Bruce Lesley, president of First Focus on Children, says one crucial fact is being ignored in debates over birthright citizenship: this is about babies. Lesley, who filed an amicus brief in Trump v. Barbara, told policymakers that discussions about administrative hurdles, history and politics have largely failed to consider the direct impact on children. “The word ‘child’ does not cross their lips,” he said, arguing that any change would affect every infant born in the United States.
Under current law, infants born in U.S. hospitals or birth centers are automatically U.S. citizens and typically have immediate access to supports. Pregnant people are eligible for Medicaid in every state regardless of immigration status, which covers prenatal, delivery and postpartum care. Medicaid finances roughly 40% of U.S. births, and most newborns remain eligible for Medicaid during their first year. Still, maternal and infant mortality in the U.S. is higher than in peer countries.
In 2023 an estimated 300,000 babies were born to parents without legal status; about 3.6 million babies are born in the U.S. annually. If birthright citizenship were ended, parents might be required to prove their own citizenship to secure benefits for their newborns. Lesley warns that this would disrupt the continuity of care families rely on: well-child visits, immunizations and other early services could be interrupted if eligibility for Medicaid, SNAP or WIC is questioned.
Hospitals currently help families obtain Social Security numbers for newborns, a step that enables enrollment in health insurance and other supports. Removing the presumption of citizenship would force hospitals, clinicians and administrators to change longstanding practices and could slow or block access to infant care. Major medical groups including the American Hospital Association, the American Medical Association and the American Academy of Pediatrics declined to comment on the case.
Legal and logistical hurdles could be heavy. Hannah Steinberg, staff attorney at the ACLU Immigrant Rights Project, notes that about 10% of birth certificates list the father as unknown; in situations where parentage is unclear or a baby is found with no known parents, tying a child’s status to parental documentation could leave children without practical access to citizenship benefits even if legally protected. Steinberg says an executive order or policy removing birthright protections would ripple across federal, state and local systems.
Lesley also points to families who could be uniquely affected: same-sex couples, surrogates, users of assisted reproduction, and parents who have lost documents in fires or disasters. Fear of immigration enforcement is already deterring some people from seeking prenatal care, says Arturo Vargas Bustamante of the UCLA Latino Policy and Politics Institute, which can lead to worse outcomes such as low birth weight. He notes the disproportionate impact on Latino families: about 75% of children with noncitizen parents are Latino, according to a UCLA policy brief on ending birthright citizenship.
President Trump issued an executive order in his first term seeking to limit birthright citizenship; lower courts blocked that order. Advocates warn that if the Supreme Court upholds restrictions, the practical effects would be sweeping: changes in how hospitals treat newborns, which families can access early supports, and how quickly infants receive essential care that supports healthy starts in life.