It’s a hot, sticky April morning in the Rio Grande Valley of South Texas, just 10 miles from the Mexican border, and I’m driving with Dora Proa, a reproductive health community educator for a local organization called ACCESS Esperanza. We’ve just passed a field of scrub trees and grazing cattle, and entered a neighborhood that will go unnamed. Unnamed because it’s a colonia—one of hundreds of unincorporated subdivisions in the area that lack running water and street lighting—and it’s filled with poor and frightened people. Many of them are undocumented immigrants.
Nearly half of all women in the Rio Grande Valley live in poverty, and the uninsured rate for those of reproductive age in 2015, even after Obamacare, was 56%. (In the entire U.S., it was 22%.)
These bleak statistics reflect horrors like a high rate of young women in South Texas dying of cervical cancer, which could have been easily treated in its early stages if affordable, preventive health care were available.
Instead, it’s become even less available since 2011. That’s when anti-abortion politicians in the state legislature voted to effectively defund all of Texas’ Planned Parenthoods. Their methods became a model for the proposed American Health Care Act making its way through Congress. The AHCA aims to defund Planned Parenthood nationally by cutting it off from Medicaid, which is where it gets most of its public funding.
Proa used to work for Planned Parenthood—until the Texas defunding. For a half century the group served women in South Texas. Its clinics never did abortions, but no matter. Planned Parenthood of Hidalgo County, which encompasses the colonia we’re in, stayed open but could no longer treat most of its 23,000 patients. Its patient census plummeted to only 10,000. Desperate for its work to survive, the agency disaffiliated from national Planned Parenthood in 2014. Then it changed its name, to ACCESS Esperanza. The second word is Spanish for “hope.” Proa kept working with the newly named group.
Virtually everyone in the colonia we’re visiting today is Latino. Virtually all live under the poverty line. The kids are typically born in this country, but many of their moms and dads are undocumented immigrants. ACCESS Esperanza runs reproductive health care clinics a few miles from here, which serve residents of the hundreds of colonias dotting the area. Proa goes house to house and knocks on doors to sign people up for appointments. She used to have no trouble recruiting patients. But these days it’s a challenge to get them into the clinics, because they’re afraid to do almost anything.
This morning Proa lugs pamphlets and plastic models of vaginas, cervixes, and uteruses in a big pack while walking through the colonia. She guides me past stray mutts mid-street, while assessing the ramshackle old trailers and jerry-rigged houses, looking for likely doors. She’s seeking women who are not behind chained gates or “Beware of Dog” signs, backed by the sound of insane barking.
Soon she spies a very pregnant young woman checking the mail at some outdoor postal boxes.
It turns out she’s seen Proa before, so she trusts her. She tells us she’s from Honduras and undocumented. She agrees to talk if I identify her only by her middle name, Yesenia.
Yesenia is in her thirties. It’s her fifth child, all boys so far, and the sonogram showed this one is, too. He’s due in two months, and she’s seeing an OB/GYN for prenatal care and the birth. I pose the question I’ve come here to ask the women residents:
“Have you ever missed your reproductive health-care appointments because you’re afraid to leave your house?”
Yesenia does not answer immediately. Instead, she launches into a description of how the colonia is paniqueando—panicking. All because of constant Border Patrol presence, along with Texas state troopers and local police who help the Border Patrol. They’re doing sweeps, Yesenia says. The sweeps work this way: Undocumented people in the state can’t get drivers licenses, but they need to go to work, and in this largely rural region, public transport is somewhere between impractical, unaffordable, and non-existent. So law enforcement stop drivers with broken taillights. Then they check papers, round up people without documents, and deport them.
This has been a long-time problem, Yesenia says. But since Trump became president, it’s gotten much worse. And it’s scaring the daylights out of people, including women of childbearing age.
The neighbors have been trying to anticipate danger, Yesenia says. A man from an immigrants’ and workers’ rights group runs a raids-warning system on WhatsApp, where most Latino immigrants message. All the neighbors are members, and when their WhatsApps ping, they mobilize, hide, or both.
The area teems with state troopers, reassigned from Texas’ interior at a cost of hundreds of millions of dollars. The state legislators who voted for the reassignment say the troopers bar terrorists and smugglers from crossing the border. But evidence for their effectiveness is murky. Before the inauguration, the Border Patrol often did what the agency has called “catch and release.” When someone was detained and investigation showed no prior criminal record, many years in the U.S., and a passel of U.S.-born kids, the immigrant was often let go.
Now, per Trump’s executive orders, word is out that masses of people are being sent to detention centers or quickly booted to Mexico. Things are only expected to get worse now that Texas just passed SB4, a state law giving police, sheriffs, and all other local law enforcers the power to ask people about their immigration status. Even though enforcement is not in effect until September 1, SB4 is terrifying to colonia residents. News and rumors fly. Proa hears them as she does her fieldwork.
