Merilys Huhn for their outstanding research assistance. reform. Am J Public Health. 2014;104(3):397–405. This work was presented at the Population Association of 13. Martinez O, Wu E, Sandfort T, et al. Evaluating the impact of America 2017 Annual Meeting, April 27–29, 2017, immigration policies on health status among undocumented immigrants: a systematic review. J Immigr Minor Health. , ; Social Mobility in an Unequal World: 2015;17(3):947–970. Evidence and Policy Solutions, Cornell University April 14. Philbin MM, Flake M, Hatzenbuehler ML, et al. State-level 20–22, 2017, Ithaca, ; the American Sociological immigration and immigrant-focused policies as drivers of Association 112th Annual Meeting, August 12–15, 2017, Latino health disparities in the United States. Soc Sci Med. , Quebec, ; the Child Health and 2018;199:29–38. Immigration Conference, May 25, 2017, Stanford, 15. Enriquez LE. Multigenerational punishment: shared California; and the Family Working Group Seminar Series experiences of undocumented immigration status within (Department of Sociology, University of California, Los mixed-status families. J Marriage Fam. 2015;77(4):939–953. Angeles), February 7, 2018, , California. 16. Santos C, Menjivar C, Godfrey E. Effects of SB 1070 on Conflict of interest: none declared. children. In: Magaña L, Lee E, eds. Latino Policies and Arizona’s Immigration Law SB 1070. New York, NY: Springer; 2013:79–92. 17. Fix M, Zimmerman W. All under one roof: mixed-status REFERENCES families in an era of reform. Int Migr Rev. 2001;35(2):397–419. 18. Asad AL, Clair M. Racialized legal status as a social 1. Warren R. US undocumented population drops below 11 determinant of health. Soc Sci Med. 2018;199:19–28. million in 2014, with continued declines in the Mexican 19. Brown HE. Race, legality, and the social policy consequences undocumented population. J Migr Hum Secur. 2016;4(1): of anti-immigration mobilization. Am Sociol Rev. 2013;78(2): 1–15. 290–314.

Am J Epidemiol. 2019;188(1):24–33 Restrictive Immigration Law and Birth Outcomes 33

