On August 7, 2019, as a fresh crop of kindergarteners began their first day of school, Immigration and Customs Enforcement (ICE) agents stormed seven chicken processing plants and arrested 680 workers without immigration status across Mississippi. It was the largest single-state worksite immigration raid in U.S. history.

Many workers were Indigenous immigrants who had fled the Guatemalan genocide. For them, immigration was about survival. There was no viable alternative. It was also about reproductive justice: the human right to maintain bodily autonomy, have or not have children, and parent in safe, healthy, and just communities. Now, their families were torn apart, left to grapple with the knowledge that for many, deportation to Guatemala would mean death.

Mere days after the ICE raids, the Trump administration finalized its public charge rule. When someone applies for lawful permanent resident status (also known as a green card) or a visa to enter the country, immigration officials consider whether they will likely become a public charge, and if so, deny their application. For decades, the federal government defined a “public charge” as someone who primarily depended on the government for sustenance, either through public cash assistance or long-term institutional care. Before 2019, receiving Medicaid was not enough to be deemed a public charge. Former President Trump’s new rule radically expanded the meaning to include a person who receives Medicaid or other listed public benefits.

In an era of heightened immigration enforcement, Trump’s public charge rule was designed to intimidate and confuse; damage the health and well-being of Black, Indigenous, and other people of color (BIPOC); and perpetuate reproductive injustice. When the Trump administration first proposed the rule in 2018, it acknowledged that the rule could cause many people—particularly those who are pregnant or postpartum—to withdraw from or forgo Medicaid coverage and suffer worse health outcomes. From the beginning, it sparked a severe chilling effect on enrollment among immigrant families.

According to the Urban Institute, by 2019—the year that ICE hit central Mississippi—1 in 5 adults in immigrant families with children avoided applying for public benefits for fear of the public charge rule. Because white supremacy and sexism fuel poverty, the rule disproportionately harms Black, Latina, Asian American, and Pacific Islander women, for whom Medicaid is often a crucial lifeline. Even before the new public charge rule, immigrant women aged 15-44 were three times more likely than U.S-born or naturalized citizens to be uninsured. The Trump administration compounded that injustice.

After the ICE raids, hundreds of frightened and overwhelmed people urgently needed to secure legal representation for loved ones in detention. They also needed help establishing guardianships for children in case parents were deported. And they required legal support to access health care, food, and other basic human rights.

As a community lawyer with the Mississippi Center for Justice, I provided immigrant families with legal guidance on the health-care and public benefits issues that most concerned them, including the new public charge rule. I saw firsthand how the policy fuels reproductive injustice, withholding the resources people need to make their own decisions about their families, health, bodies, and lives.

One day, a young Indigenous Guatemalan immigrant without immigration status, who I’ll call Elina to protect her privacy, approached me after a “know your rights” training on public charge. She explained that her 2-year-old daughter, a U.S. citizen, was born with a life-threatening heart condition. Elina and her husband enrolled her in Medicaid to access lifesaving open-heart surgery and ongoing care. Then the Trump administration proposed the public charge rule. Terrified that their daughter’s continued enrollment in Medicaid could mean their deportation and the family’s separation, they pulled her out and stopped scheduling health-care appointments.

Although over three-quarters of adults in immigrant families with children believe otherwise, under the public charge rule, officials cannot consider a child’s Medicaid participation in their parents’ public charge determination. I told Elina that it was safe to enroll her daughter in Medicaid again.

Before we parted, Elina shared that women and children were prime targets in Guatemala’s genocide. When she fled, she dreamed that one day, in the United States, she could hold the power and resources to have a family and parent in safety. In a United States marred by a radical public charge rule, immigration raids, and family separation, that dream remains unfulfilled.

In Mississippi and around the country, Medicaid offers essential and often lifesaving health-care access. It provides life-sustaining cardiovascular care to people like Elina’s daughter. It covers family planning services that empower people to decide if and when to start or grow their families. It enables people to access vital pregnancy-related care. By obstructing access to Medicaid, the public charge rule worsens health conditions, permits preventable conditions to take hold, and thwarts reproductive justice.

A year ago, I walked up a gravel path and entered a small church in Forest, Mississippi. The room was packed wall-to-wall with community members. I joined Luis Espinoza, a community organizer with the Mississippi Immigrant Rights Alliance, at the back. We soaked in the mellow tone of the marimba until it quieted and it was time to head to the front.

We introduced ourselves and shared that we were there to talk about the public charge rule. As we had in rooms across Mississippi, we asked how many people had heard of the Trump administration’s rule. Nearly everyone raised their hands. We asked how many had avoided health care or disenrolled from Medicaid because of it. Nearly all hands remained in the air. That moment—as the public charge rule’s chilling effect was laid bare—was always harrowing.

But on that night, just weeks before the COVID-19 pandemic hit Mississippi, those hands were harbingers. Since then, many have avoided emergency care for fear of the public charge rule. Many lost their lives.

As the pandemic rages on and I continue to advocate for equitable health-care access for immigrants, I reflect on that show of hands daily. I wonder how many of those who raised their hands died because of the intrinsically racist and xenophobic public charge rule. In my work, I carry and am sustained by the voices, stories, and raised hands of immigrants across the communities I served in Mississippi, and the knowledge that their lives and reproductive destinies hang in the balance.

Last month, President Biden signed an executive order directing federal agencies to review the public charge rule. I urge his administration to not only swiftly end the rule, but also build on that foundation to make health-care access and reproductive justice possible for all.