The United States is embroiled in a debate about whether to protect or deport its estimated 11 million unauthorized immigrants, but the fact that these immigrants are also parents to more than 4 million U.S.-born children is often overlooked. We provide causal evidence of the impact of parents’ unauthorized immigration status on the health of their U.S. citizen children. The Deferred Action for Childhood Arrivals (DACA) program granted temporary protection from deportation to more than 780,000 unauthorized immigrants. We used Medicaid claims data from Oregon and exploited the quasi-random assignment of DACA eligibility among mothers with birthdates close to the DACA age qualification cutoff. Mothers’ DACA eligibility significantly decreased adjustment and anxiety disorder diagnoses among their children. Parents’ unauthorized status is thus a substantial barrier to normal child development and perpetuates health inequalities through the intergenerational transmission of disadvantage.

SignificanceWe provide a randomized test of policy interventions that address barriers to naturalization for low-income immigrants. We find that offering fee vouchers doubles the naturalization application rate among low-income immigrants, but nudges often used by service providers did not increase applications among fee waiver-eligible immigrants below the poverty level. Our results help guide policy efforts to address the problem of low naturalization rates. The current high fees prevent a considerable share of low-income immigrants who desire to become Americans from submitting their applications. Lowering the fees should therefore increase naturalization rates and generate long-run benefits for new Americans and their communities. However, the poorest immigrants face deeper challenges to naturalization that are not easily overcome with the low-cost nudges we tested.

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Background The Deferred Action for Childhood Arrivals (DACA) program provides temporary relief from deportation and work permits for previously undocumented immigrants who arrived as children. DACA faced direct threats under the Trump administration. There is select evidence of the short-term impacts of DACA on population health, including on birth outcomes, but limited understanding of the long-term impacts. Methods We evaluated the association between DACA program and birth outcomes using California birth certificate data (2009–2018) and a difference-in-differences approach to compare post-DACA birth outcomes for likely DACA-eligible mothers to birth outcomes for demographically similar DACA-ineligible mothers. We also separately compared birth outcomes by DACA eligibility status in the first 3 years after DACA passage (2012–2015) and in the subsequent 3 years (2015–2018) - a period characterized by direct threats to the DACA program - as compared to outcomes in the years prior to DACA passage. Results In the 7 years after its passage, DACA was associated with a lower risk of small-for-gestational age (− 0.018, 95% CI: − 0.035, − 0.002) and greater birthweight (45.8 g, 95% CI: 11.9, 79.7) for births to Mexican-origin individuals that were billed to Medicaid. Estimates were consistent but of smaller magnitude for other subgroups. Associations between DACA and birth outcomes were attenuated to the null in the period that began with the announcement of the Trump U.S. Presidential campaign (2015-2018), although confidence intervals overlapped with estimates from the immediate post-DACA period. Conclusions These findings suggest weak to modest initial benefits of DACA for select birthweight outcomes during the period immediately following DACA passage for Mexican-born individuals whose births were billed to Medicaid; any benefits were subsequently attenuated to the null. The benefits of DACA for population health may not have been sufficient to counteract the impacts of threats to the program's future and heightened immigration enforcement occurring in parallel over time.

Immigration legal services providers (ISPs) are a principal source of support for low-income immigrants seeking immigration benefits. Yet there is scant quantitative evidence on the prevalence and geographic distribution of ISPs in the United States. To fill this gap, we construct a comprehensive, nationwide database of 2,138 geocoded ISP offices that offer low- or no-cost legal services to low-income immigrants. We use spatial optimization methods to analyze the geographic network of ISPs and measure ISPs’ proximity to the low-income immigrant population. Because both ISPs and immigrants are highly concentrated in major urban areas, most low-income immigrants live close to an ISP. However, we also find a sizable fraction of low-income immigrants in underserved areas, which are primarily in midsize cities in the South. This reflects both a general skew in non-governmental organization service provision and the more recent arrival of immigrants in these largely Southern destinations. Finally, our opti- mization analysis suggests significant gains from placing new ISPs in underserved areas to maximize the number of low-income immigrants who live near an ISP. Overall, our results provide vital information to immigrants, funders, and policymakers about the current state of the ISP network and opportunities to improve it.