As heat gets more extreme, pregnant farmworkers are increasingly at risk

One hot day last summer, Clarisa Lugo was inspecting and counting corn and soybean plants in the middle of a 300-acre farm field in Illinois when she started throwing up and panting. Her heart raced, she stopped sweating and a pounding headache didn’t go away for hours.

The heat index — a blend of temperature and humidity — had hit 105 F (40.56 C), and Lugo, who was eight months pregnant, was suffering from heat illness.

“I remember that that day it was hard for me to go back to normal” despite drinking water and putting ice on her body, she recalled.

Agricultural workers are already among the most vulnerable to extreme heat, and pregnant workers are coming under greater risk as temperatures rise because of climate change. Many in the U.S. are low-income Latino immigrants who toil under the sizzling sun or in humid nurseries open year round. Heat exposure has been linked to many extra risks for pregnant people, and while protections exist, experts say they need better enforcement and more safeguards are needed.

Compounding these risks is the Trump administration's immigration crackdown. Many people are too afraid to seek medical and maternal care, according to research and interviews with advocates and health care providers, and are increasingly fearful of retribution if they advocate for safe work environments.

The Associated Press interviewed four agricultural workers who recounted experiences of working in extreme heat while pregnant. Three spoke under the condition of anonymity because they’re in the country illegally or fear reprisals from their employers.

California, one of the nation's most agriculturally productive states, employed more than 893,000 agricultural workers in 2023, according to state data. Iowa, also among the top 10 agriculture-producing states, provides more than 385,000 jobs in the agriculture industry, according to a 2024 study.

Since the start of the 20th century, California temperatures have increased almost 3 F (1.67 C), according to state and federal data. Warming has accelerated, and seven of the past eight years in that state through 2024 were the warmest on record. Iowa has seen temperatures increase by more than 1 F (0.56 C) during the same period while in Florida, another big agriculture state, average temperatures have increased by more than 2 F (1.11 C).

When it comes to how the body reacts, even small temperature increases can make a difference.

One study found that agricultural workers had more than 35 times the risk of heat-related deaths than other workers. But deaths are hard to track and are likely undercounted. In the U.S., an estimated one-third of farmworkers are women — an increasing share of the farm workforce.

Lugo and her baby ended up fine. But others haven’t been so lucky.

As one nursery worker in Florida put it: “I’ve wanted to leave this work,” but “I have to fight for my children.”

An agricultural worker recalled working in a Florida nursery in 2010 amid intense heat. She was four months pregnant and would spend hours carrying heavy pots of plants and bent over weeding and planting indoor foliage such as monsteras. At work one day, she felt painful abdominal cramping. She knew something was wrong when she saw blood in the toilet.

“(At the hospital) they told me that I had already lost the baby,” she said. She believes the physical work combined with heat caused her miscarriage.

Another nursery worker in Florida worked four months into her pregnancy in 2024, vomiting — sometimes after drinking water — and feeling nausea and headaches in part because of the heat.

Her baby was born prematurely, at seven months. “(The doctor) told me that I spent too much time bent over ... and I wasn’t eating well for the same reason, because of the heat," she said.

Pregnancy increases the risks of extreme heat because the body has to work harder to cool down. Heat exposure has been linked to increased risk of miscarriages, stillbirths, preterm births, low birth weight and birth defects.

Combining pregnancy and heat with physical labor can more quickly overwhelm the body's cooling system, increasing the likelihood of dehydration, heat illness and heat stroke. Even short-term exposure to heat can increase the risk of severe maternal health complications, such as high blood pressure disorders of pregnancy, according to the Environmental Protection Agency.

In the worst cases, it can kill.

Maria Isabel Vasquez Jimenez was 17 and two months pregnant when she died in 2008 from heatstroke after pruning grapes in a California farm. Her supervisors failed to provide shade and water while she worked for hours in nearly triple-digit heat, authorities said.

California’s outdoor heat standard, enacted in 2005, was later named in Jimenez's honor.

