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Markkula Center for Applied Ethics

Episode 2: Amy Reed-Sandoval on Migration, Gender, and Pregnancy

Episode 2: Amy Reed-Sandoval on Migration, Gender, and Pregnancy: Traveling for Prenatal Care and Abortions, COVID-19 Abortion Bans, and “Socially Undocumented” Identity

[Note: This transcript has been edited for clarity.]

JK: Welcome to Borderland, an interview series on immigration ethics. I’m Jonathan Kwan, the Inclusive Excellence Postdoctoral Fellow at the Markkula Center for Applied Ethics at Santa Clara University. And I’m very pleased to be joined today by Dr. Amy Reed-Sandoval, who is Assistant Professor in the Department of Philosophy and participating faculty in the Latinx and Latin American Studies Program at the University of Nevada, Las Vegas. Her primary research interests are in political philosophy with a special focus on migration issues, Latin American and Latinx philosophy, bioethics, feminist philosophy, and philosophy for children. She is the author of Socially Undocumented: Identity and Immigration Justice, which was published last year by Oxford University Press, and co-editor of Latin American Immigration Ethics and Ética, Política, y Migración. She is the founding director of the Philosophy for Children in the Borderlands program in El Paso, Texas and Ciudad Juárez, Mexico. Thanks so much for being with us today, Amy.

ARS: Thank you, Jonathan, for having me, for inviting me.

JK: So just to begin, much of your work, especially recently, has been focused on the intersection of migration and reproductive justice. And I think it’s fair to say that most people, when they think of these issues, they don’t really think of them as connected with one another. They just think of immigration, on the one hand, and reproductive health or abortion rights, on the other hand. But you analyze cases in which people cross borders for prenatal care or for abortions, and you show us how such cases really challenge and call on us to transform our very ethical understandings of both migration and reproductive justice. So, I was wondering if we could just start with you telling us the story of Salma that you mentioned in your book Socially Undocumented and exploring the ethical lessons that you think we should draw from cases such as hers.

ARS: Yes, thank you. And thank you for that broad overview of my research at present. Yes, so Salma’s story, you’re right, it comes from a chapter of my book, Socially Undocumented. And for that chapter, I had done ethnographic research, including interviews with some Mexican women who had crossed or were in the process of crossing the US-Mexico border to seek prenatal care and to give birth in the United States. And for various reasons for the purpose of that chapter in the book, I was focusing on the experiences of pregnant Mexican women who had a legal permission to enter the United States for prenatal care.

And so in the case of Salma (a pseudonym), she had a complicated pregnancy, and she was getting some prenatal care in Ciudad Juárez where often pregnant people in the region who cross borders, for example, in Ciudad Juárez and El Paso will get prenatal care on both sides of the border for various strategic reasons. And her doctor in Juárez had put her on bed rest, and she was told that getting up and moving around or even sitting up straight for extended periods of time would seriously risk her health and could also present problems for pregnancy. But Salma, for various personal reasons, was committed to getting prenatal care and eventually giving birth in the United States. This was very important to her. And so she decided she would continue to cross the US-Mexico border by car and with legal permission to seek prenatal care there. What she would often do is she would put her seat back. She would be in the passenger seat. She reported that her husband would drive the car. And so she would sit in this line about two hours, sometimes three hours, waiting to cross the border, waiting for her encounter with immigration enforcement. They would ask her, what she was up to, why she was entering the US. And for most of that time, she would put her seat back and she would be able to follow her doctor’s orders in that case.

But she reported to me that, as she found herself approaching the border and as her own body became visible to immigration enforcement, she would go against her doctor’s orders. And she would sit up straight in her chair, even though she had been ordered not to do this. And she would sometimes sit there for a half an hour, maybe even longer. And so of course I asked her, why would you do this, your own health is at risk here. And she told me that she was fearful of being perceived as a pregnant Mexican woman, possibly a poor pregnant Mexican woman. She is a middle-class woman, but she was afraid of being perceived this way and as someone who was sick and who would perhaps be perceived as being a drain on the system in the United States. And so this is a problem that I take up in the book.

Everything that she was doing was legal: she had legal permission to enter the US; it’s completely legal for people who are not US citizens to give birth in the United States and to seek prenatal care there. But she was nevertheless putting herself at risk. And as I explore in the book, I argue that this is because for Salma and others similarly positioned, Salma is socially undocumented. She was socially undocumented in those encounters. In other words, she was presumed to be legally undocumented on the mere basis of her appearance, and she was subjected to demeaning immigration related constraints on that basis. I think that this is significant. It’s significant when we’re thinking about gender and migration and pregnancy and migration. And even more broadly, it shows that, in my view, we need to broaden our immigration categories, including our category of what it means to be undocumented because there are people who have internalized a sense of illegality and this is something that we’re not talking enough about.

