Bearing the Borderlands - The Margin

Editor’s note: Karina is a pseudonym to honor the source's request for safety, privacy, and anonymity. Para leer la historia en español, haga clic aquí.

Cathy Durón, 25, a preschool teacher in Nogales, Arizona, was 35 weeks pregnant when she started bleeding. She was already tucked in for the night in the home she shares with her husband, Juan Antelo, their seven cats, four dogs, and many plants. 

That evening in January 2025, Durón and Antelo were laughing about the chocolate bar he’d eaten, which was hers. A piece caught in her throat, and she got up for water. That’s when the blood rushed down her legs. She had bled at other moments during her pregnancy, but this time it wouldn’t stop. 

The couple got into their car and left Preston Mobile Home Park just before midnight and drove three miles to the Carondelet Holy Cross Hospital, the only 25-bed critical access hospital in this border town of 20,000 people, where Cathy was rushed into an emergency C-section due to the placental abruption.

In the wee hours of January 9, 2025, Antelo, who was also in the operating room, exclaimed: “Ya salió!”— “She’s out” in Spanish, and Durón heard their daughter cry. They named their first child Sahuari, inspired by the beloved Sonoran cactus, Saguaro.  She weighed only three pounds and thirteen ounces at birth. 

Between 4 and 5 am Sahuari was airlifted, without her parents, to Banner University Medical Center Tucson, where she was placed in the Neonatal Intensive Care Unit (NICU). Antelo drove to be with their baby at Banner, while Durón spent another day at Carondelet Holy Cross Hospital recuperating. After she was discharged, she went home to shower and pack her bag, and then drove 70 miles to Tucson, barely 48 hours after surgery.

“It hurt a lot, but I think my brain kind of blocked it, because I had to go be with her,” Durón recalled. National medical guidelines recommend at least a two-week recovery before a woman can drive after a C-section. But like many other smaller communities along the border, Nogales doesn’t have a NICU or ICU.

The health of mothers and their infants is a raw topic in Arizona, where the maternal mortality rate has long surpassed the national average — 30.4 to 17.9 deaths per 100,000 live births. Each year, around 900 women in Arizona suffer severe complications during labor and delivery, and many more develop chronic conditions like gestational diabetes and high blood pressure in the course of their pregnancies. 

Across the vastness of Arizona, the sixth-largest state in the U.S., where a woman lives may well determine how her pregnancy ends. The crisis is particularly obvious in remote rural areas, frontier towns and colonias, often unincorporated and under-resourced, predominantly Spanish-speaking settlements within 150 miles of the U.S.-Mexico border.

“Where you live matters in terms of what you have access to,” said Martín Celaya, chief of the Bureau of Assessment and Evaluation at the Arizona Department of Health Services. 

Celaya co-authored the state’s 2020 Title V Maternal and Child Health Needs Assessment, which identifies Arizona’s most pressing maternal and child health needs and prioritizes them for funding. The reports are part of a federal-state partnership aimed at improving the health of mothers and children.

To better understand the scope of the problem and document women’s experiences weathering the compounding crises, The Margin dispatched to Santa Cruz and Yuma counties and spoke with over two dozen women in kitchens, living rooms, parking lots, lobbies, and waiting areas of health centers in consulate buildings in Yuma, San Luis, Somerton, Dateland, Nogales, and Rio Rico.

Interviews with researchers, healthcare professionals, and state officials, along with state records, including on pesticide regulation, show how overlapping environmental issues make pregnancy in the Arizonan borderlands particularly fraught. Pesticides, air and water pollution, and extreme heat compound a shortage of providers and long distances to care.

Arizona state agencies with the power to investigate and regulate the health hazards of environmental pollution on maternal and child health don’t explore the overlap.

Our Neighbor, The Cornfield

About 300 miles west of Nogales along the border, in the Yuma County town of Somerton, Karina, 37, burst into happy tears when she saw two lines on her pregnancy test. 

Karina, who moved to the U.S. from Mexico for love, already had a teenage son Luis, but this would be the couple’s first pregnancy. 

As an event decorator, Karina got straight to work on their pregnancy announcement. “I got a tiny onesie ready, a little sign that said 'Daddy, I’m on my way,' [I] put up some balloons, and made a little cross-stitch piece to announce he was going to be a dad,” said Karina.

