Minister Christian Dubé, we are urgently calling on you to guarantee access to free health services for uninsured pregnant women living in Quebec.
In August 2023, following a broad mobilization of organizations, institutions and professionals in health, law and social services, a ministerial committee that you mandated, which included Médecins du monde and seven other parties stakeholders, has provided you with a program proposal for this purpose. The latter aims to provide free prenatal and postnatal care to women without health coverage, regardless of their migration status, in order to ensure safe pregnancies and births.
Despite our numerous reminders, we have not received any news on the progress of this crucial issue on which we have been actively working with your Ministry of Health and the Régie de l’assurance santé du Québec (RAMQ) since 2021.
Every year, hundreds of women living in different regions of Quebec, but excluded from RAMQ coverage due to their precarious immigration status, give birth without having had access to essential prenatal care, which endangers their health. and that of their child. This is, for example, the story of Maria (fictitious name), pregnant and originally from Latin America, living in Montreal thanks to a temporary work permit. Facing complications during her pregnancy, she was reluctant to go to the hospital for fear of exorbitant costs, risking her life and that of her child, leading to normally avoidable complications for both her and her baby .
In addition to being denied essential prenatal care, these women find themselves in heavy debt after giving birth. A delivery without complications can cost $15,000, while a delivery with complications can increase the bill to more than $150,000.
Supporting reports and testimonies
For several years, numerous reports, research and reports as well as a growing number of testimonies from health and social service professionals have revealed similar stories, highlighting the challenges and injustices that these women face. Examples are described in the report Precarious immigration status, precarious health of Médecins du monde, and in the study Care pathways of immigrant women without access to the Quebec health insurance plan, conducted in collaboration with the SPOT Clinic.
These women, already vulnerable due to their precarious migration status, find themselves in situations of great physical, financial and emotional distress, often without family or community support. Their children are born in precarious conditions, which increases the risks of birth complications and long-term health problems.
Each day that passes without a decision sees the situation of these women, who nevertheless contribute to the development of the province, deteriorate.
Avoidable burdens for our struggling health system
The lack of a concrete solution penalizes not only these women and their families, but also our public health system. When prenatal care is delayed or avoided, medical complications become more frequent and more serious, requiring more expensive, complex and time-consuming interventions. This increases the workload of healthcare personnel, who must bear the responsibility of meeting the vital needs of these women alone and without resources, and leads to sub-optimal public health policies.
The urgency to act for these women
Over the past three years, all the expert stakeholders on this issue, as well as the three opposition parties, have repeatedly expressed their support for a policy to guarantee access to essential sexual and reproductive health services. for migrant women with precarious status who live in Quebec.
Given the urgency and importance of this situation, as well as the broad consensus on this issue, we ask you, Mr. Minister, for a clear and favorable decision in favor of a program of free prenatal and postnatal care. for all uninsured pregnant women in Quebec. It is crucial to act to enable front-line workers to meet the needs of these women in line with the standards of their profession and to ensure their safety and that of their children.
* Have co-signed this letter:
(Professional orders and associations) Association of doctors specializing in maternal-fetal medicine of Quebec, Dr. Suzanne Demers, vice-president; Association of Obstetricians and Gynecologists of Quebec, Dr. Dominique Tremblay, president; Association of Preventive Medicine Specialists of Quebec, Dr. Marie-Laure Hemery, president; College of Physicians of Quebec, Dr. Mauril Gaudreault, president; Quebec Women’s Federation, Sara Arsenault, responsible for political files; Federation of women’s shelters, Manon Monastesse, interim general director; Quebec Federation for Birth Planning, Jess Legault, general coordinator; Quebec Interprofessional Health Federation, Françoise Ramel, vice-president; Quebec doctors for the public system, Dr. Isabelle Leblanc, president
(Institutions in the health and social services network) CHUM, Obstetrics and Gynecology Department, Dr. Carole Kamga-Ngande, head of department; Quebec University Hospital, Perinatal Department of Saint-François d’Assise Hospital, Dr. Véronique Pelchat, head of department; CHU Sainte-Justine, Mother-Child Infectiology Center, Dr. Isabelle Boucoiran, director; CHU Sainte-Justine, Adoption and International Health Clinic, Dr. Jean-François Chicoine; CHU Sainte-Justine, Department of Obstetrics and Gynecology, Dr. Lucie Morin, head of department; Pointe-Saint-Charles Community Clinic, Martial Mainguy, general director; Maizerets GMF University Clinic, Cécile Jeanmart, medical director; Public health department of the CIUSSS de l’Estrie-CHUS, Dr. Isabelle Samson, director of public health; Public health department of Gaspésie and Îles-de-la-Madeleine, Dr. Yv Bonnier Viger, director of public health; Marie-Paule-Lanthier birth center, Marie-Pier Mainville, responsible for midwifery services