JK: It’s so striking to me that in that case, and other cases that you explore, these people are doing what is legal. They have the legal permission to do all these things. And yet they feel all these pressures to sacrifice their very health in order to counter certain perceptions of them as being, like you’re saying, maybe a drain on resources or a sick pregnant Mexican woman trying to give birth in the US, etc. At one point in your book, you say that hospitals themselves are experienced as sites of border crossings and illegalizations. I think that’s another interesting concept. When people think of the border, they usually think, well, the border between these two nation-states. How can hospitals themselves be a site of illegalization and border crossings? Can you explain that a little bit more?

ARS: Yes, thank you. And I neglected to add when I was talking about Salma and this is relevant here: Salma could have been denied entry to the United States by an immigration officer. And this is relevant to what I’m going to say in response to your question as well. Immigration officers and other officials have a lot of discretionary power when it comes to immigrant admissions and the treatment of immigrants. And so, if that officer had deemed Salma liable to become a public charge, her formal legal authorization to enter—she could have been denied entry. So, I think with this in mind, thinking about hospitals as themselves sites of immigration enforcement—this is very complicated.

On the one hand, there are cases we know, we’ve seen widely publicized cases of hospital staff collaborating with immigration enforcement in different ways. And as a result, immigrants who might be legally undocumented might feel reluctant to go to the hospital and to seek care there. So, it can actually be places where getting medical care could result in deportation. But beyond that, there are racist attitudes that can come up on the part of medical care providers. Medical care providers might themselves be subjected to racist attitudes that are intertwined with anti-immigrant attitudes as well. These are experiences that woman I interviewed reported to me. And so, imagine enduring a stressful border crossing like the one that I just described in Salma’s case. And then you go into a hospital. You have questions about the extent to which hospital administration might be collaborating with immigration enforcement. You enter this space and if then one is subjected to additional racist treatment or anti-immigrant treatment, if one is being called an “illegal”—a so-called “illegal”—that feels like an extension of the border and perhaps is an extension of the border.

In addition, there’s one part of the book that is interesting—it’s so interesting when you write a book, you never know what parts people are really going to respond to and often that’s the parts that you think are the most interesting and compelling. There was one woman that I interviewed, a Mexican woman, who had gotten most of her prenatal care in Ciudad Juárez, but her plan was to give birth in the United States. And so, she had gotten lots of lab work done and she had a lot of medical reports of the prenatal care she had received in Juárez. And then in the last month of her pregnancy, she made an appointment with an OB-GYN in El Paso. She was getting her birth plan together. She brought all of this lab work. And by the way, these medical labs, they’re the same companies on both sides of the border. It’s literally the same company that’s doing blood testing of pregnant people on both sides. But she expressed this frustration when she presented her prenatal care. And for her, it’s a source of pride, of maternal pride—she’s being a good mom, she’s going to her prenatal care appointments. But the nurse wrote in her chart, “No prenatal care.”

All this work that she had done was completely written off in this new context because it had to be done in a US-based laboratory. Even though it’s literally the same company, it had to be US-based. And so, for this woman that I interviewed, this felt like an extension of her social illegalization. So, we think about being socially undocumented and how one’s very immigration papers can be overwritten or disparaged. Well, that can extend into a hospital setting when your prenatal care history—your lab work, your medical history—is also written off. And so, this is why I think an ethnographic approach is so interesting when you approach this issue from the perspective of the pregnant person who has crossed the border into the United States to get this medical care, the hospital paperwork becomes part of the immigration paperwork, and the disparaging of the hospital stuff is connected to these kinds of patterns of social illegalization.

JK: Right, so fascinating. I definitely think your work and that concept of socially undocumented is such a useful framework for thinking about all these issues—issues that at least in political philosophy are not really addressed when people think about immigration. Can we talk a little bit more next about your work on COVID-19 abortion bans? So maybe that’s a bit more recent. But can you tell us about what were these bans and the intersection between pandemic ethics and migration ethics? You argue that we should really think of these bans as a kind of immigration control. People who travel for abortion should be thought of as migrants. Could you expand on that a little bit more?