“I just couldn't wait—I was absolutely dying to tell him,” she said.

At the end of June 2025, Karina had an ultrasound, which brought more good news: They were expecting twins. “We heard their heartbeats," she said.

For the first two trimesters of Karina’s pregnancy, the family lived in Somerton’s Las Estrellas neighborhood, in a rental house near a cornfield. “It was my backyard,” she said.

Where the U.S. and Arizona stand

The U.S. has one of the highest maternal mortality ratios among high-income OECD countries. Within the U.S., Arizona’s rate is higher than the national rate. Hover over the below chart to view the maternal mortality ratio per country.

Established in 1898, Somerton — which until 2010 was considered an economically distressed colonia on the outskirts of the Yuma County seat — is now a fast-developing agricultural town of about 15,000 residents. The community is surrounded by farmland, so living close to a field is not unusual.

An agricultural powerhouse, Yuma grows 175 different crops, most of which are leafy greens.

At night, Karina would hear the buzz of the planes flying overhead, spraying the fields with pesticides. “The noise from the small planes was definitely very loud,” she said.

Researchers have linked exposure to toxic environmental agents, including pesticides, to preterm birth and low birth weight, as well as childhood cancer, autism spectrum disorder, and other neurodevelopmental issues. 

Multiple studies published between 2024 and 2026 by Melissa Furlong, an environmental epidemiologist at the University of Arizona, link pesticide exposure to gestational diabetes, stillbirth, and a lower Apgar score, an assessment of a newborn’s condition minutes after birth.

Somerton and the 500-meter distance

Three studies of Arizona births co-authored by Melissa Furlong counted a mother as exposed to a pesticide if a reported agricultural application was within 500 meters of her home address at delivery. In the 2020 Census, 80% of Somerton’s residents lived in blocks that lie entirely within 500 meters of cropland mapped in 2025.

Hover over the census blocks below to view total number of residents, with colors representing the proportion of residents within 500 meters of cropland.

“Just living within 500 meters of these pesticide applications is associated with gestational diabetes,” Furlong said. “[It’s] bad for the mom, obviously. And also, for the baby.”

Dust from the fields, noise from planes overhead, and extreme heat kept the family mostly indoors. In August 2025, temperatures surpassed 100 degrees Fahrenheit on at least 28 days, and 109 degrees on at least 15.

Early that August, during her first prenatal visit, Karina found out that one of her twins stopped growing. “We were told it didn't work out, the other baby stayed tiny,” Karina said through tears. The couple had already shared the news about the twins with their friends and family.

Karina was also diagnosed with placenta previa, a condition where the placenta attaches low in the uterus and covers all or part of the cervix, causing spontaneous bleeding. Her pregnancy was considered high-risk. Anxious about the surviving baby, Karina ordered several at-home ultrasounds, just to make sure the child’s heart was beating.

Arizona law does not require a minimum distance between farmland and people’s homes. Instead, the state’s rules require application buffer zones for farm operators using “odoriferous” and “highly toxic” pesticides. The rule, however, is only effective if there are at least 25 residences adjoining the field. 

Karina’s family lived in one of 17 houses lining the western edge of the field, according to a count by The Margin. Public records obtained through state public records law reveal permethrin, pronamide and bensulide—active pesticide ingredients linked by Furlong and other researchers to adverse health outcomes—were used on the fields close to her home in 2025.

Even if Karina’s street did not have a buffer zone, drift on individual residences is against state law. Additional public records obtained by The Margin show that the penalties for this violation are rare. 

Between April 2022 and March 2026, the Arizona Department of Agriculture investigated six instances of pesticide drift and application exclusion zone violations. Only two of those incurred penalties of $213.00 and $85.00, respectively.

Karina delivered healthy, chubby-cheeked Emily via C-section.

Karina and her family have since moved out of Las Estrellas. In June, she sat with her curtains drawn inside her one-story stucco house on a hot, bright afternoon. Karina sports slightly highlighted hair and her dimples crease as she talks. On the June day she spoke to The Margin, she wore a chambray sundress. 

Family photos and flowers decorated the spacious living room painted light grey. Karina, propped up by pillows on the couch, cradled baby Emily, wrapped in a pink cotton-candy-esque dress with a ribbon on her head.

