Bruce Lesley is frustrated that one clear aspect of the national debate over birthright citizenship is being ignored: the infants themselves. “It’s in the words: ‘birth’ right citizenship — this is about babies,” Lesley said. He is president of First Focus on Children, a bipartisan advocacy group for children and families that filed an amicus brief in the case Trump v. Barbara, which the Supreme Court was scheduled to hear on April 1.
Lesley and other child advocates say congressional hearings and media coverage have focused on administrative mechanics, historical interpretation and politics, but rarely on how a change would touch newborns and their families. “The word ‘child’ does not cross their lips,” he told reporters, arguing the stakes extend to every baby born in the United States.
What birthright citizenship currently provides
Under current law and practice, a baby born in an American hospital or birth center is automatically a U.S. citizen and, in practice, has immediate access to a range of supports. Pregnant people are eligible for Medicaid in every state regardless of immigration status, which covers prenatal care, delivery and postpartum visits. Medicaid pays for roughly 40% of U.S. births, and coverage during pregnancy is widely considered critical to giving infants the healthiest possible start. Many infants born in the U.S. are also automatically eligible for Medicaid for their first year of life.
Even with these protections, the United States has higher maternal and infant mortality rates than peer countries. Advocates warn that overturning or limiting birthright citizenship would create new barriers at the most vulnerable time.
Scale of the potential impact
Federal data show about 3.6 million babies are born in the U.S. each year. In 2023, an estimated 300,000 babies were born to parents without legal immigration status. Advocates emphasize that a change to birthright citizenship would not only affect children of immigrant parents: it would introduce a new requirement that parents’ citizenship or immigration status be proven for every newborn, creating a nationwide administrative burden that does not yet exist.
Early life requires a cascade of appointments and paperwork — well-child visits, immunizations and developmental screenings — and advocates fear those essential services would be harder to access if a newborn’s citizenship were uncertain. Lesley warned that questioning a baby’s citizenship could cut off enrollment in programs like Medicaid, SNAP and WIC when families most need them.
Hospitals and paperwork
Under current processes, hospital staff routinely assist families with the paperwork a newborn needs, including submitting information to the Social Security Administration so the child can receive a Social Security number. That number is often required to enroll in health insurance, nutrition assistance and other supports. If birthright citizenship were restricted, hospitals, doctors and health systems would need to revise practices and policies; the American Hospital Association, American Medical Association and American Academy of Pediatrics declined to comment for this report.
Proving parentage and other complications
A rule that ties a child’s status to parental documentation would create many practical problems. Hannah Steinberg, a staff attorney at the ACLU Immigrant Rights Project, noted at a press briefing that roughly 10% of birth certificates list the father as unknown. In cases where paternity is unclear, or where one or both parents are absent or unidentified — including newborns found in the U.S. — the process of establishing citizenship could be lengthy, costly and uncertain.
Steinberg said the law as written declares these children U.S. citizens, but proposed changes and certain executive actions would effectively require proof of their parents’ status. “Our entire system of law has been set up around this birthright citizenship guarantee — all of our administrative procedures, state laws, local laws,” she said.
Lesley added that families formed through same-sex parenting, surrogacy, assisted reproductive technology or those who have lost documents to disasters could face particular hurdles if asked to produce paternity tests, surrogacy contracts or other proof. He described the prospect of hospitals requesting such documentation as “just crazy.”
Chilling effects on care
Researchers and public-health experts say the debate itself is already affecting behavior. Arturo Vargas Bustamante, director of faculty research at the UCLA Latino Policy and Politics Institute, said fear around immigration policy can lead pregnant people to avoid care. Missing prenatal visits is linked to higher rates of low birth weight and other outcomes that can affect children across their lifetimes.
Bustamante also highlighted the racial and ethnic dimensions of the issue: about 75% of children with noncitizen parents are Latino, a statistic he included in a recent policy brief examining the health and social consequences of ending birthright citizenship.
Legal background
President Trump issued an executive order on his first day in office seeking to limit birthright citizenship; that directive has been blocked in lower courts. The Supreme Court agreed to hear the challenge in Trump v. Barbara. Advocates for children argue the litigation and the policy proposals it reflects have focused too little on the newborns who would be affected by any change to existing law.
For advocates like Lesley, the central point is simple: policies that alter who is automatically entitled to citizenship must be judged not only by constitutional or historical arguments, but by the concrete effects on babies’ health, access to services and family stability.