No federal heat protections exist in the U.S., although the Trump administration appears to be moving forward with a proposed rule. Some states, including California and Washington, have their own protections, while others, like Texas and Florida, have barred local governments from implementing their own. In states with protections, advocates say they’re not adequately enforced and pointed to a widespread distrust of reporting systems.

More than 30 states and cities have laws requiring employers to provide accommodations for pregnant workers. Most recently, 2023's federal Pregnant Workers Fairness Act requires employers to provide “reasonable accommodations” to pregnant workers, those who recently gave birth or have medical conditions related to birth or pregnancy unless they will cause the employer “undue hardship.” Other laws make it illegal to fire or discriminate due to those factors.

Even so, there aren’t enough legal protections for pregnant workers, said Ayana DeGaia, assistant professor of obstetrics and gynecology at the University of Washington in Harborview. “It’s probably one of the reasons why we have some of the highest rates of maternal and infant mortality in high-income countries in the world,” she said.

It’s also unclear how some of these protections benefit women farmworkers, said Alexis Handal, an associate professor at the University of Michigan, who led a recent study examining the experiences of the state's women farmworkers.

In Florida, a top U.S. producer of indoor plants and tropical foliage, the nursery industry’s mostly women workers have joined a fight for heat protections. In California, workers have been advocating for guaranteed compensation when they lose wages due to heat waves and other extreme weather events, as well as extra pay when they work during dangerous weather conditions.

Trump’s immigration crackdown has instilled deep fear in immigrant communities.

In California, a physician said her clinic recently had a patient suspected of carrying a fetus with birth defects. They set her up for specialty consultation and care about two hours from home. But the woman couldn’t access that care during her pregnancy. Arranging transportation and child care was difficult. The overarching reason, however, was fear, in part of being detained, said Dr. Katherine Gabriel-Cox, director of obstetrics, midwifery and gynecology at Salud Para La Gente, a community health center.

She added that she hears similar stories "over and over.”

It's a growing concern nationally. Health care providers have reported seeing fewer walk-ins, patients delaying prenatal care, and more pregnant patients whose first doctor’s visit was for labor and delivery, according to a brief published in April by the group Physicians for Human Rights. Others have reported an increase in no-shows and canceled appointments.

“I’d be concerned that people are not going to present for medical care until it’s too late," said Katherine Peeler, medical adviser with Physicians for Human Rights and assistant professor of pediatrics at Harvard Medical School.

Pregnant farmworkers in rural areas already have less access to maternity care because clinics are farther away and finding transportation could be difficult. Other times, they can’t afford to miss hours of work or aren't given time off. Many also don't get employer-sponsored medical care or paid leave.

Farmworkers are less likely to demand employers provide adequate shade, water or rest, or speak out when they’re feeling heat illness for fear of being fired or having immigration enforcement officials called on them, said Juan Declet-Barreto, senior social scientist for climate vulnerability with the Union of Concerned Scientists.

Some workers who spoke with the AP described employers who wouldn't provide accommodations or water, face covers or other equipment to protect them from pesticides and heat. They continued working during pregnancy out of necessity.

“There were times when my back and entire body hurt … but I had to do it,” said a third nursery worker from Florida. “No one was helping me, and so I had to keep going. If not, no one was going to pay my bills.”

The nursery worker who had a miscarriage said she had to urinate often during pregnancy, but the portable toilets were up to a 10-minute walk away. Another described dirty bathrooms infested with flies. And another recalled pregnant women who were only allowed to use the bathroom during scheduled breaks.

Yunuen Ibarra, programs director with Líderes Campesinas, a farmworker advocacy organization, said women working in agriculture who have been sexually assaulted at work can also be more vulnerable to heat. They might cover their bodies with extra clothing “to not feel exposed to a potential assault,” she said, which can raise their body temperature.

At home, farmworkers might find little escape from extreme temperatures because they are more likely to lack air conditioning, be lower income or live in hotter areas, multiple studies have shown.

As human-caused climate change continues, heat waves will only get longer, hotter and more frequent. Without adequate protections and enforcement, pregnant farmworkers and their unborn babies will suffer the consequences.

“We can’t prevent temperatures from rising,” said Ibarra, “but we can prevent farmworkers from dying or feeling sick or being disabled due to heat-related illnesses.”

