United States Immigration and Customs Enforcement has typically released pregnant women from custody under a policy implemented by former President Barack Obama, but the Trump administration has effectively put that to an end, The Hill first reported Thursday. ICE will now keep most pregnant women in detention, including those seeking asylum.

ICE publicly announced the new directive on Thursday. “ICE has ended the presumption of release for all pregnant detainees,” the agency wrote on its website, explaining the changes. “Instead, as with all detainees, absent the requirements of mandatory detention, ICE will complete a case-by-case custody determination taking any special factors into account. ICE detention facilities will continue to provide onsite prenatal care and education, as well as remote access to specialists for pregnant women who remain in custody. In addition, ICE ensures access to comprehensive counseling and assistance, postpartum follow up, and in certain cases, abortion services.” The old policy stated that pregnant women were generally not detained, unless it was mandatory by law or warranted under “extraordinary circumstances.”

ICE said the change was made to “better align” with an executive order issued by Trump in January last year, which broadly enabled immigration enforcement agencies to more strictly follow immigration laws. Philip Miller, a deputy executive associate director for ICE, told Reuters that 506 pregnant women have been detained by ICE since the new directive was first implemented back in December. “Just like there are men who commit heinous acts violent acts [sic], so too have we had women in custody that commit heinous acts,” Miller told reporters on Thursday, according to Reuters. Miller also said that there were 35 pregnant women in ICE custody on March 20, the most recent date for which the agency had data. “To miscategorize this as some wholesale change or some kind of draconian act is really just hyperbole,” Miller said, according to the Huffington Post. “We’re aligning this policy, as we have with all of our policies, with the direction from the president.”

ICE’s detention facilities are notorious for offering poor health services to detainees. The facilities are often kept so cold that aluminum coated blankets are given to detainees and immigrants have begun calling the facilities hielera, which means cooler in Spanish. Twelve detainees died in ICE custody in 2017, the deadliest year since 2009. One hundred seventy-nine people have died in ICE detention since 2003. Report after report from immigrants’ rights watchdog groups have been critical of ICE’s ability to provide health care to detainees. Last year, the Department of Homeland Security’s Office of the Inspector General conducted surprise investigations of five detention facilities across the country, and found “significant issues” in four of those facilities, including poorly documented medical record keeping, dirty or insufficient hygienic supplies, and long waits to receive medical care for detainees suffering from painful conditions, like infected teeth and an injured knee. A recent report on the West Texas Detention Facility in Sierra Blanca found that officers at the privately operated facility denied health care to detainees suffering from serious medical conditions, including those who required surgery or had sustained serious injuries, like gunshot wounds and broken bones, prior to their detention. Detainees also said officers punished them with solitary confinement after they asked for medical attention.

Pregnant women have not fared much better with ICE lately. Obama’s administration ordered in an August 2016 memo that, “absent extraordinary circumstances or the requirement of mandatory detention,” pregnant women would generally be released from ICE custody. But even under that policy, pregnant women were still sometimes held in detention for weeks or months, a trend that immigrant advocates have said increased after Trump was elected. “Suddenly, starting in July or August, we started to hear of more and more cases [of pregnant women in detention],” Katharina Obser of the Women’s Refugee Commission, a national organization, told the Texas Observer last October.

Over the last year or so, several horror stories from pregnant women held in detention have surfaced. A Salvadoran rape survivor said she was held at Houston’s Joe Corley Detention Center for six months after she found out she was pregnant and requested her release. She was one of ten women whose experiences were documented in a complaint filed by the American Civil Liberties Union with the Department of Homeland Security’s Office of Civil Rights and Office of the Inspector General in September last year, describing poor medical treatment for women who were detained while pregnant or had recently suffered miscarriages.

The Huffington Post reported last year that two women had suffered miscarriages while in immigration detention facilities. One of the women, Jennye Pagoada Lopez of Honduras, said she was four months into a high-risk pregnancy when she was detained in California. She repeatedly notified detention officers that she was bleeding and in intense pain, but her requests were ignored, and she found out later from doctors at the detention center that she had lost the baby. “I was eagerly awaiting the birth of my baby, and I didn’t know why God had done that to me,” Pagoda told Vice News. “I wanted to die.”