ARS: Yes, thank you for that question and for the background reading that you’ve done. I started working on the question of abortion and border crossing for abortion care after I did this ethnographic research project in the US-Mexico borderlands. So, I already had in mind this idea that we need to expand upon our categories, expand upon our understanding of who counts as a migrant and even what counts as migration. So for me, following the footsteps of social scientists and also philosophers like Alex Sager, I think that we need to transcend a methodological nationalist paradigm that only focuses on national borders. And we need to think about internal borders as well: state borders and different types of borders and barriers. And I think this is really important when we think about gender and migration. So, just by way of background, that was the history behind this.

I became interested in questions about crossing borders for abortion care before the pandemic. I started doing ethnographic research in Albuquerque, New Mexico in 2017. Albuquerque is home or (it’s not literally home) the workspace of two of only four physicians in the United States who regularly practice third trimester abortions. And folks don’t know this, but this also holds true in cases where the pregnant person’s life might be threatened by the pregnancy. You might find yourself in that kind of dire situation. You might find yourself having to make your way to a place like Albuquerque to get abortion care later in a pregnancy. So, I was interested in the narratives of people who had crossed different kinds of borders—national border, state borders—or even just travelled long distances to get abortion care later in pregnancy in Albuquerque.

It was interesting. It was also very hard research. Because as we know, people are talking about a future without Roe v. Wade or debating Roe v. Wade. When people have to travel long distances to get abortion care, if the people in question suffered from different patterns of social marginalization—if they’re poor, if they can’t afford to hop on a plane ride or to drive across the country, or if they’re undocumented and driving across the country to Albuquerque puts them at risk of encounters with law enforcement and immigration enforcement—I mean, there are serious consequences. So, this was the general background, but of course then the pandemic hit.

And so to answer your question more directly: at the beginning of the pandemic, a number of states that are governed or led politically by folks who want abortion to become illegal therein use the pandemic to deny abortion access to pregnant people. And so the argument that was made—this was at the beginning of the pandemic and there were questions about getting medical supplies to doctors, the essential medical equipment and this idea that we had to prioritize dealing with COVID and treating COVID. There was this kind of hierarchy of procedures that needed our attention.

The argument was made that abortion care, that providing for abortion care, was depleting resources that needed to be used to deal with COVID during these very first COVID surges. And so abortion care, it was deemed non-essential medical care in a lot of these states. And as a result, folks who needed to get abortions were often having to travel to Albuquerque and to other sites where they could still get abortion care. And it was incredibly complicated because they had to cross internal borders. They had to pay all of the associated costs. But in addition, they sometimes had to violate stay at home orders as well.

So, I did a follow up study. This was over the phone. It was during the early days of the pandemic. I didn’t travel to Albuquerque. But I heard from physicians that some of their patients had reported their frustration in having to violate their own stay at home order, having to travel during a really scary time. This was a time when we still didn’t know a lot about how COVID worked, how it was transmitted. They had to make their way to Albuquerque. And then when they got to the abortion clinic, there were anti-abortion protesters who were themselves violating stay at home orders trying to dissuade them from entering. And sometimes if they were, in certain respects, fortunate enough to be able to get an abortion early in pregnancy, it could be a question of driving for 16 hours under these conditions to be given an abortion pill, which they swallowed, and then they had to drive 16 hours back home. And so, this was the general framework. And so, I argue, again, building upon my previous research on prenatal care at the US-Mexico border, that we need to expand upon our categories, especially if we want to think about the neglected issues under the rubric of gender and migration. And that as a matter of fact, yes, these COVID-19 abortion bans should be regarded as forms of immigration enforcement control, and that they’re also immigration bans. That’s my ultimate argument there.

JK: It’s so interesting to me because when I think about COVID-19 and immigration bans, again, I usually think—and I think most people think about—the national borders where this pandemic was used as a pretext for all kinds of more restrictive immigration policies: to not process asylum and refugee seekers, etc. But when you really dropped the methodological nationalism, as you call it, when we’re just focusing on nation states, and you think about internal borders, you can see more broadly how this global pandemic, not only was it used an excuse to be more anti-immigrant on these national borders, but it was also used in these internal borders as well. Thanks so much for sharing the broader history of your work and how you came about thinking about these more current issues of COVID-19 abortion bans. It really, I think, helps to show that mobility and traveling for abortion has always been an issue. And this is just the latest iteration of it. And depending on how the Supreme Court decides Roe v. Wade and the Mississippi case, we may see a lot more people traveling for abortions and a lot more migrants on this particular issue for years to come.