The Associated Press receives support from the Walton Family Foundation for coverage of water and environmental policy. The AP is solely responsible for all content. For all of AP’s environmental coverage, visit https://apnews.com/hub/climate-and-environment

Pears wait to be transported out of an orchard in Naches, Wash., Thursday, Aug. 28, 2025. (AP Photo/Annika Hammerschlag)

A worker reaches for a water bottle while harvesting pears at an orchard in Naches, Wash., Thursday, Aug. 28, 2025. (AP Photo/Annika Hammerschlag)

A water jug for farmworkers sits at an orchard in Naches, Wash., Thursday, Aug. 28, 2025. (AP Photo/Annika Hammerschlag)

A worker harvests pears at an orchard in Naches, Wash., Thursday, Aug. 28, 2025. (AP Photo/Annika Hammerschlag)

FILE - A pregnant patient is examined Aug. 31, 2023, in Summertown, Tenn. (AP Photo/George Walker IV, File)

A worker harvests pears at an orchard in Naches, Wash., Thursday, Aug. 28, 2025. (AP Photo/Annika Hammerschlag)

WASHINGTON (AP) — The U.S. Supreme Court has begun hearing arguments over the constitutionality of President Donald Trump’s order to end birthright citizenship for children born in the United States to someone in the country illegally or temporarily.

The birthright citizenship order, which Trump signed on Jan. 20, 2025, the first day of his second term, is part of his Republican administration’s broad immigration crackdown.

Trump is in attendance; he is the first sitting president to attend oral arguments at the nation’s highest court.

Every lower court to have considered the issue has found the order illegal and prevented it from taking effect. A definitive ruling by the nation’s highest court is expected by early summer.

Here’s the latest:

Trump spent just over an hour inside the courtroom. He apparently was only interested in hearing the arguments by the government’s lawyer, Solicitor General John Sauer.

The president departed shortly after Sauer wrapped up and the plaintiff was invited to present her case.

Cecillia Wang, the American Civil Liberties Union legal director facing off against Sauer, often centered her arguments around American courts’ reliance on English common law, which provides for citizenship based on the legal concept of jus soli, or “right of soil.”

“When the government tried to strip Mr. Wong Kim Ark’s citizenship on largely the same grounds they raised today, this court said no,” she said, adding “this court held that the 14th Amendment embodies the English common law rule: Virtually everyone born on U.S. soil is subject to its jurisdiction and is a citizen.”

Justice Jackson is drilling down into exactly how the government would actually figure out who’s entitled to citizenship and who’s not.

“Are you suggesting that when a baby is born people have to have documents? Present documents? Is this happening in the delivery room? How are we determining when or whether a newborn child is a citizen of the United States under your rule?” she’s asking Sauer.

Sauer seems to be saying that it would fall to the computer systems that give out Social Security numbers, saying they would automatically check the citizenship of the parents.

Roberts says the word is used 20 times in the 1898 decision. “Isn’t it at least something to be concerned about?”

Wang says it’s true that the Chinese parents were domiciled in the U.S., but that the decision did not turn on that fact, but instead a long history of basing citizenship on where the child was born.

More than an hour in, it’s the opponents’ turn

The ACLU’s Wang has begun her presentation in defense of birthright citizenship.

Sauer noted that the government is “not asking you overrule Wong Kim Ark,” which extended citizenship to children born in the U.S. to foreign parents.

But he added that it was “totally unambiguous” that the 1898 ruling “relates to domiciled aliens,” and not what he called “sojourners,” or temporary visitors.

Judge Alito is asking Sauer about the humanitarian issue of people who have been in the U.S. for a long time and are “subject to removal” but in “their minds” have made a permanent home in America.

Alito also says that immigration laws in the U.S. have been “ineffectively and in some cases unenthusiastically” enforced over the years.

He’s asking Sauer to address the “humanitarian problem” that arises with how to deal with those people when it comes to birthright citizenship.

Sauer is saying that when it comes to birthright citizenship the U.S. is an “outlier among modern nations” and is pointing to places in Europe who don’t allow birthright citizenship and suggesting there doesn’t seem to have been any humanitarian fallout there.

