Explores forms of maternal harm stemming from US policies on the US-Mexico border In El Paso, Texas, the racist undertones of anti-immigrant sentiment have contributed to various forms of violence in the region, including the 2019 mass shooting that was the deadliest attack on Latinos in US history. As the community continued to mourn this tragedy, the COVID-19 pandemic unleashed yet another set of economic, social, and public health catastrophes that were disproportionately felt within the border region. In Birth in Times of Despair, Carina Heckert traces women’s emotional experiences of pregnancy, birth, and the postpartum period in the midst of a series of longstanding and ongoing crises in the US-Mexico border region. Drawing from interviews, surveys, and medical records of women who gave birth during an intense period of sociopolitical crisis, she examines how limited access to health care, inhumane immigration policies, and exposure to an array of harmful social environmental circumstances serve as sources of intense harm for pregnant and recently pregnant women. In so doing, Heckert reveals how these experiences serve as a profound critique of policies that continue to fail to protect women and their families. She concludes with suggestions for practical, humane, and urgent policy changes to alleviate the needless suffering of this vulnerable group. With its comprehensive portrait of the abysmal physical and mental health outcomes pregnant women face within the border region, Birth in Times of Despair expands our understanding of how obstetric violence is enhanced by the structural violence of the state, and unveils the urgency to ameliorate the harm caused by current immigration policies.