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 made a decision: every pregnant migrant girl in its custody — no matter her age, no matter how far along, no matter the circumstances of her pregnancy — would be sent to a single facility. One place. Urban Strategies, LLC, at 250 N. Crockett Street in San Benito, Texas.

The building is a converted Baptist church.

San Benito does not have an emergency room. The nearest one is ten miles away in Harlingen — about fifteen minutes on a good day. The nearest maternal-fetal medicine specialist, the kind of physician these pregnancies require, is a hundred miles away. The facility had already been shut down once by federal investigators for failing to provide these same girls with basic prenatal care. It was reopened anyway, with no new clinical staff and no upgraded qualifications, under a remediation plan that changed almost nothing.

This is not a story about a program that failed. It is a story about a program that is working exactly as it was designed.

Who These Girls Are

Some of them are thirteen years old. Some are survivors of rape. Many spent weeks crossing terrain that would test a healthy adult, arriving malnourished and without having received any medical attention along the way.

Amnesty International reports that up to 60% of women and girls who cross the southern border are sexually assaulted or raped. Sexual violence frequently causes infections — up to 70% of Chlamydia and Gonorrhea cases in women are asymptomatic — meaning many of these girls would have no way of knowing they were infected. Left untreated, those infections scar the reproductive tract. That scarring makes a woman more than six times more likely to develop an ectopic pregnancy, in which a fertilized egg implants outside the uterus.

An ectopic pregnancy cannot survive. It will rupture. When it does, the bleeding is internal and invisible. The patient goes into shock. She needs emergency surgery within hours or she will die. One early ultrasound catches it before any of that happens.

For the majority of girls at the San Benito facility, no one has done that scan.

In obstetric medicine, every single one of these pregnancies is considered high-risk by definition. Very young adolescent bodies are not finished developing. Pregnancy in early adolescence carries significantly elevated rates of dangerous blood pressure complications and surgical delivery. These are not edge cases or statistical abstractions. These are predictable, medically certain outcomes for at least some of the girls sitting in that converted church right now.

Seven Officials Said No. They Were Overruled.

Seven senior career health officials within the federal government — not political appointees, but professionals whose expertise was specifically in child welfare and the care of unaccompanied minors — objected to this directive in writing and proposed alternatives. They were overruled without explanation.

The order came from ORR Chief of Staff Matt O'Neill Levine, acting under the authority of Angie Salazar — a career ICE enforcement agent with no child welfare background, who reports to Stephen Miller.

Miller is not a physician. He is not a child welfare specialist. He is a policy architect whose fingerprints are on one of the most deliberately dangerous medical arrangements in recent American history.

The Location Is the Policy

Texas has a near-total abortion ban. Under the Texas Trigger Ban — Health and Safety Code Section 170A.002, enacted thirty days after the Dobbs decision — abortion is illegal. There is no exception for rape. There is no exception for being thirteen years old. Whatever exception you are trying to construct in your mind right now, it does not exist in Texas law.

Physicians in this part of Texas who might want to intervene are too frightened of arrest, too frightened of losing their licenses and livelihoods, to do so.

There was a rule requiring that if a girl in federal custody needed to terminate a pregnancy, the government was obligated to help her reach a state where she legally could. That rule is being eliminated. The funding to pay for that travel has already been cut, pursuant to the administration's expanded enforcement of the Hyde Amendment.

Nobody has to say any of this out loud to a thirteen-year-old rape survivor. Nobody has to look her in the face. The location says it for them.

Jonathan White, who ran this program during Trump's first term, has confirmed on the record that the policy of placing pregnant girls in Texas is entirely and exclusively about preventing abortion. He also described Scott Lloyd, Trump's first-term ORR Director, personally blocking pregnant minors from terminating their pregnancies — including calling White late at night to demand that a specific girl be transferred to Texas to prevent her from accessing abortion care.

What Happens Next

When these girls go into labor, they will do it in a converted church with no emergency room on the premises, ten miles from the nearest hospital, in one of the most medically underserved regions in the country.

