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.
(2022) 22:1449 Torres et al BMC Public Health https://doi.org/10.1186/s12889-022-13846-x Open Access RESEARCH The Deferred Action for Childhood Arrivals program and birth outcomes in California: a quasi‑experimental study Jacqueline M. Torres1*, Emanuel Alcala2,3, Amber Shaver2, Daniel F. Collin4,5, Linda S. Franck6, Anu Manchikanti Gomez7, Deborah Karasek8, Nichole Nidey9, Michael Hotard10, Rita Hamad4,11 and Tania Pacheco‑Werner2 Abstract Background: The Deferred Action for Childhood Arrivals (DACA) program provides temporary relief from deporta‑ tion 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 cer‑ tificate 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 years after DACA passage (2012–2015) and in the subsequent 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 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 individu‑ als 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 Keywords: DACA, Birth Outcomes, Quasi-Experimental, Population Health *Correspondence: Jacqueline.Torres@ucsf.edu Department of Epidemiology and Biostatistics, UC San Francisco, 550 16th Street, 94143 San Francisco, CA, USA Full list of author information is available at the end of the article Introduction On June 15, 2012, the Deferred Action for Childhood Arrivals (DACA) program was introduced by an executive branch memorandum [1] DACA provides temporary protection against deportation and work © The Author(s) 2022 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ The Creative Commons Public Domain Dedication waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data Torres et al BMC Public Health (2022) 22:1449 permits for those who immigrated as children and were undocumented DACA has undergone substantial legal challenges since its passage [2] Notably, the Trump administration announced the termination of the program in September 2017 [3] DACA was upheld by the U.S Supreme Court in June 2020 on administrative grounds [4] but remains without the protection of Congressional legislation Prior research has identified the beneficial impacts of DACA on the health outcomes of recipients [5–7] and their children [8] One prior study evaluated the shortterm impacts of DACA on birth outcomes at a nationallevel, finding evidence of positive impacts on birthweight outcomes for Mexican-origin mothers in the years following DACA passage [9] These results may be explained by a number of mechanisms, including the effects of the program on improved employment [10, 11], occupational and educational outcomes [11, 12] and the psychological wellbeing and self-rated health of recipients, including reduced stress related to deportation [5, 6, 13] In addition, in some states and localities, DACA recipients with qualifying incomes gained expanded access to health care [14], which could have led to improved access to pre-pregnancy and prenatal care for DACA recipients compared to their counterparts who remained undocumented Nevertheless, there is evidence suggesting that the population health benefits of DACA may have been attenuated following direct threats to the program under the Trump Presidency and campaign [13, 15] However, the long-term impacts of DACA on birth outcomes have not been evaluated In this study, we examined the population-level effects of DACA on birth outcomes using longitudinal data on births in California, the U.S state with the largest proportion (28.5%) of DACA recipients [16] We evaluated the impact of DACA on outcomes across the years following DACA passage However, following a prior study of DACA’s long-term impact on self-rated health [13], we separately evaluated birth outcomes in the immediate years post-DACA passage and the subsequent years These latter years were characterized by, among other events, the promise of the end to the DACA program during the announcement of the Trump campaign in July 2015 and the announcement of the end to the DACA program in September 2017 Methods Data Birth record data spanning 2009–2018 came from the California Department of Public Health’s Birth Statistical Master Files Analyses were pre-registered at Evidence for Governance and Politics (EGAP) (20190605AB) The Page of 10 Committee for the Protection of Human Subjects, the institutional review board for the California Health and Human Services Agency, and Vital Statistics Advisory Committee approved the study protocol Study sample We first restricted our data to approximately years before DACA passage through approximately years after DACA passage (June 2009–May 2018), Because there are no direct measures of DACA eligibility or recipient status in California birth records, we followed prior research [6, 17] and used proxy measures of DACA eligibility based on mothers’ birthdate, birthplace, and educational attainment The DACA memorandum mandated that DACA-eligible individuals were younger than age 31 on June 15, 2012 and had earned a high school degree or GED or were current students, which we used as core criteria to define eligibility Additionally, DACA eligible individuals must have arrived in the U.S at age 16 or younger, resided in the U.S since 2007, and never been convicted of a felony or more than misdemeanors; information on these factors was not available in the birth record We restricted the sample to births for which vital statistics data indicated that maternal educational attainment was equal to or greater than high school completion or a GED by the time of delivery and maternal birthplace was one of the top 15 countries of origin for DACA recipients [18] As of 2017, individuals from these 15 countries of origin accounted for 95.3% of DACA recipients However, we additionally analyzed outcomes for the subset of births to individuals born in Mexico; Mexican-born individuals comprise 80% of DACA recipients [16, 18] We further restricted our primary analyses to DACA-eligible individuals born within year before vs year after the DACA birthdate cut-off, which we elaborate on further in our discussion of treatment vs control groups below We restricted the analytical sample to all live singleton births We excluded birth records with gestational ages 44 weeks and with birthweight for gestational age greater than standard deviations from the sample mean [19] We excluded 8.6% of observations because of data missing for the following covariates: nativity, date of birth, education, parity, and race/ ethnicity of pregnant individuals, and infant sex assigned at birth See eFigure 1 for the derivation of the analytic sample Measures Adverse birth outcomes We evaluated continuous birthweight (in grams), and term birthweight (in grams, among infants born > 37 weeks gestation), and binary outcomes of preterm Torres et al BMC Public Health (2022) 22:1449 birth (PTB,