In March 2026, LDI Senior Fellow Diana Montoya-Williams, MD, MSHP, testified before the the Philadelphia City Council Committee on Public Health and Human Services at a hearing held to examine the current state of Philadelphia’s reproductive health care system, the current federal landscape affecting reproductive policy, and the City’s response to protect reproductive freedom.

Her testimony focused on the reproductive health of Hispanic and Latine women in Philadelphia, particularly those in immigrant and mixed status families. She described the chilling effect of punitive immigration policies on health care use and the resulting harms to mothers and infants, and outlined three evidence based solutions to improve the health of Latine and immigrant women.

You can watch her testimony below.

Views expressed by the researcher are their own and do not necessarily represent those of the University of Pennsylvania Health System (Penn Medicine), the University of Pennsylvania, or the Children’s Hospital of Philadelphia.

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Written Testimony of Diana Montoya-Williams, MD, MSHP
Assistant Professor of Pediatrics, Perelman School of Medicine
Attending Neonatologist, Children’s Hospital of Philadelphia
Senior Fellow of the Leonard Davis Institute of Health Economics at the University of Pennsylvania
Clinician Scientist at CHOP Policy Lab

BEFORE THE COMMITTEE ON PUBLIC HEALTH AND HUMAN SERVICES REGARDING RESOLUTION NO. 260051
MARCH 2, 2026 1:00 PM

Good morning Chair and Members of Council,

My name is Dr. Diana Montoya-Williams. I am a neonatologist — a baby doctor — and an immigrant health researcher focused on the health of mothers and infants at the Children’s Hospital of Philadelphia’s PolicyLab and the Leonard Davis Institute of Health Economics at the University of Pennsylvania. I’m also a mother.

Thank you all, and especially Councilmember Nina Ahmad, for creating space to address the reproductive health needs of Philadelphia residents. I’d like to speak with you about Hispanic and Latine women in Philadelphia as well as immigrant women.

Recent data shows that about one in four births in Philadelphia are to Hispanic/Latina mothers.¹ And while not all Hispanic or Latine women in our city are immigrants, many are. Many live in mixed-documentation status families. That reality has profound implications for the reproductive health of Hispanic women and thus the public health of our city.

For years, we have known that immigrant women face barriers to health care, insurance eligibility gaps, language barriers, and fear tied to immigration status.²

But we are now in a moment of heightened risk.

A large body of research shows that punitive immigration policies and aggressive enforcement create what we call a “chilling effect” on healthcare use and use of other critical health-promoting benefits.^3–7 This has profound consequences for pregnant individuals and their infants in particular. When families fear deportation or separation, pregnant women may delay prenatal care.^8–10 Some may avoid it entirely.

In areas of the country that have experienced increased immigration enforcement or heightened anti-immigrant rhetoric, researchers have even documented higher rates of maternal anemia¹¹ and lower birthweight among infants born to Hispanic mothers.¹²

This is measurable. But this is not abstract data to me.

In the past months, I have been working alongside community organizations in our city as they support families trying to navigate this moment. Families struggling to decide whether to bring their new babies to follow-up appointments. A pregnant refugee woman worried about how she will access postpartum healthcare when her Medicaid eligibility disappears later this year due to federal policy changes. Parents afraid to visit their own baby in the NICU because they fear immigration enforcement on the way to the hospital.

I want to let that last one sink in. A woman recovering from childbirth afraid to come see her hospitalized sick newborn because of fears about the safety of her entire family.

That is the level of stress we are talking about. And we know toxic stress is biologically harmful.

It increases the risk of hypertensive disorders of pregnancy, preterm birth, postpartum depression, and long-term developmental challenges for children. Right now, many immigrant women are navigating pregnancy and early motherhood under acute, destabilizing toxic stress.

As a physician, I worry about what happens when a woman with severe hypertension hesitates before going to the emergency department.

When a mother with postpartum depression stays home because she fears being targeted. Or when she can’t access contraception.

When a baby misses preventive visits that could catch feeding issues or developmental delays early.

When mothers do not feel safe seeking care, it is not only a personal crisis, it is a public health issue for our entire city.

But there are solutions.

First, trusted messengers matter. In my own community-engaged research, we have found that culturally and linguistically concordant community health workers, doulas, and peer navigators are essential during times like these.^13,14 Women need accurate information from people they trust. And sometimes they need accompaniment —someone physically or virtually present — to buffer fear with support. We must advocate for and support the existing doula and community health worker programs that exist within the Philadelphia health department and our local communities perhaps through special funds to sustain this indispensable workforce.

Second, we must strengthen and protect telemedicine infrastructure. Telehealth is not a replacement for in-person reproductive care — but it is a powerful supplement. Virtual care can provide blood pressure monitoring, lactation support, mental health services, and pediatric follow-up when families are fearful of travel. But telehealth must be accessible, language-appropriate, and supported by digital navigation,¹⁵ and this requires policy advocacy.