Kavanaugh says Congress might have used different language in laws enacted in 1940 and 1952 if it wanted to make clear that children of people here illegally or temporarily were not entitled to citizenship.

Much of the early discussions revolved around the concepts of “domicile,” or a person’s permanent residence, and to which government that person owes “allegiance.”

Solicitor General D. John Sauer began his arguments by noting that the citizenship clause “was adopted just after the Civil War to grant citizenship to the newly freed slaves and their children, whose allegiance to the United States had been established by generations of domicile here.”

It did not, he said, “grant citizenship to the children of temporary visitors or illegal aliens who have no such allegiance.”

Sauer insists that Trump’s order would apply “only prospectively.”

But Justice Sonia Sotomayor says the logic of the administration’s argument would allow a future president to try to strip citizenship from U.S.-born children years from now.

Sauer was asked by Chief Justice John Roberts about how significant is the issue of “birth tourism.”

Critics of birthright citizenship have long said that it attracts people from other countries who come to the U.S. in order to give birth so that their children can become American citizens. Then they go back to their home country.

Sauer was asked by Roberts about any data on how many people come to the U.S. for this reason. “No one knows for sure,” Sauer said, and cited “media estimates” for various numbers.

Thomas recounts that the aim of the 14th amendment was to make citizens of the freed slaves. “How much of the debates around the 14 Amendment had anything to do with immigration?”

Conservative and liberal justices are questioning Sauer’s history of the debates that led to the adoption of the 14th Amendment. Justice Neil Gorsuch says there’s precious little discussion about domicile, a key part of Sauer’s argument.

Justice Elena Kagan says part of Sauer’s case rests “on some pretty obscure sources.”

Many of the arguments in today’s case go back to the Supreme Court’s 1898 ruling in the case of Wong Kim Ark, which said a U.S.-born child of Chinese nationals was a citizen.

In that ruling, Justice Horace Gray wrote that Fourteenth Amendment “affirms the ancient and fundamental rule of citizenship by birth within the territory. That, he wrote, is “including all children here born of resident aliens.”

Roberts says it’s not clear how the recognized exceptions to citizenship, children of ambassadors and foreign invaders, can be applied to “a whole class of illegal aliens.”

Roberts says he’s not sure “how you get to that big group from such tiny and idiosyncratic examples.”

Sauer, Trump’s top Supreme Court lawyer, is at the lectern, defending the president’s birthright citizenship order. Trump is in the courtroom.

On American Samoa, an island cluster in the South Pacific roughly halfway between Hawaii and New Zealand, native-born children are considered “U.S. nationals” — a distinction that gives them certain rights and obligations while denying them others.

American Samoans are entitled to U.S. passports and can serve in the military. Men must register for the Selective Service. They can vote in local elections in American Samoa but cannot hold public office in the U.S. or participate in most U.S. elections.

Those who wish to become citizens can do so, but the process costs hundreds of dollars and can be cumbersome. In 2022, the Supreme Court rejected an appeal seeking to extend birthright citizenship to American Samoa.

An Alaska appeals court is weighing whether to dismiss criminal charges against an Alaska resident born in American Samoa after she was elected to a local school board.

Crowds watched from the sidewalks as Trump’s motorcade drove along Constitution and Independence Avenues, passing the Washington Monument and the National Mall on the way to the court building.

Justice Felix Frankfurter, a native of Austria, was the last of six justices who were born abroad. The current court is American from birth.

Still, the citizenship issue hits close to home for some justices.

Thomas and Ketanji Brown Jackson are descended from enslaved people who eventually had their citizenship established by the 14th Amendment.

Justice Sonia Sotomayor’s parents were born in Puerto Rico, where residents became citizens under a 1917 law enacted by Congress. The justice most closely tied to an immigrant is Alito, whose father was born in Italy.

Way back in 1841, former President John Quincy Adams represented a shipload of African men and women who had been sold into slavery in the famous Amistad case.