Things are quiet today, and Proa pulls out a card with a white, latex oval. The beige color does not match Yesenia’s skin, but the texture does: It’s velvety and soft. “Touch,” Proa instructs Yesenia. “Push it. Do you feel the thing inside? Like a hard cigarette?” That’s Implanon, a three-year supply of birth-control hormones that can be implanted in an upper arm. Proa also touts IUDs and pills. She signs up Yesenia for a post-partum visit to the clinic.
But silently, Proa wonders whether Yesenia will come. Since the inauguration, many people are skipping their clinic appointments. Proa is sure it’s because of the immigration sweeps.
In ACCESS Esperanza’s office in McAllen, Martha Leos measures fear on Excel sheets. She’s the organization’s education supervisor, and she says that since the inauguration her clinics have noticed a 2 to 4% drop in the percentage of people showing up for their appointments. In some clinics the decline is far steeper. “We used to make 50 appointments to be sure that 20 people would actually show up,” Dora Proa says. Nowadays, in one clinic, making 50 appointments guarantees that only eight to 12 will come.
Not long before I visited the colonia, Leos had told me things are also dire at health fairs, which are a very big deal in rural South Texas—or used to be.
Held at schools and community centers on weekends, the fairs traditionally have been attended by very low-income mothers with their young kids in tow. Not only do these free events provide the moms with swag such water bottles, recipe books, and cute refrigerator magnets, the fairs shower their kids with DJ music, bouncy rooms, and hugs from giant Minnie Mouses. While the kids amuse themselves, moms walk from health-agency table to table, schmoozing with friends, having their blood pressure and sugar levels tested, picking up information about family planning, and making appointments at clinics like ACCESS Esperanza’s, which provide free care regardless of immigration status.
“Oh my god!” Leos says. “These fairs used to be very highly attended. But now not so much. It doesn’t matter if they’re in the morning, afternoon or evening, or how well-organized everything is.”
I’d attended a health fair a week before I went to the colonia. It was on the green lawn of a community center, in 103-degree heat—not unusual for South Texas in April. Dora Proa was there, with a card featuring several 3-D plastic cervixes in various stages of health, ranging from shiny and normal to increasingly pocked by illness, until one looked totally riddled with end-stage cancer.
A 37-year-old undocumented mother of a 10-year-old daughter was cheerfully hovering over ACCESS Esperanza’s table at the fair. “I’ve learned a lot from Dora,” she said. “Like how to do breast self-exams. How to prevent STDs.”
She’s been attending health fairs for years, she added. It used to be that women from her colonia carpooled just so they’d find a parking space—the parking lots were that crowded. At the tables, lines formed, and the women had to wait their turn.
The day I went, I had my choice of empty parking spaces. And most tables had only three women hanging around. Some had none. The new emptiness gives people like Proa the willies, especially when they think about things like the end-stage cancer card.
After Planned Parenthood was defunded in 2011, lost half its patients, and changed its name to ACCESS Esperanza in 2014, the effects of a three-year gap in medical care were shocking. Patients dribbled back, and in the first three months, clinic workers saw as many women with abnormal pap smears—indicating possible cervical cancer—as they’d previously seen in an entire year. The statistics proved what they feared: that when women have nowhere to go for preventive reproductive health care, they get sick.
Back at the colonia, I wonder who will get sick there because of Donald Trump. I think about this as I talk with Yesenia, who’s telling me about a recent incident that led to a WhatsApp ping cascade.
“At noon this past Saturday we heard that the Border Patrol was at the local tortillería, right by the entrance to the colonia,” she says. “Someone who was a legal resident went to check and said that yeah, they were there.” She adds that most people got on their phones, then canceled whatever Saturday activities they had planned. After that they stayed inside the colonia, many locked in their homes.
“What did you do?” I ask.
“Well, I was supposed to see the obstetrician that day,” she says. “But my husband said, ‘Don’t go!’ So I didn’t. I missed my appointment.”
In the next few weeks, I will speak with other organizations that run health clinics for the Rio Grande Valley’s poor and undocumented residents. One group, La Union del Pueblo Entero, in the little town of San Juan, tells me they lost about a fifth of their mobile health-clinic patients in the first few months after Trump was elected. Another, the Border Community Health Center, in Brownsville, says patients are expressing reluctance to come in because they fear harassment by immigration authorities, and even punishment for accepting free medical treatment.
For now, Dora Proa wishes Yesenia a good birth experience and a healthy new son. Then she says softly to me as we walk away: “It could get worse.”
Debbie Nathan is based in Brownsville, Texas and freelanced this article for Fusion. She is also the investigative reporter for the ACLU of Texas.
This feature is part of Fusion’s project to recruit local, embedded reporters, essayists, and photographers across the country. Read more here.