Giving birth with anxiety in your stomach and a checkbook in your hand: this is the reality experienced by the hundreds of women who give birth each year in Quebec without health insurance coverage. A digital book recently launched with open access on the Web highlights their journey on the sidelines of the Régie de l’assurance santé du Québec (RAMQ), where birth always rhymes with debt.
These are mothers-to-be whose situation, already precarious, is worsened due to a migration status making them ineligible for health insurance. They are students, workers, sometimes undocumented, and as soon as they cross the threshold of a clinic or hospital, the counter starts.
Care journey of immigrant women without access to the Quebec health insurance planpublished by the FEMSAM Collective in collaboration with the Accès savoirs research team at Laval University, reports the testimonies of some of these women for whom pregnancy, already anxiety-provoking, becomes a financial burden.
There is, for example, Fatim, who, between two contractions, saw the anesthesiologist ask him to pay $1,000 to receive the epidural.
There’s also Nelly, originally from Cameroon, struggling with a complicated pregnancy and a premature baby, who emerged from her cesarean delivery with a child in her arms — and a bill for nearly $100,000 in her pocket.
“For the 30 days I spent in the hospital, the CHUL billed $3,300 per day, times 30 days,” she says in the book. That came to about $101,700 and something. » A debt that seems insurmountable to pay off for her husband, a refugee and student, and her, a minimum wage worker.
“She told us her story in person,” explains Marie-Pier Landry, general coordinator of the SPOT community clinic in Quebec. She held her stomach as she cried and begged her child to come out as quickly as possible because every day the bill grew. A mother should never have to say that to her unborn child — it’s inconceivable in Quebec. »
However, between 2015 and 2022, nearly 10,000 women gave birth in the same circumstances as Nelly in Quebec. Last year alone, in the capital, more than 200 women gave birth at their own expense. The total bill rises quickly in these cases since the State increases the price of health care by 200% for those who benefit from it without affiliation to health insurance.
“Their precariousness also continues after childbirth,” adds Cathie Bordeleau, perinatal care worker and peer support at the SPOT clinic. If the mother experiences problems with breastfeeding, if her child has health problems or if she herself has difficulty recovering from childbirth, she remains in a truly precarious situation, in debt and without medical coverage. »
Despite her scar becoming more and more painful after giving birth, Nelly implored heaven to heal her to avoid an increase in her financial burden. Especially since upon returning home, the bills continued to pile up in the new family’s mailbox: costs of ultrasounds, consultations given by specialist doctors, laboratory analyzes, etc.
In this context, a prayer remained free, unlike another hospital stay.
“My wound was horrible, it was terribly hot, but I didn’t dare go to the hospital because I knew that just for emergencies, it’s $700,” she says in her testimony. So I put up with it, hoping it would end. »
“These women don’t really have a choice,” adds Marie-Pier Landry. All the options available to them lead them to precariousness, whether it is poor health or socio-economic precariousness. »
A tiny minority of pregnant women not registered with RAMQ can count on the SPOT community clinic in Quebec or on care from Médecins du monde and Maisons bleues in Montreal. SPOT opens its doors one day a week to provide free perinatal care that the public system charges them at great expense.
“It cannot be a solution,” explains Marie-Pier Landry. “We would need two SPOT clinics dedicated full time to perinatal care to meet the demand,” adds Cathie Bordeleau.
“It’s a collective and societal problem,” explain the two. The needs increase from year to year: last year, CHU statistics told us that 2.5% of births concerned mothers without RAMQ. This year, we are already at 3%. What will it be like in a year? »
The SPOT clinic believes that the only possible solution is to cover the care of all pregnant women, regardless of their status. “It would cost what it would cost to bring the Kings from Los Angeles three times,” says Marie-Pier Landry with irony.
Work “in finalization”
An interministerial committee, mandated by the Ministry of Health to look into the issue of these pregnant women without access to the public system, published a report in June 2022. It detailed four possible solutions: maintaining the status quo, eliminating the overload of 200% for obstetrics services, expand pregnant women’s access to care surrounding their pregnancy, and offer free services so that all future mothers, regardless of their immigration status, benefit from Quebec health care.
The cost of the most generous measure: between $16.4 and $20.6 million per year. “ We We are sensitive to the situation of migrant women, writes the office of Quebec Minister of Health, Christian Dubé. But we must be attentive to the effects of the expansion of the bill for pregnant women, particularly with regard to obstetric tourism. »
The firm adds that various work took place following the publication of the report, almost two years ago, “in particular in order to examine the eligibility criteria and other modalities that would be associated with such a program. This work, indicates the firm’s response, is currently being finalized.
In the meantime, at the bedside of these pregnant women for whom the joy of starting or expanding a family mixes with the apprehension of emerging from debt, impatience is felt.
“It’s as if everyone is putting their head in the sand,” laments Evelyne Lavergne, one of the front-line specialist nurse practitioners who gives one day a week at the SPOT clinic.
“It’s absolutely disgusting,” she adds angrily: “these are people who want to integrate, but whom we condemn to significant debt as soon as they start a family on Quebec soil. It creates resentment, too: these mothers, who sometimes pay taxes at the same rate as everyone else, wonder why they are not entitled to the same services as all other mothers. »