You talk a lot about your methodology of using ethnography and philosophy. And I think when most people think about philosophy—philosophers alike as well, members of the public but also academic philosophers—they don’t usually think about ethnography. Maybe they think about the stereotype of the armchair philosopher who just sits in that chair and thinks really hard about the problem and tries to come up with some answers. You’ve already spoken a little bit about it, but can you tell me more about how it has informed to work, why it’s so important to use these kinds of tools, maybe even some challenges that you face doing the ethnography in the discipline of philosophy. How has it been received in academia to use both ethnography and philosophy and combine them together in your methodology?

ARS: Yes, thank you for that question. You’re right, this methodology is really important to me in my work. I’ll say I’m glad to see increasing numbers of philosophers using ethnographic approaches to their philosophical work. I think that’s exciting. And so, I’m inspired to see movement in this direction. But you’re right. It’s definitely a departure from traditional armchair philosophizing. And maybe I’ll talk a little bit about the challenges and then I’ll end on a positive note on my response to this question, I’ll talk about why I think it’s important. But you’re right, it is a challenge.

On the one hand, not all philosophers regard ethnographically informed philosophizing as philosophy—capital “P” Philosophy. And so maybe just because they might reject the idea that ethnography could play a role in philosophy. I’ll also say, to be a little bit more charitable toward that position, it can be challenging, and I know that anthropologists, for example, deal with this challenge as well. There’s always the challenge of making the rich ethnographic detail really speak to the argumentation that comes afterward. And so, you don’t want a paper, like an ethnographic philosophy paper to look like, section one, here’s all the contexts and the ethnography and the interviews. And then there’s the philosophy part and they almost read like two different papers. One wants them to be integrated. And so, I think it’s always fair to ask questions about the extent to which those two parts are speaking to one another and informed by one another. So, that’s a challenge that maybe some skeptical philosophers will perceive when they’re reviewing a paper that’s ethnographically informed.

But sometimes I also face challenges from the other side. Maybe if I apply for a grant in which I say I want to do this ethnographic project that’s going to inform this philosophy. Some social scientists remain skeptical that philosophers can actually do ethnography. And so, I’ve done funded ethnographic research. I think that I still have lots to learn, of course, but I have experience in that area. But there are some folks that think that it’s really not the job of philosophers to be doing ethnography. And so those are the challenges that come with doing this type of work.

But it is nevertheless important to me. So first of all, reading multidisciplinary contributions to ethical conversations about migration has always informed my own research. And being able to actually do ethnography enables me to build upon that existing body of research. It enables me to explore dimensions of migration that philosophers haven’t been so attentive to but social scientists haven’t either. If you want to work on the question, sometimes you have to do the background research yourself. And so, I think that it serves to expand upon our sense of what questions we ought to be exploring. It says to identify philosophical projects that really speak to the lived experiences of the people about whom we are writing, which we should all ultimately want to do, and to pursue philosophy in a bottom up way that’s ultimately, in certain respects, relevant to the real world. I think that’s important, especially in ethics and political philosophy. So, for all of those reasons, it’s really important to me despite the challenges.

And I’ll just say one more little remark. I think that many of us in our very first undergraduate philosophy class, what are we exposed to?—often, Plato’s dialogues. And I know that we like to say that, for those of us that found philosophy this way, it’s certainly fun to see the philosophical questions that Socrates via Plato is taking up. But I actually think that a lot of the joy that undergraduates get out of reading those dialogues also comes from that from the fact that these dialogues are often embedded in a social context. And we’re imagining the characters and the conversations and we’re thinking about Socrates’s life, his trial, and all of his challenges. We tend to kind of cut that off in our heads and just focus on the Euthyphro dilemma itself or the philosophical challenges. But I actually think that there’s something really wonderful about this kind of embedded philosophy and I think it’s part of what often gets people excited about philosophy in the first place. That’s just my own view on the matter.

JK: I think at the Markkula Center, we’re definitely in line with that view. Obviously, we’re a center for applied ethics. So, we really want to use ethics and speak to people’s lived experiences, people’s embeddedness in the actual context and problems that they’re facing. Speaking of boundary policing, it seems like in academia, the boundaries between different disciplines, that is policed. And it seems like there are certainly challenges. Obviously, there are people like you who are doing very interesting, interdisciplinary work in philosophy and in other disciplines to challenge and move academic research in new directions.

But speaking about the Markkula Center, at our center we often like to use ethical lenses to guide decision making. We have a framework online that is a tool that’s been recently updated. It has six such lenses. Recently, we’ve added an ethics of care lens to include more feminist perspectives. It seems like in your work, there are some resonances with this lens of care ethics. So, I was wondering if you can tell us more about what you think about care ethics and how it has informed your work on migration and reproductive justice.

