In June 2021, the Minister of Health, Christian Dubé, changed the lives of many children in Quebec who were deprived of health care due to the immigration status of their parents. These children had access to education, but not to medical aid, which was both illogical and iniquitous. Thanks to Bill 83, these children are now covered by the Régie de l’assurance maladie du Québec (RAMQ), regardless of the immigration status of their parents.
However, the Minister was reluctant to include the health of pregnant women in this new law in favor of the rights and protection of children, for fear of encouraging obstetric tourism. Médecins du monde heard the concerns of Minister Christian Dubé on this issue following the publication of Suzanne Colpron’s file “Migrants with precarious status, going into debt to give birth”1on February 16.
The health of children is closely linked to the health of the mother.
Malnutrition during pregnancy may be associated with the onset of future chronic diseases as well as cognitive developmental delays in the child.
The lack of follow-up throughout pregnancy makes it impossible to identify the risks and to put in place the necessary measures to avoid unfortunate consequences for the development of the fetus, the increased risk of premature births, babies with low weight or birth defects. Science is clear on this point.
Today, we are able to demonstrate that the social and financial risks associated with obstetric tourism have been greatly exaggerated.
Hospitals in Quebec do not record data on the immigration status of women who give birth there. It is therefore impossible to distinguish between women without medical insurance who live in Quebec and those who are simply passing through the territory. In addition, the obligation to be present in Quebec for 183 days a year to have access to the RAMQ greatly mitigates this risk.
For these women without medical insurance, some will be tempted to suggest the use of private medical insurance. It turns out that almost a third of pregnant women who call the Doctors of the World clinic during the year for pregnancy monitoring have private insurance which does not, however, cover the costs related to the pregnancy, or which imposes limits claims for certain treatments.
Exactly, let’s talk about costs!
Several European and American studies have shown that the lack of access to health care during pregnancy can cost the State up to more than 200% more than providing public health insurance.
Neither doctors nor nurses are immigration agents: their role is to provide care. Among the women who come to the health services to give birth, many have not received any pregnancy monitoring and do not have a medical file, which can have significant consequences for the birth and their unborn baby. Health professionals must navigate blind and witness, in spite of themselves, the impact of the flaws in the system on their patients and their children. While the nursing staff is at the end of its rope, the management of these complex situations creates significant and unnecessary stress for the teams of the health system.
On the Ministry’s website, a note appears under the definition of obstetric tourism. It is stated that “this practice, which is not possible in all countries, often also makes it possible to benefit from free childbirth and postnatal care”. However, nothing is free. Women pay, negotiate, have sleep problems due to this stress and sometimes go so far as to deprive themselves of food to reimburse the costs associated with childbirth. Minister Dubé was the Minister of Children’s Health, but will he also be the Minister of Women’s Health?