Third, we must stabilize and fund the community-based organizations already doing this work. They are the backbone of trust in our neighborhoods. If we want Latina and immigrant mothers to access care, we must ensure the organizations guiding them right now are resourced, protected, and sustained. They are working so hard under such challenging and often scary conditions.

The health of immigrant mothers is inseparable from the health of Philadelphia. When mothers receive timely reproductive, prenatal, and postpartum care, we reduce complications. When babies are born healthy and full term, we reduce NICU admissions. When families feel safe engaging with healthcare, our entire city benefits.

I am grateful to Councilmember Nina Ahmad and to this body for approaching these issues in a solutions-oriented way. I stand ready to partner with the City Council to ensure that every woman and mother in Philadelphia can safely seek the care they need, regardless of where they were born. Because when we protect the people who give birth, we protect our future.

Thank you.

Views expressed are my own and do not necessarily represent those of the University of Pennsylvania Health System (Penn Medicine), the University of Pennsylvania, or the Children’s Hospital of Philadelphia.

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References

1. Percentage of births by race/ethnicity: Philadelphia, 2021-2023 Average. March of Dimes | PeriStats. Accessed February 27, 2026. https://www.marchofdimes.org/peristats/data?top=2&lev=1&stop=10®=42&creg=42 101&obj=3&slev=6
2. Advocating for safe and equitable obstetric and gynecologic care for immigrants. Obstet Gynecol. Published online February 3, 2026. doi:10.1097/AOG.0000000000006213
3. Friedman AS, Venkataramani AS. Chilling Effects: US Immigration Enforcement And Health Care Seeking Among Hispanic Adults. Health Aff . 2021;40(7):1056-1065.
4. Haley JM, Kenney GM, Bernstein H, Gonzalez D. One in Five Adults in Immigrant Families with Children Reported Chilling Effects on Public Benefit Receipt in 2019. 2020. Accessed June 23, 2022. https://www.urban.org/sites/default/files/publication/102406/one-in-five-adults-in-immigrant-families-with-children-reported-chilling-effects-on-public-benefit-receipt-in-2019_1.pdf
5. Page KR, Polk S. Chilling Effect? Post-Election Health Care Use by Undocumented and Mixed-Status Families. N Engl J Med. 2017;376(12):e20.
6. Nwadiuko J, German J, Chapla K, et al. Changes in Health Care Use Among Undocumented Patients, 2014-2018. JAMA Netw Open. 2021;4(3):e210763.
7. Choi SW, Park S, Duah A, Kim K, Park M. Consequences of the 2019 Public Charge Rule Announcement and Publication on Prenatal WIC Participation Among Immigrant Families: Evidence of Spillover Effects. J Immigr Minor Health. Published online August 2, 2023. doi:10.1007/s10903-023-01523-z
8. Choi SW, Agbese E, Kim G, Makhlouf MD, Leslie DL. Uninsured immigrants in the United States significantly delayed the initiation of prenatal care after the changes to the Public Charge Rule. Public Health. 2023;225:1-7.
9. Young MEDT, Tafolla S, Saadi A, Sudhinaraset M, Chen L, Pourat N. Beyond “chilling effects”: Latinx and Asian immigrants’ experiences with enforcement and barriers to health care: Latinx and Asian immigrants’ experiences with enforcement and barriers to health care. Med Care. 2023;61(5):306-313.
10. Rhodes SD, Mann L, Simán FM, et al. The impact of local immigration enforcement policies on the health of immigrant hispanics/latinos in the United States. Am J Public Health. 2015;105(2):329-337.
11. Chu DM, Aagaard J, Levitt R, et al. Cohort Analysis of Immigrant Rhetoric on Timely and Regular Access of Prenatal Care. Obstet Gynecol. 2019;133(1):117-128.
12. Novak NL, Geronimus AT, Martinez-Cardoso AM. Change in birth outcomes among infants born to Latina mothers after a major immigration raid. Int J Epidemiol. 2017;46(3):839-849.
13. Montoya-Williams D, Barreto A, Laguna-Torres A, et al. Philadelphia Latine Immigrant Birthing People’s Perspectives on Mitigating the Chilling Effect on Prenatal Care Utilization. Med Care. 2024;62(6):404-415.
14. Marshall D, Perez M, Wang X, Matone M, Montoya-Williams D. Exploring prenatal care quality and access during the COVID-19 pandemic among pregnant immigrants in Philadelphia through the lens of community-based organizations. Womens Health Rep (New Rochelle). 2023;4(1):241-250.
15. Obregon E, Ortiz R, Wallis KE, Morgan S, Montoya-Williams D. Feasibility, acceptability, and health outcomes associated with telehealth for children in families with limited English proficiency. Acad Pediatr. 2024;24(1):13-22.

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