ARS: Yes, thank you. I love this enthusiasm for care ethics. And though I don’t explicitly use the terminology of care ethics in my book, for example, or more recent work, my work is absolutely informed by care ethics. So, thinking about pregnancy and migration or issues of migrating as a family (which I’m also very interested in my current work as well), being able to really perceive and deal with these ethical challenges responsibly demands that we think beyond and transcend this paradigm of the atomistic individual who is just going through life untethered to social obligations and familial and community context. To be able to theorize pregnancy and migration or migrating as a parent or a family member, it involves us understanding that individuals are embedded in these relationships of loving and caring and that our very agency and rationality comes from that. It’s an incredibly important insight that we need to be able to challenge the oppressive forces that the people that I write about are facing. Because not being able to cross borders to get pregnancy related medical care—I’ve seen this in my ethnographic research—can really challenge one’s understanding of one’s own agency and rationality, one’s autonomy and self-trust. Because we get that through our ability to participate in flourishing interpersonal relationships. And so, I work in feminist political philosophy, which is of course informed and uses care ethics and works within that paradigm. And so yes, a care ethics approach is very important to my own way of thinking about these issues.

JK: And then I was curious, again, going on this line of using ethical lenses—in the context of issue of immigration, is there an ethical lens that you think would be especially helpful for thinking about immigration ethics?

ARS: Thank you. I hate to self-promote but I feel like I would be remiss if I didn’t offer my own framework of socially undocumented identity as an ethical lens for thinking about ethical dimensions of migration. I just want to say that a focus on being socially undocumented enables us, I think, to challenge a great deal of immigration related injustices without necessarily having to fall into, what I sometimes called, the trap of the open borders debate. It sometimes seems like the only way to get to a very progressive vision of immigration justice involves removing borders from our philosophizing and from our framework. And I’m not sympathetic to borders. I’m in fact sympathetic to the open borders position. But it can cause some problems for doing applied ethics in the realm of immigration in my view.

And so, this idea of being socially undocumented, it demonstrates, in my view, that many of the immigration injustices that people—migrants and perceived members of migrant communities—deal with don’t stem directly from their legally undocumented status. It’s the result of intersecting racism and sexism and sometimes classism. So, I would encourage thinking about being socially undocumented as a means of diagnosing a lot of these social ills but without having to use an open borders framework that strike some people as too utopian or that might make it hard to conceive of a lot of these injustices that are happening on the ground.

JK: I think that’s good because the even if you defend open borders, you’re primarily thinking about legal questions of immigration. I know you explained “socially undocumented” a little bit earlier. But could you just explain it one more time for our viewers. If you had to succinctly describe what it means to be socially undocumented, how would you explain it?

ARS: Okay, I’ll try to be as succinct as possible. So, a socially undocumented person is someone who in the United States and often in other contexts as well, is read as a so-called “illegal.” Obviously, the term “illegal” is a slur and so I propose that we use the term, “socially undocumented.” But as we all know, people who are read as so-called “illegals,” often have legal authorization to be in the United States and even if they are legally undocumented, being perceived in this way and treated in this way is unjust, regardless of one’s legal status. So that’s what it means. So, I say, let’s think about immigration illegality in terms of a social identity and not a legal status to understand how it works and to realize that it’s not a problem of legally undocumented migration. What’s really happening here is a sustained pattern of racism and classism that often intersects with sexism.

JK: Thank you so much for answering these questions. My last question is just if you could tell us what you are working on next, what future projects are on the horizon for you.

ARS: Thank you. Right now, I’m working to develop a feminist theory of borders and obviously thinking a lot about care ethics in the process. I think that philosophers ought to spend more time theorizing borders themselves because I believe that our understanding of what counts as a border informs our normative work on migration in ways that are not always as apparent as they could be. So, I think a feminist theory of borders will enable us to conceptualize borders in ways that make these kinds of gender injustices happening in the realm of migration more visible. And it will enable us to have better philosophical conversations about the ways in which women, pregnant people, and other vulnerable border crossers are oppressed and treated unjustly by our immigration system, broadly construed.

JK: Am I right that the tentative title for this project to come will be Intimate Borders?

ARS: That’s right. The tentative title for the forthcoming book. Thank you for knowing that.

JK: That’s awesome. Well, everyone should be on the lookout for that book to come. Thank you so much, Amy, for speaking with us today about immigration, gender, ethnography, reproductive justice. Thank you so much for sharing your work.

ARS: Thank you so much for taking the time to talk with me about my work. I really enjoyed our conversation. Thanks, Jonathan.

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