They will be transported to that hospital alone. No family. No advocate. No one who speaks their language in any way that matters. They will be a detained minor in federal custody, in a state where the physicians attending them are legally prohibited from discussing certain options. They will give birth under guard, and then they will be transported back.

That is the version where they remain in the country long enough to give birth. There is nothing in current law that prevents the government from deporting a girl in her ninth month of pregnancy. Some of them will not give birth in Harlingen. They will give birth in the country they fled — the country so dangerous they risked everything to leave — now recovering from childbirth, with a newborn in their arms, and nowhere to go.

A System With a Paper Trail

This did not happen in secret. The paper trail is extensive.

A congressional investigation found over 1,000 credible reports of life-threatening abuse inside immigration detention facilities in a single year — people denied food, denied water, denied sleep, and subjected to physical and sexual abuse by guards. In 2025, 36 people died in ICE custody, more than in any year of the past two decades. In just the first three months of 2026, at least 13 people have already died.

A nurse at one facility called 911 because a pregnant woman was bleeding. The 911 dispatcher asked her to check whether the baby's heart was still beating. The nurse said she did not have the equipment to do that. A pregnant woman was bleeding inside a federal detention facility, and the answer was that there was no fetal monitoring equipment on the premises. At least 14 women lost pregnancies or suffered serious physical harm due to neglect while in government custody. A woman coughing up blood waited more than two hours for an ambulance to be permitted through a facility's security gates.

The government's own lawyers documented over 100 reports of facility staff sexually abusing children as young as five years old across 29 shelters operated by Southwest Key Programs, a contractor that had received over $1.3 billion in federal contracts. In March 2025, the Trump administration dismissed that legal case. They closed it. They threw it away.

Flores, and the Last Guardrail

The 1997 Flores Settlement Agreement established the minimum legal standards for the treatment of migrant children in federal custody. It was not proactive policy — it was a consequence. A child was abused in federal custody, and years of legal fighting produced a settlement that required the government to treat detained children as human beings: state-licensed facilities, a 20-day detention cap, and oversight from outside DHS.

In May 2025, the Trump administration filed a formal motion to terminate the Flores Agreement entirely.

If Flores is dismantled, the 20-day limit disappears. The requirement for licensed facilities disappears. The legal barrier to holding children indefinitely in unregulated facilities run by cost-cutting contractors disappears. And when children disappear inside those facilities, no one will be required to say where they went, because there will be no legal framework demanding an answer.

The free legal representation for unaccompanied minors that Flores supports — often the only adults in the system actually fighting for these children — was eliminated, then partially restored by a court order that runs out at the end of April 2026. The regulations requiring proper medical care for pregnant girls are being proposed for elimination. A senior official lied to a federal court under oath about whether children in these facilities were safe. Whistleblowers from inside the same office said she was lying.

This Is a Choice

There is a difference between a system that is trying and failing and a system that is working exactly as designed. These girls were not overlooked. They were found, processed, and placed — with documented, deliberate intention — somewhere their options would disappear before anyone ever had to officially admit those options existed.

They survived rape. They survived trafficking. They survived crossings that would test anyone. And the government that stopped them at the border has spent months carefully constructing a situation designed to ensure that survival meant nothing.

These are children. They are pregnant and alone and afraid, and they have no idea that the system that told them it would protect them was being built, piece by piece, with specific people making specific decisions, to be used against them instead.

The names are not hard to find. Matt O'Neill Levine. Angie Salazar. Stephen Miller. They have offices. They have salaries paid by American taxpayers. They made these choices about children who have no power, no voice, and nowhere to go.

That is not a failure of the system. That IS the system.

Sources and further reading:

• Dissent in Bloom, March 23, 2026
• NPR: Pregnant migrant girls, Texas shelter
• El País: The girls of San Benito
• Sen. Ossoff report: Patterns of abuse in immigration detention
• Sen. Ossoff report: Pregnancy in ICE detention
• DOJ complaint, United States v. Southwest Key
• Wikipedia: List of deaths in ICE detention