II. Methodology

This report is based primarily on interviews conducted by Human Rights Watch in the United States in 2008 with individuals possessing direct knowledge of the medical care provided to women in immigration detention. Our research included consultations with legal and health service providers and immigration policy experts, and a review of relevant published materials. The research also included interviews with 48 women detained by Immigration and Customs Enforcement (ICE) (34 of whom were in detention when we interviewed them and 14 who had been detained for some period of time since the formation of ICE in 2003); 17 detention officials and health services administrators; and two off-site specialists contracted to provide prenatal and gynecological services to women in ICE custody.

In these interviews and visits to nine detention facilities, Human Rights Watch investigated care for a range of women’s health concerns and collected information regarding each type of facility where ICE policies govern health care: service processing centers operated directly by ICE, contract detention facilities managed by private companies, and state and county jails contracted through intergovernmental service agreements. On October 30, 2008, we met with officials at ICE headquarters to share our preliminary findings, clarify a number of medical care policies, and discuss ICE’s plans for health services going forward.

Human Rights Watch informed ICE of our intent to carry out this and two other research projects in February 2008 and entered into discussions with ICE officials regarding the parameters of our access to detention facilities.[3] ICE asked Human Rights Watch to propose a schedule of facility visits that were to include a tour and private interviews with detained individuals identified by Human Rights Watch in advance of the visit. In selecting the facilities for this research project, Human Rights Watch sought to identify states with a high concentration of women in detention, examples of each of the types of facility referenced above, and local legal service providers and other partners able to identify women willing to talk about their detention experience. On the basis of these criteria, we identified ten facilities in Florida, Texas, and Arizona.[4] With the exception of one facility visit, ICE accommodated the requests for visits to these facilities and arranged for them on the dates we specified.[5] It should be noted that Human Rights Watch adopted this methodology to enhance the breadth and depth of the research but we did not conduct a scientific sampling and we do not contend that generalized conclusions about conditions at ICE facilities nationwide can be drawn on the basis of our findings.

While the bulk of the interviews for this report were conducted at detention centers between April 7 and May 2, 2008, in accordance with the schedule of announced facility visits negotiated with ICE, Human Rights Watch arranged further interviews with women released from detention, community service providers, and local activists during the same period. In addition, in June, July, and August 2008, we interviewed six formerly detained women in the Washington, DC and New York metropolitan areas. Follow-up research continued through February 2009 and included meeting with ICE and DIHS and examining materials obtained through a request submitted to ICE under the Freedom of Information Act.

Our main method for reaching women willing to speak with us, whether currently or formerly detained, was through legal service providers, who discussed our project with women they identified as possibly having information relevant to our research. However, with more than 80 percent of individuals in detention unrepresented, many women were simply beyond our reach. Also, fear among women that speaking with us about detention conditions could adversely affect their immigration status led some to decline an interview.

ICE had no input in identifying which women would be interviewed for this research. However, an ambiguous limitation imposed by ICE regarding the number of interviews and shifting requirements for documentation of the individuals’ consent to be interviewed proved obstructive. Shortly before the start of the first trip, ICE introduced a limit of 12 on the number of individuals in custody who could be interviewed, without indicating whether this limit applied per facility, per day, per state, or per Human Rights Watch project. Despite efforts to clarify this issue, the limit became a major impediment, as each ICE field office varied in its application of the limit set by headquarters, and none permitted us to interview more than 12 detained individuals per facility for all three projects. Further, the field offices imposed different requirements regarding the form in which the individuals, and sometimes their lawyers, were to demonstrate their consent to the interviews. They also required up to five business days notice for the list of interviewees, a particularly impractical demand given the transience of the immigration detention population.

As noted above, of the 48 women who spoke with Human Rights Watch about their experience with medical care in immigration detention, 34 were in ICE custody at the time of their interview; the other 14, all of whom had been detained for some period of time since the formation of ICE in 2003, had been released from custody and were living in the US. The length of time the women had spent in ICE custody varied considerably, from less than 24 hours to over two-and-a-half years. The backgrounds of the women interviewed also varied in terms of the length of time they had spent in the US, the manner in which they had come to be in ICE custody, and their countries of origin, although 29 of the 48 came from Latin America and the Caribbean. No one below the age of 18 was interviewed for this report, and the majority of the women were in their 20s or 30s.

Human Rights Watch conducted an individual interview with each woman. With the exception of two, the interviews at detention centers took place in a room in which only the woman, the Human Rights Watch interviewers, and any interpreters were present. In two cases, the interviews were conducted in a corner of a large room in which other detained women were present but out of earshot. In a single instance, one woman we interviewed interpreted for another woman in a subsequent interview with the second woman’s express consent. Human Rights Watch met with women who had been released from detention in a variety of locations selected for their comfort and privacy. In four cases, family members of the women were present at the request of the interviewee for all or a portion of the interview and in one case a woman’s lawyer participated in the interview. The primary interviewers for this project were women; however, due to logistical constraints, a male colleague pursuing a separate line of research was present for several of the interviews.

The interviews ranged in length from 15 minutes to almost four hours; most lasted approximately one hour. Interviews were conducted in English or in Spanish, and, in one case, in French. They began with a discussion of the purpose of the interview and an explanation that participation was entirely voluntary and could be stopped at any time. Where appropriate, Human Rights Watch attempted to provide contact information for other organizations offering legal, counseling, or social services. No one received or was promised any material compensation for their participation. To protect their privacy and alleviate concerns regarding retaliation, Human Rights Watch assured women that their real names and the potentially identifying details of their interview would not appear in this report. For this reason, the names of all women interviewed for this report have been replaced with pseudonyms (in the form of names and initials which do not reflect real names) and the exact date and precise location of the interviews have been withheld.