(University institutes and faculties) Interdisciplinary Center for International Health Development of the University of Sherbrooke, Sarah Stecko, director of operations and partnerships; Claire-Bonenfant Chair — Women, knowledge and societies, Isabelle Auclair, holder; Faculty of Medicine and Health Sciences of the University of Sherbrooke, Dr. Dominique Dorion, dean; Faculty of Medicine of the University of Montreal, Dr. Patrick Cossette, dean; Intersectoral health research group at the University of Quebec, Cathy Vaillancourt, director
(Community organizations and non-governmental organizations) Allaitement Québec, Christine Marcotte, general director; ARO CoopérAction InterNational, Colette Lavergne, president and founder; Cooperative Home Economy Association of Northern Montreal, Émilie Laurin-Dansereau, budget advisor; Association for Public Health of Quebec, Anne-Marie Morel, director of perinatal projects; CALACS de Charlevoix, Sophie Fortier Mallette, coordinator; Crossroads for intercultural action, Laurie Arsenault-Paré, director; Crossroads for animation and participation in an open world, Yves Carrier, coordinator; Family crossroads for disabled people, Capitale-Nationale disabled women committee, Julie Montreuil, co-director; Bon Courage Community Center, Kadiétou Savadogo; Multi-ethnic community center of Montreal-North, Guillaume André, director; Center for social pediatrics of Montreal-North, Édith Sauvageau, general director; Saint-Laurent Social Pediatrics Center – At the heart of childhood, Christine Durocher, general director; Lowertown Women’s Center, Laura Santamaria, co-coordinator; Haute-Ville family center, Aurélie Mélot, director; Portneuf Women’s Center, Victoria Beaulieu; Beauport Women’s Resource Center, Marie Céline Domingue, president; Chantelait, Isabelle Poulin, director; Saint-Roch proximity clinic, Isabelle Hautbout, coordinator; SPOT Clinic, Marie-Pier Landry, general coordinator; Collective for Free Choice, Johanne Bilodeau, co-coordinator; Committee of Immigrant Women of Quebec, Lorena Suelves Ezquerro, president; SABSA solidarity cooperative, Amélie Bédard, general director; Entraide Sein-Pathique, Jan Kelly, director; Women, Politics and Democracy Group, Esther Lapointe, general director; Le Pont — APPI, Arthur Durieux, director; Les Perséides, Janie Tremblay, general director; Maison de la famille-MRC Bonaventure, Josée Barlow, coordinator; Maison du coeur for women, Kathy Mathieu, director; Maison Marie-Rollet, Cynthia Roussel, clinical coordinator; House for immigrant women, Samia Belkhir, coordination assistant; Mamie-Lait, Gaétane Cliche, general director; Nouri-Source Montréal, Sophie Morel, general director; LUNE Project, Gabrielle Vaudry, speaker responsible for feminist struggles; RÉCIF 02, Gisèle Dallaire, coordinator; Group of women’s groups of the Capitale-Nationale, Élise Landriault-Dupont, co-coordinator; Network of Regional Tables of Women’s Groups of Quebec (RTRGFQ), Audrey Gosselin Pellerin, feminist political organizer; Family resources The old Montmorency barracks (Re-Fa-Vie), Marie-Ève Bouchard, social perinatal worker; SOS Pregnancy, speaker and support for termination of pregnancy; Perinatal reference service for immigrant women in Quebec (SRPFIQ), Marielle M’Bangha, director; Laval consultation table on the status of women, Marie-Ève Surprenant, general coordinator; Consultation table of women’s groups from Gaspésie and Îles-de-la-Madeleine, Nastassia Williams, coordinator; Consultation table of Montérégie women’s groups (TCGFM), Linda Crevier, general director; Consultation table for organizations serving refugees and immigrants, Stephan Reichhold, director; Consultation table of the Mauricie women’s movement (TCMFM), Joanne Blais, director; Consultation table of the women’s movement of Centre-du-Québec, Maryse St-Arneault, deputy director; Table of Montreal women’s groups, Marie-Ève Desroches, responsible for consultation and community life; Violence Info, Nathalie Igonène, director; Viol-Secours, Julie Tremblay, general director; YWCA Quebec, Stéphanie Lampron, Lorinne Larouche, director of social programs
(Doctors and health professionals) Annick Larochelle, gynecologist-obstetrician; Béatrice Cormier, gynecologist-obstetrician; Caroline Lachance, gynecologist-obstetrician; Carolyne Gervais, gynecologist-obstetrician; Catherine Taillefer, gynecologist-obstetrician; Emilie Gorak Savard, gynecologist-obstetrician; Emily Brander, obstetrician-gynecologist; Emmanuelle Dennie-Filion, midwife; Éric Paradis, gynecologist-obstetrician; Esther Bélair-Kyle, obstetrician-gynecologist; France Durocher, gynecologist-obstetrician; Geneviève Bertrand, gynecologist-obstetrician; Gregory Courtoy, specialist in internal medicine; Isabelle Vachon, gynecologist-obstetrician; Joëlle Paquin-Marcotte, gynecologist-obstetrician; Karine Girard, gynecologist-obstetrician; Kateri Lévesque, obstetrician-gynecologist; Katherine Thériault, obstetrician-gynecologist; Liliane Brassard, gynecologist-obstetrician; Marianne Chevrette, gynecologist-obstetrician; Martine Bernard, gynecologist-obstetrician; Meggie Lallier Beaudoin, gynecologist-obstetrician; Mélissa LeBlanc, obstetrician-gynecologist; Nathalie Ouellet, gynecologist-obstetrician; Pascale Gaudet, gynecologist-obstetrician; Philippe Sauthier, gynecologist-obstetrician; Valérie Kingsbury, obstetrician-gynecologist; Vanessa Picard Fortin, gynecologist-obstetrician