It is impossible to say whether Karina’s pregnancy complications were caused by pesticide exposure or something else. Linking exposure to individual outcomes is hard even for researchers studying it.

“It's very difficult to study pesticides, because the biomarkers are very transient,” Furlong said. In other words, the biological traces of pesticides leave the body quickly. But research shows, even short exposure may have long-lasting effects.

Acres Upon Acres of Pesticide-Sprayed Farms

In 2013, a team of researchers from the University of Arizona’s Mel and Enid Zuckerman College of Public Health ranked the most hazardous pesticides for human health used in Yuma County. Maneb, metam sodium, trifluralin, pronamide, and bifenthrin made it to the top of the grim chart. These active ingredients cause cancer, endocrine disruption, and reproductive/developmental toxicity according to their research.

Twelve years later, when Karina was pregnant, three out of five most hazardous pesticides — trifluralin, pronamide, and bifenthrin — were still used in Yuma County, according to data The Margin received from the Arizona Department of Agriculture. 

Additional hazardous pesticides were used, including pyrethroids beta-cyfluthrin, permethrin, organophosphates acephate, bensulide, and dimethoate, which Furlong linked to gestational diabetes mellitus. And cyfluthrin, zeta-cypermethrin, carbaryl, formetanate hydrochloride, and several pesticides linked to stillbirth.

Other records The Margin obtained from the Arizona Department of Agriculture show that in 2025, Yuma County growers sprayed more than 600,000 pounds on their fields. These chemical cocktails have 170 different names.

According to Furlong’s research, if a person lives inside the radius of a 500-meter exposure zone, their health may be compromised. This distance is 16 times bigger than Arizona’s current 100-foot buffer zone policy for highly toxic pesticides.

In Yuma, acres upon acres of pesticide-sprayed farms end where backyards begin.

In the last five years, The Arizona Department of Health Services has started collecting data on pesticide-related illnesses. Between 2020 and 2025, there have been 3,980 cases of unspecified pesticide-related diseases, with Yuma registering 92 of them. The number is likely an undercount.

Mariana Sandoval, a Democrat, represents District 23, which partially includes Yuma County, in the Arizona House of Representatives. Originally from California, where environmental regulations are stronger, Sandoval has advocated for restrictions on certain kinds of pesticides for years.

In January 2026, she again sponsored a bill, HB 2472, that would restrict the sale and use of neonicotinoid pesticides that are harmful to bees and, potentially, humans. It didn’t advance through committee.

Sandoval sees pesticide regulation as a party-line issue. “In the state house in Arizona, Republicans have been in charge for the last 60 years, and they're a party of less regulation,” she said.

According to Sandoval, Arizona’s commitment to the agriculture industry and its influence on the state economy have resulted in low regulation and high cost to those working or living close to farms.

Arizona Republican state Senator Tim Dunn, who is a farmer in Yuma County, and House Majority Leader Michael Carbone did not respond to The Margin’s requests for comment.

“There’s No Shade Here”

For ten days after giving birth, Cathy Durón slept in a recliner in the NICU beside her daughter, Sahuari, who was fed through a tube. “You could fit her in a shoebox,” she said. 

Eventually, when Sahuari gained some weight, Durón was able to take her daughter home and start healing. 

Nogales is equipped with a community health center, Mariposa Community Health Center, and a rural hospital, Carondelet Holy Cross, that handle most healthy pregnancies and manage emergency C-sections in under 30 minutes — a gold standard in obstetrics. Carondelet Holy Cross, which was put at risk of closing in May 2025, due to federal Medicaid cuts, is one of five critical access hospitals — out of 17 total in rural counties in Arizona — that still deliver babies. For over four decades, Mariposa Community Health Center has supported women throughout their pregnancies, birth, and postpartum. Yet resources and personnel shortages are acutely felt here.

“We operate our OB/GYN department at a significant loss— we lose about 2.9 million dollars just on our labor and delivery services,” Mariposa’s CEO Amy Taylor told The Margin.

Women living in this frontier town have to travel to Tucson if their pregnancies are considered high-risk, or for specialty care. 

