Even abused, immigrant women are not entitled to medical coverage

“Is there anyone who can help me?” » Eva is almost seven months pregnant, but she has not yet had any medical follow-up. A victim of domestic violence, she has no status and, therefore, no health coverage. By connecting to a nearby unsecured network, this woman launches a call for help on an Internet site. She has no phone and not a penny, and her pregnancy is one of “the worst times” she has experienced.

Like her, more and more women without status who are victims of domestic violence are attending a clinic for migrants in Montreal. “At least once a week”, domestic violence is one of the reasons for consultation, indicates Sophie Savoie, clinical nurse at the humanitarian organization Médecins du monde.

The duty has documented in recent months the increase in the number of women with precarious status in shelters, whether they are on a temporary visa or without status altogether.

The absence of health care is one of the most severe consequences of precarious immigration. While they “need even more” medical services, says Mme Savoie, “they are really left to their own devices”. The violence has direct effects on their health, and they sometimes completely deprive themselves of consultation. “I had been hit in the head so many times that it felt like my head was swollen. Not having a health insurance card, I did not go to the hospital,” says Caroline.

This woman from the West Indies, who like Eva requested anonymity for security reasons, arrived in Quebec with a work permit linked to her husband, a foreign student. The duration of his license was too short to provide him with RAMQ coverage.

Pregnancy against a background of domestic violence is a frequent reason for consultation, as was the case for Eva. Shelters also contact Sophie Savoie directly for this purpose. “They turn to us because it’s quite difficult to find pregnancy support when you don’t have medical coverage. It’s really very, very, very expensive. Each examination, each consultation, each step of follow-up is chargeable. »

Getting pregnant sometimes even results directly from the violence suffered. “Sometimes, you don’t always have the choice to have sex,” explains the nurse. And the spouse controls access to contraceptive methods.

Another woman who told us her story spoke at length about this hospital debt of more than $12,000 — in her name — incurred due to giving birth without medical coverage. She tried to have part of the debt attributed to the child’s Quebec father, but without success.

“We see women with hospital debts very often,” confirms Maria Gabriela Diaz, social worker at Médecins du monde.

A vicious circle

Domestic violence is often at the very source of this precariousness in immigration, which in turn creates a hole in health services.

Several women in fact lose their status because they denounced their violent spouse. Three immigrant women told us that their husbands withdrew their sponsorship application as soon as they filed a complaint with the police.

Other spouses, like Eva’s, lie about the real steps taken. Arriving from Mexico to work here, she remained trapped in a cycle of violence for several years. Pregnant, she received blows, some to the stomach, and experienced financial and sexual violence.

One day when her nose bleeds after receiving a blow from her partner, she gathers her courage and tells him that she is going to leave him.

This is where she discovers the pot of roses. “He told me: ‘You don’t even have papers here, you’re illegal.’ I was like: no, I’m not illegal, we did the sponsorship. He told me: “No, there is no demand. If you want to see the request, it’s in the drawer.” »

After this event will follow his appeal for help on the Internet. Doctors of the World will contact her. It is thanks to this organization that she will undergo several routine tests, have blood tests done and receive vaccinations.

But before even starting medical follow-up, she must convince her partner to let her follow him. “I told him that it was an organization that I had found and that it was going to give us what we needed for the child, such as a cradle, clothes and also money. And that’s why he agreed to call, in fact. »

A situation which does not surprise Maria Gabriela Diaz, even if she deplores it. Withdrawal of sponsorship or false promises in this regard are “a way for them to maintain control”, to exercise a certain “power” over the woman. She is financially dependent on her partner, who does not always agree to pay even small amounts for tests. “It’s his health that is penalized,” says Sophie Savoie.

Entrance door, exit door

Women are often hesitant to seek medical help, even though, in the secrecy of the social worker’s or nurse’s office, the conversation also often becomes an anchor.

They do not necessarily immediately mention what they are experiencing, or do not yet recognize it themselves. The first time Eva went to a consultation, the counselor put forward the idea that she was perhaps experiencing domestic violence. “I was like no, I was denying it. I said, “I don’t.” »

“There are a lot of women who are just afraid to leave the house, so they don’t do it. And then, they come here to consult on a medical level, not necessarily to talk about their situation at home,” explains M.me Diaz. It is rather during the conversation that some will mention elements of violence, for example the fact that they do not have access to the family’s money, that their husband gets angry and even that he raise your hand on them.

He told me: “You don’t even have papers here, you’re illegal.” I was like: no, I’m not illegal, we did the sponsorship. He told me: “No, there is no demand. If you want to see the request, it’s in the drawer.”

Both the worker and the nurse ask the question directly if their suspicions are strong enough. They talk about the cycle of domestic violence while offering information, even if in general these women “are not ready to leave” their partner during this first approach. The important thing is to “maintain the bond of trust,” says the speaker, because if they do not carry out their exit plan or if they return to their violent partner, women “often feel ashamed.”

As for the scale of the phenomenon, Médecins du monde estimates that 50,000 women in Quebec live without health insurance. With the increase in the number of people without status, the needs are an “infinite chasm”, the clinic must sometimes prioritize “the person who has greater difficulties”, taking into account in particular the criterion of domestic violence, continues Mme Savoy.

Children without status should have access to health care in Quebec since 2021, but not their parents. The Minister of Health, Christian Dubé, commissioned a report in June 2021 with the aim of having a portrait of pregnant women without RAMQ coverage as well as solutions to help them. More than two years later, the Ministry of Health confirms to us that there has not yet been a decision on “the best approach” to take. “It is not possible to advance further at this stage. »

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