Current events often confront us with the fragility of minorities, especially that of irregular migrants. Vulnerability is even more acute in the case of migrant women, especially those who are pregnant. Their only protection is human rights: they are inalienable, inseparable, independent and above all universal. Article 25 of the United Nations Universal Declaration of Human Rights states that "Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services (...)" and "Motherhood and childhood are entitled to special care and assistance. Unfortunately, we are nowadays witnessing the violation of the fundamental rights of pregnant migrant women who land on European shores.
Maternal and Reproductive Care
The number of women trying to emigrate to Western countries is increasing. Most of them are very young and at the peak of their fertility, as shown by the study carried out by the United Nations Development Programme (UNDP) on a sample of immigrant groups:
The average age of the respondents when they arrived in Europe was 24 years, with no major difference between men and women. Of those interviewed, 58% were between 20 and 29 years of age, and 94% were under 35 years of age. Overall, out of 77% of the respondents, 23% were women. In addition, 14% were under 18 years of age at the time of departure.
As a result, if they engage in sexual intercourse during or after the arduous journey, they will be very likely to become pregnant, given the lack of protection tools and sexual education.
Very often this pregnancy hides a hard story of rape that took place before or during the journey, in the desert or in the detention camps in Libya. These young women may reach European shores in a state of pregnancy, with a newborn baby in their arms, or with post-abortion trauma, either physical or psychological.
In any case, it is very difficult for irregular migrants to access health care in host countries. Among them, the most vulnerable groups, such as women and children, do not benefit equally from health services in EU member states.
What factors prevent irregular pregnant migrant women from accessing health care?
Most European countries only allow irregular migrants to receive emergency care, which is not always free of charge. For example, in some European countries, an irregular pregnant migrant woman may have to pay thousands of euros to access health care during the entire pregnancy and during the birth of the baby. This will create fear among these future mothers, who will eventually carry their pregnancies to term without follow-up and who will give birth secretly and at home, risking irreparable complications, endangering their life and that of the child.
On the one hand, European health systems are struggling to balance public health and cost considerations. On the other hand, patients in an irregular situation are not aware of their rights. It is also true that authorities working with migrants, some civil society actors and some health care providers are not always aware of the rights of migrant patients.
The European Union Agency for Fundamental Rights (FRA) also believes that the risks of control and expulsion prevent illegal foreigners from seeking health care.
Studies show that childbirth is considered an emergency in almost all European countries. Therefore, health personnel do not have the right to refuse to carry out their work for the benefit of the migrant woman in childbirth. But as we have already pointed out, this service is not always free of charge.
This may vary from country to country. If we take the example of Sweden, birth costs are charged to irregular migrant women and generally hospitalization costs can be as high as 2.684 EUR. In the case of Ireland, the costs depend on the health care provider. These data show that irregular migrant women are required to pay a large amount out of their own financial means in order to receive this care.
However, if a patient is not creditworthy, the amount of the bill is declared non-recoverable and the health care provider can claim reimbursement from the state. In some countries where migrants are billed for care, there are systems to amortize expenses in case of non-payment.
The table below provides an approximation of the health care course in ten EU member states for prenatal care, based on a global classification.
Note: Not included in the table are emergency treatment and regional or local policies emanating from national policies. Source: FRA
We can see that, out of a sample of ten countries, only four of them offer comprehensive pre- and post-natal care: Belgium, France, Spain and Italy.
In the other four countries (Hungary, Ireland, Poland and Sweden), irregular migrant women receive treatment during pregnancy only in emergencies. In Germany, however, there is a high risk of reporting to the authorities.
Access to medication also presents complications for irregular patients in some host countries. Patients may be forced to pay reduced prices for medicines in some countries, in others the same or higher prices than national citizens.
In other countries, if they are authorized, they may be entitled to free or discounted medication. However, antiviral drugs for tuberculosis or certain infectious diseases are free of charge.
These women are in dire need of specific health services. This is an emergency and that is why it is necessary to carry out an awareness campaign in reception centers, hospitals and among health personnel. Those involved should be aware of Article 24 of the International Convention on the Rights of the Child, which states that "appropriate prenatal and postnatal health care for mothers should be provided". We also have Article 12 of the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW), which calls on states to provide women, "during and after pregnancy, and during and after childbirth, with appropriate services and, when necessary, free of charge, as well as adequate nutrition during pregnancy and lactation".
Sources: European Union Agency for Fundamental Rights (2011). L’accès aux soins de santé des migrants en situation irrégulière dans 10 États membre de l'Union européenne, pages 3 et 26.