Public Health — News & Analysis

Is Stephen Miller Making Medical Decisions for Pregnant Children in ICE (March 23, 2026)

March 23, 2026 — In July 2025, the federal government directed that every pregnant migrant girl in its custody be sent to a single facility: Urban Strategies, LLC in San Benito, Texas — a converted Baptist church with no emergency room within ten miles and the nearest maternal-fetal medicine specialist a hundred miles away. The facility had previously been shut down by federal investigators for failing to provide these same girls with basic prenatal care. It was reopened with no new clinical staff and no upgraded qualifications.

Some of these girls are thirteen years old. Many are rape survivors. Most have had no prenatal screening at all, including basic ultrasounds that would identify ectopic pregnancies — a predictable and life-threatening risk given that up to 60% of women crossing the border are sexually assaulted, and untreated infections from sexual violence make ectopic pregnancy more than six times more likely. An ectopic pregnancy will rupture and kill without emergency surgery. One early ultrasound catches it. Most of these girls have not had that scan.

Seven senior career health officials objected in writing and proposed alternatives. They were overruled without explanation by ORR Chief of Staff Matt O'Neill Levine, acting under Angie Salazar — a career ICE enforcement agent with no child welfare background who reports to Stephen Miller.

The choice of Texas is not incidental. Abortion there is illegal without exception — not for rape, not for age. Funding to transport girls to states where they could legally access abortion care has been cut. The former director of this program has confirmed on the record that placing pregnant girls in Texas is entirely and exclusively about preventing abortion. The policy does not need to say this out loud. The location says it for them.

When these girls give birth, they will do so alone — no family, no advocate, no one who speaks their language — under guard, in a hospital ten miles away, in one of the most medically underserved regions in the country. There is nothing preventing the government from deporting a girl before she gives birth. Some of them will deliver in the country they fled.

This is not an isolated failure. A congressional investigation found over 1,000 credible reports of life-threatening abuse in immigration detention facilities in a single year. Thirty-six people died in ICE custody in 2025 — the highest annual total in two decades — and at least 13 have died in just the first three months of 2026. The government's own lawyers documented more than 100 reports of staff sexually abusing children as young as five across 29 federally contracted shelters. The Trump administration dismissed that case in March 2025.

The 1997 Flores Settlement Agreement — which mandates licensed facilities, caps detention at 20 days, and requires independent oversight — is the last legal framework standing between these children and indefinite, unregulated detention. The Trump administration filed to terminate it in May 2025. Free legal representation for unaccompanied minors was eliminated and only partially restored by court order through April 2026. Proposed federal rule changes would eliminate the requirement that pregnant girls in custody receive proper medical care.

The people responsible for these decisions have names and offices and salaries paid by American taxpayers. They made specific choices, with a documented paper trail, about children who have no power, no voice, and nowhere to go. That is not a system failing. That is a system working as designed.

Further reading   NPR · El País · Sen. Ossoff detention report · DOJ v. Southwest Key complaint

Detailed summary 🔗 long-20260323-miller-pregnant-girls-ice.md