When Roukhaya found out that she was pregnant, she was still living in the African nation of Chad.
When she found out it was a girl, that's when she says she knew it was time to leave.
In Chad, she explains, female genital mutilation is still practiced. Roukhaya and her husband are both doctors, and they think it is brutal. I ask if she herself was subjected to it. She nods quietly.
"I don't want that for my daughter," she says.
(NPR does not identify survivors of sexual violence, so we are withholding Roukhaya's last name.)
In the last year or so, over 100,000 migrants from all over the world have come to New York City. Some, like Roukhaya, are pregnant, and seeking shelter. NPR spent time with several of these women, their babies, and the team of doctors, nurses and social workers who assist them.
Roukhaya's first stop was at the Roosevelt Hotel in Manhattan. It's the city's Arrival Center — the entry point to New York for all migrants to be registered and access shelters and legal and medical services.
The hotel retains an air of 1920s opulence: massive paintings, glittering chandeliers and sprawling stairways. But these days, it serves as a sort of modern-day Ellis Island. The national guard watches over while thousands of migrants wait to receive medical evaluations and immunizations.
Roukhaya was sent to The Women's Health Medical Center at Bellevue Hospital, part of NYC Health + Hospitals, which is the city's public health system. This is where most migrant women are seen for OB-GYN care.
Staff there told NPR that one of the biggest concerns is the lack of prenatal care in some of the new arrivals. That's a concern that some patients share too.
"It worried me," says Yuniaski López. She apologizes for her voice sounding a little hoarse and explains that she's just exhausted. López is in her mid-20s. She jokes that back home in Venezuela, her mother-in-law was always insisting on a grandchild. She and her husband would tell López that it was not a good time to have a child, between the country's dire economic crisis and government repression.
López says the trip to the U.S. was nearly impossible. "It was so rough," she says. "Especially the jungle. All of it. The train ... it was too difficult. I could hardly bear it. I slept in the streets. I often didn't have enough to eat."
So it scared her when she arrived in the U.S. and found out she'd been pregnant the entire time.
Staff at Bellevue say they are keenly aware that the journey to the U.S. is especially harrowing for women.
In one of the rooms at the Roosevelt Hotel, a woman named Estefani is jovial and talkative. Except when she gets to this part of her story. She stares down at her hands and says: "They got me on my way up."
Estefani and her husband are also from Venezuela. She's a nurse, but it was hard to make ends meet with a new baby. She says that in Venezuela, if you have a kid, you have to choose: Are you going to give them lunch? Or dinner? It probably can't be both.
She was riding the train through Mexico when she was assaulted. Her friend got hurt badly. She says she doesn't mind talking about it, but she doesn't have much more to say. "I don't think about the journey. Or what happened there. I focus on my daughter."
Many sexual assaults happen further south, in the dangerous jungle straddling Colombia and Panama called the Darién Gap. According to Doctors Without Borders, sexual assaults on migrant women and girls crossing the area are prevalent.
"I've met moms who are pregnant as a result of a rape that they've experienced during their migration, which is just so difficult," says Dr. Natalie Davis, associate medical director of ambulatory women's health services at Bellevue. "They're carrying a baby that is a product of a trauma they had along the way."
When a patient mentions assault, NYC Health + Hospitals says they are provided with emotional support as needed. "First, just giving them the space to talk about it, I think that's key," says Michele Maron-Knobel, the social work supervisor for Bellevue's Women's Health Clinic. For all patients who are less than 24 weeks pregnant, there's a discussion about whether the pregnancy is desired. The clinic also has an in-house victims services program, and the Program for Survivors of Torture.
Even for patients who haven't experienced this level of trauma, it's an all-hands-on-deck situation just to get the basics covered. Throughout New York City, mutual aid groups have been essential in assisting mothers with food, clothing, toys, first aid and diapers.
Bellevue refers families to agencies that provide support for first-time moms, pregnancy support groups, and material needs for families. Still, folks at Bellevue say, they are stretched thin and feeling the pressure. "We need more staff," says Maron-Knobel. "It's just not tenable."
The instability of the women's living situations makes even the simple things a herculean effort. Maria Vasquez, head nurse of the Women's Clinic at Bellevue, says many patients don't have a cellphone and are being shuttled around from shelter to shelter. "That has become a problem for us, following the patient. Where have they moved? The number one concern is that the patient come back to us, and continue bringing their babies here."
Davis says her staff has come to care deeply about these women, and there is also a lot of hope here. "These women are strong. It's incredible to think they walked through the jungle. They somehow made it here. They've survived. And this child is kind of a new chance for hope in a new country. And that kind of keeps me going."
In the last year, NYC Health + Hospitals says it has assisted with 300 babies born to asylum-seekers. Staff say they've worked to track women's due dates, arranged appointments and transportation to and from shelters to hospitals, and provided care packages for mothers returning with their newborns. Over 2.1 million baby wipes, 400,000 diapers and nearly 100,000 bottles of baby food and formula.
Some New Yorkers say that's an egregious spending of taxpayer money.
Others say it's the city's humanitarian duty, part of the quintessential American story.
And in the dimly lit, strangely magnificent waiting rooms of the Roosevelt Hotel, it's impossible not to wonder: Where do these people's stories end?
A few days ago, Yuniaski López, the hoarse-voiced woman who was worried about having been pregnant on the journey, gave birth to a healthy baby boy.
Estefani, the woman from Venezuela who shared about her assault, expresses a universal desire: "I'd love to be who I used to be." At the very least, she'd like to work as a nurse again. Maybe taking care of the elderly.
The Biden administration recently extended TPS, or Temporary Protected Status, to some Venezuelans. And, New York state has announced a program for eligible migrants, which promises to open thousands of jobs in industries where there are labor shortages. This could mean López might get a work permit.
For Roukhaya, the woman from Chad, there's not such a clear path. Her baby girl was born a few days ago. In Arabic her name means "love in the sky." Roukhaya sadly observes that she needs a 15-year reprieve: girls generally get circumcised between birth and 15 years of age. In the meantime, she's hoping to get asylum, but she'll be joining over a million applicants who are awaiting processing.
As she breastfeeds, she leans in, and puts her face to her baby's forehead. The chaos of the hotel seems to disappear, and Roukhaya repeats a sort of mantra:
"For her I will do it. For her, I will do everything. Everything possible. Everything."
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