The reality is more dire for women in remote rural communities, colonias, or whole counties, like La Paz and Greenlee, that have no reproductive, labor and delivery care at all. 

“[While] there are not a lot of people, there are people out in these communities, and in the areas of agriculture and ranching and mining, there are people of childbearing age having to figure out how to get to care,” said Erin McMahon, the director of the Nurse Midwife Program at the University of Arizona, who for over two decades has served pregnant people, including in small, under-resourced communities.

Dateland is a small, under-resourced colonia where women have some of the state’s longest travel distances to labor and delivery units. Surrounded by miles of farmland dotted with trees bearing the date fruit the area is named for, Dateland is also extremely vulnerable to pesticide drift.

A tiny desert outpost and a federally certified colonia located just off Interstate 8, located 67 miles from Yuma and 118 miles from Phoenix, many women from Dateland and the communities nearby travel for hours for prenatal care or labor and delivery.

The Margin interviewed Maria Elena Oñate, 59, of Dateland, who came to Arizona from Mexico when she was 17. 

Before moving to Dateland, she lived twenty miles northeast, in Hyder, where she had her four kids. She received prenatal care in Gila Bend, 47 miles away. And she had to travel 115 miles, or two hours one way, to give birth in Phoenix. 

Her 33-year-old daughter Lisa, who lives nearby, had her children in Yuma, an hour away.

Being on the road for hours while pregnant may quickly become a life-or -death situation, especially when travel happens during long stretches of extreme heat. In 2026, Arizona registered the second hottest summer in history, with long stretches of daily highs of over 116 degrees in Phoenix and Yuma, and temperatures remaining above the high 90s at night. 

State data from a 2020 report captures a direct correlation between distance traveled to care and severe, life-threatening complications during delivery.

The distance to maternity care

Logan Kenny’s map below provides the approximate total miles from each of 107 colonias to the nearest of 40 listed labor-and-delivery hospitals. Hover over each dot to view the distance from that colonia to the nearest hospital.

“You're on a road and driving an hour, or two hours, and it's 120 degrees outside, and you get a flat tire, and there's no shade here. There's no place on the side,” McMahon said of the circumstances many women in remote corners of Arizona find themselves in.

Warning Mothers About Environmental Risks

During her first year in high school, nearly 11 years ago, Cathy Durón was introduced to her future husband, Juan Antelo, by his mother. She described him as a “beautiful son with a lot of gratitude.” At first, Durón was lukewarm about Antelo, but “he was very consistent, and he won my heart,” she admitted.

Now, it’s the couple’s fourth year in The Preston Mobile Home Park, in northern Nogales. It sits just minutes away from busy Interstate 19. 

Durón has lived most of her life in trailer parks, and while Preston is near busy Interstate 19, where vehicles pump pollution into the air, its wide streets, greenery, and friendly neighbors have made it a beloved home. 

“It's a pretty peaceful neighborhood, and neighbors take care of each other,” she said. One neighbor’s chicken lays an egg on their porch every day, except Sunday. “It’s God’s day,” Durón said, laughing.

Sahuari, her daughter, is tall and lean. And like other toddlers her age, she’s quick to put everything in her mouth. 

An avid gardener, Durón has an orchard by her trailer — a mandarin, fig, and an apple tree with a single green apple waiting to be picked. Cacti abound. A small pink swing sways gently off a tree branch. A water hose snakes along the ground. When she was little, Durón remembers drinking from a hose all the time, and that the water tasted great.

Today, people often avoid drinking tap water in Nogales.  

Ambos Nogales — or “both Nogales” — are twin cities bifurcated by the fourteen-foot-high, two-mile-long steel wall of the U.S.-Mexico border.

On the Arizona side, Nogales is a slow-paced town of about 20,000 — this number easily doubles on a daily basis, with visitors entering from Mexico. On the other side of the border, Nogales, Sonora is a bustling town of 264,000 and over 100 maquiladoras — foreign-owned, export-oriented factories and plants that have been the backbone of its economy since the 1960s, and the silent killer of the residents of both towns. 

Undeterred by the international border, toxic waste from the maquiladoras, fumes from burning garbage and resin, and raw sewage, laced with heavy metals, flow through la frontera by water, air, and on truck tires northward, from the higher elevation Nogales, Sonora down to Nogales, Arizona.