20. Jiménez TR. Replenished Ethnicity: , care and public assistance among Mexican-origin adolescent Immigration, and Identity. Berkeley, CA: University of mothers and their mother figures. Am J Public Health. 2014; California Press; 2010. 104(suppl 1):S28–S34. 21. Viruell-Fuentes EA, Miranda PY, Abdulrahim S. More than 39. Abadie A, Diamond A, Hainmueller J. Synthetic control culture: structural racism, intersectionality theory, and methods for comparative case studies: estimating the effect of immigrant health. Soc Sci Med. 2012;75(12):2099–2106. California’s tobacco control program. J Am Stat Assoc. 2010; 22. Novak NL, Geronimus AT, Martinez-Cardoso AM. Change in 105(490):493–505. birth outcomes among infants born to Latina mothers after a 40. Buckles KS, Price J. Selection and the marriage premium for major immigration raid. Int J Epidemiol. 2017;46(3):839–849. infant health. Demography. 2013;50(4):1315–1339. 23. Almond D, Currie J. Killing me softly: the fetal origins 41. Roth J, Hendrickson J, Schilling M, et al. The risk of teen Downloaded from https://academic.oup.com/aje/article-abstract/188/1/24/5144386 by Stanford Law Library user on 31 January 2019 hypothesis. J Econ Perspect. 2011;25(3):153–172. mothers having low birth weight babies: implications of recent 24. Conley D, Strully KW, Bennett NG. The Starting Gate: Birth medical research for school health personnel. J Sch Health. Weight and Life Chances. Berkeley, CA: University of 1998;68(7):271–275. California Press; 2003. 42. McCrary J, Royer H The effect of female education on fertility 25. Senate Bill 1070. Support Our Law Enforcement and Safe and infant health: evidence from school entry policies using Neighborhoods Act. 49th Legislature Arizona; 2010. https:// exact date of birth. Am Econ Rev. 2011;101(1):158–195. www.azleg.gov/legtext/49leg/2r/bills/sb1070s.pdf. Accessed 43. Wu L, Wolfe B. Out of Wedlock: Causes and Consequences of January 13, 2017. Nonmarital Fertility. New York, NY: Russell Sage; 2001. 26. Magaña L. Arizona’s immigration policies and SB 1070. In: 44. Bohn S, Lofstrom M, Raphael S. Did the 2007 legal Arizona Magaña L, Lee E, eds. Latino Politics and Arizona’s workers act reduce the state’s unauthorized immigrant Immigration Law SB 1070. New York: Springer; 2013:19–26. population? Rev Econ Stat. 2014;96(2):258–269. 27. National Conference of State Legislatures. State Omnibus 45. Thiede BC, Monnat SM. The and America’s Immigration Legislation and Legal Challenges. 2012; http:// geography of unemployment. Demogr Res. 2016;35:891–928. www.ncsl.org/research/immigration/omnibus-immigration- 46. Singh GK, Yu SM. Adverse pregnancy outcomes: legislation.aspx. Accessed August 10, 2017. differences between US- and foreign-born women in major 28. Blitzer J. Trump’s ideas man for hard-line immigration policy. US racial and ethnic groups. Am J Public Health. 1996;86(6): New Yorker [electronic article]. 2016; www.newyorker.com/ 837–843. news/news-desk/trumps-ideas-man-for-hard-line-immigration- 47. Acevedo-Garcia D, Soobader MJ, Berkman LF. Low policy. Accessed May 25, 2018. birthweight among US Hispanic/Latino subgroups: the effect 29. Camacho A. Stress and birth weight: evidence from terrorist of maternal foreign-born status and education. Soc Sci Med. attacks. Am Econ Rev. 2008;98(2):511–515. 2007;65(12):2503–2516. 30. Torche F. The effect of maternal stress on birth outcomes: 48. Hummer RA, Powers DA, Pullum SG, et al. Paradox found exploiting a natural experiment. Demography. 2011;48(4): (again): Infant mortality among the Mexican-origin population 1473–1491. in the United states. Demography. 2007;44(3):441–457. 31. Black SE, Devereux PJ, Salvanes KG. Does grief transfer 49. Dunkel Schetter C. Psychological science on pregnancy: stress across generations? Bereavements during pregnancy and child processes, biopsychosocial models, and emerging issues. Annu outcomes. Am Econ J Appl Econ. 2016;8(1):193–223. Rev Psychol. 2011;62:531–558. 32. Dinan S. A year later, Ariz. Immigration fights rage. 50. Beijers R, Buitelaar JK, de Weerth C. Mechanisms underlying Washington Times. April 21, 2011. the effects of prenatal psychosocial stress on child outcomes: 33. Trevizo P, Brosseau C. Lax record-keeping blurs SB1070 beyond the HPA axis. Eur Child Adolesc Psychiatry. 2014; impact. Arizona Daily Star. March 2, 2014. 23(10):943–956. 34. Anderson KF, Finch JK. Racially charged legislation and 51. Hobel CJ, Goldstein A, Barrett ES. Psychosocial stress and Latino health disparities: the case of Arizona’s S.B. 1070. pregnancy outcome. Clin Obstet Gynecol. 2008;51(2): Sociol Spectr. 2014;34(6):526–548. 333–348. 35. Ayón C, Becerra D. Mexican immigrant families under siege: 52. Wadhwa PD, Garite TJ, Porto M, et al. Placental corticotropin- the impact of anti-immigrant policies, discrimination, and the releasing hormone (CRH), spontaneous preterm birth, and fetal economic crisis. Adv Soc Work. 2013;14(1):206–228. growth restriction: a prospective investigation. Am J Obstet 36. Hardy LJ, Getrich CM, Quezada JC, et al. A call for further Gynecol. 2004;191(4):1063–1069. research on the impact of state-level immigration policies on 53. Viruell-Fuentes EA. Beyond acculturation: immigration, public health. Am J Public Health. 2012;102(7):1250–1254. discrimination, and health research among Mexicans in the 37. Szkupinski Quiroga S, Medina DM, Glick J. In the belly of the United States. Soc Sci Med. 2007;65(7):1524–1535. beast: effects of anti-immigration policy on Latino community 54. Amuedo-Dorantes C, Lozano F. On the effectiveness of members. Am Behav Sci. 2014;58(13):1723–1742. SB1070 in Arizona. Econ Inq. 2015;53(1):335–351. 38. Toomey RB, Umaña-Taylor AJ, Williams DR, et al. Impact of 55. Hoekstra M, Orozco-Aleman S. , state law, Arizona’s SB 1070 immigration law on utilization of health and deterrence. Am Econ J Econ Policy. 2017;9(2):228–252.

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