Former President William Howard Taft became chief justice nearly eight years after leaving the White House in 1913. Charles Evans Hughes left the Supreme Court for a presidential run in 1912, which he nearly won, then returned to the court in 1930 as chief justice.

In 1966, Richard Nixon argued his only Supreme Court case, which he lost.

Twenty-four Democratic state attorneys general put out a statement Wednesday morning saying they’re “proud to lead the fight against this unlawful order.”

While Democratic attorneys general have sued the Trump administration scores of times, the plaintiffs in this case are represented by the American Civil Liberties Union and other civil rights groups.

The Democratic attorneys filed court papers supporting their position. Twenty-five of their Republican counterparts filed a friend-of-the-court brief backing the Trump administration.

The only state sitting this one out is New Hampshire.

More than 250,000 babies born in the U.S. each year would not be citizens, according to research from the Migration Policy Institute and Pennsylvania State University’s Population Research Institute.

The order would only apply going forward, the administration has said. But opponents have said a court ruling in Trump’s favor could pave the way for a later effort to take away citizenship from people who were born to parents who were not themselves U.S. citizens.

The president and first lady Melania Trump showed up for the court ritual marking the arrival of a new justice following the confirmations of Justice Neil Gorsuch in 2017 and Justice Brett Kavanaugh a year later.

The ceremony for Trump’s third appointee, Justice Amy Coney Barrett, was delayed a year because of the COVID-19 pandemic and Trump, who was no longer in office, did not attend.

Traditionally the president has avoided attending arguments to maintain distance between the government branches — since the executive officer’s presence is seen by many as a way to pressure the independent court to rule in their favor.

Given the unusual nature of it all — Trump’s presence in the courtroom spotlights how high the stakes are for him, as the court’s decision will have massive consequences on his longstanding promise to crack down on immigration.

Last year, Trump said that he badly wanted to attend a hearing on whether he overstepped federal law with his sweeping tariffs, but he decided against it, saying it would have been a distraction.

Adam Winkler, a constitutional law professor at UCLA, told the The Associated Press that Trump’s attending SCOTUS oral arguments signals how important the president views this case.

However, Trump’s presence “is unlikely to sway the justices,” Winkler said, adding that the SCOTUS justices “pride themselves in their independence, even if some agree with much of Trump’s agenda.”

The fanfare of Trump being in the courtroom will make for a different experience for the justices themselves, however, as “Trump’s presence will make the atmosphere a little bit more circus-like,” Winkler said.

Solicitor General D. John Sauer is making his ninth Supreme Court argument and second in as many weeks. Sauer’s biggest win to date was the presidential immunity decision that spared Trump from being tried for his effort to overturn the 2020 election.

Sauer was a Supreme Court law clerk to Justice Antonin Scalia early in his legal career.

ACLU legal director Cecillia Wang, the child of Chinese immigrants, is presenting her second argument to the Supreme Court. In the first Trump administration, a 5-4 conservative majority ruled against Wang’s clients in another immigration case.

It’s not an April Fool’s joke. Alito was born this day in 1950. Only Thomas, who turns 78 in June, is older than Alito among the nine justices.

In the post-pandemic era, the other justices allow the 77-year-old Thomas, the longest-serving member of the court, to pose a question or two before the free-for-all begins.

In a second round of questioning, the justices ask questions in order of seniority. Chief Justice John Roberts, whose center chair makes him the most senior, gets the first crack.

The justices have routinely gone beyond the allotted time since returning to the courtroom following the Covid-19 pandemic.

A buzzer and the court marshal’s cry, “All rise,” signal the justices’ entrance from behind red curtains. The livestream won’t kick in for several minutes, until after the ceremonial swearing-in of lawyers to the Supreme Court bar.

FILE - The U.S. Supreme Court is seen in Washington on Feb. 24, 2026. (AP Photo/Matt Rourke, File)

People arrive to walk inside the U.S. Supreme Court, on Capitol Hill in Washington, Wednesday, April 1, 2026. The Supreme Court justices will hear oral arguments today on whether President Donald Trump can deny citizenship to children born to parents who are in the United States illegally or temporarily. (AP Photo/J. Scott Applewhite)