Water safety is an ongoing environmental justice issue in Ambos Nogales. 

The nearly dried-up Nogales Wash — a major drainage channel and tributary of the Santa Cruz River that runs through the twin towns has become a dumpsite for all kinds of toxic waste, garbage, and raw sewage from Nogales, Sonora. Some waste goes uncaptured by the International Outfall Interceptor, the cross-border pipeline that daily carries about 14.74 million gallons of wastewater from Mexico to the Nogales International Wastewater Treatment Plant in Rio Rico, AZ. 

The aging pipes of the Interceptor and the Nogales Wash leak cadmium, lead, copper, and zinc, as well as chlorine and bacteria into the surface water and aquifers — threatening drinking water in the region. During monsoons, the Wash swells with rainwater. Together with the arroyos — streams of stormwater that quickly turn into deadly flash floods — when it rains, the streets of Nogales turn into violent rivers of muck.

In January 2026, the U.S. House of Representatives appropriated $12.5 million for “urgent operations and maintenance needs of the International Outfall Interceptor in Nogales, Arizona.” The funding cleared the Senate, and President Trump signed it into law on February 3, 2026. Maintenance hasn’t started. 

As with Karina, it is impossible to say definitively whether pollution in Nogales might have played a role in Durón’s case. When she was pregnant, her care team didn’t counsel her about the environmental risks, against guidance from the American College of Obstetricians and Gynecologists.

The leading professional organization for obstetricians and gynecologists recommends doctors act proactively to advise pregnant patients of the health hazards environmental pollutants can cause. 

In 2013, the American College of Obstetricians and Gynecologists (ACOG) advised obstetric care clinicians to learn about the health hazards of environmental pollutants, and to include questions about environmental exposure in pre-pregnancy visits and prenatal care. In 2021, ACOG released an update to this advisory reaffirming this. 

“Obstetrics care clinicians do not need to be experts in environmental health science to provide useful information to patients and refer patients to appropriate specialists, if needed, when a hazardous exposure is identified,” the association said. 

In an effort to address the state-wide maternal health crisis, every five years, the Arizona Department of Health Services releases a series of reports to investigate and alleviate major threats to maternal and child life and health. 

Despite evidence of the effects of exposure to pollutants on maternal health, environmental risks are not considered during the preparation of the reports. 

Even though Arizona mothers on the border, like Durón and Karina, weather multiple types of environmental pollution, all of the women The Margin met in Arizona said they were not counseled about pesticide toxins and the documented risks they posed to their health during prenatal visits.

Dr. Sona Jasani, an American College of Obstetricians and Gynecologists fellow who practices medicine at Northwell Norwalk Hospital in Connecticut, is not surprised. The 2013 guidance and 2021 update recommend collecting more robust data to reach the golden standard of care. And, of course, it isn’t a directive. On-the-ground implementation is not mandated.

“Even if you read this guidance, it can be really challenging to say, ‘How do I implement that exactly in my practice? What are the resources that I go to in order to know what the exposures are for my patient population in the region that I'm at?’” Dr. Jasani said, sharing her personal opinion about possible challenges with implementing the guidance. “It can be really hard as a provider to say, ‘Well, what should I be concerned about for my patients? What should I actually counsel them on?’”

After Sahuari was born, Durón’s doctor told her that her placenta did not implant properly at the beginning, and it kept slowly detaching throughout her pregnancy. Emerging research shows that environmental factors, particularly air pollution, may cause the placenta to detach.

But ultimately, Dr. Jasani said, “There are no answers to why these women had these experiences. We cannot definitively answer the question of why this happened.”

Looking back at the first days of their daughter’s life, Durón wonders how she managed to get through those hard times, and hopes Sahuari’s path will be easier. 

“I just want her to grow up in a world where she's fine, where she's healthy, where she's loved,” Durón said. “My dream is to make her life joyful."

***

Stephanie Casanova contributed to reporting. This story has been supported by the National Press Club Journalism Institute Public Health Reporting Fellowship, funded by the Common Health Coalition.

Your donation supports in-depth reporting, data analysis, data visualizations, and original photography. Join us in the fight for environmental justice by contributing today — every dollar helps us tell the stories of the people and communities who have been and are currently experiencing injustice.