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Access to abortion of undocumented migrants seen by Médecins du Monde in the Humanitarian Hub. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
As of June 2017, the population of the Maximillian Park (an undocumented migrant camp in Brussels) is mainly Eritrean and Sudanese migrants who intend to continue their journey to the United Kingdom (Depraetere, 2017; Daher, 2018). In response to demanding needs, Médecins du Monde together with 8 organisations, created a one-stop service centre, The Humanitarian Hub, in January 2018 to offer a set of basic services to the migrants.
The Hub implemented a voluntary de-medicalized midwifery clinic. The medical team noted an under-representation of women, 40 out of 745 (5,4%), while the coordination team identified a number of complex unwanted pregnancies, many of which relating to violence. Accessing free abortion for undocumented women in Belgium requires the Urgent Medical Assistance certificate. This often takes several weeks, making it unrealistic to obtain in time for an abortion. Accordingly, the women or family planning centres cover the financial cost. The Hub’s midwifery clinic thus focused on building trust with the women, and facilitated referrals to family planning centres.
By taking steps to create a more gender-sensitive Hub, the proportion of women seeking consultations doubled. In 2018, 955 out of 8990 (10,6%) patients were women, totalling 324 midwifery consultations. 65 of these women were pregnant, and the 23 who sought abortion were referred to family planning centres. None had Urgent Medical Assistance.
It is crucial to consider the particularities of a population and their social determinants of health when implementing a holistic system. For instance, focusing on violent experiences in medical consultations can help better understand women’s situation. The coordination between The Hub and family planning centres helped in reducing barriers for migrant women. The project has seen success, thanks to the flexibility of the family planning centres in quickly receiving these pregnant women, and to the four centres who covered abortion costs.
Key messages
It is evident that the magnitude of these women’s situation is undervalued, thus it is important to increase sensitization and advocacy in order to offer them greater support. The Hub has provided a number of services for undocumented migrants, notably abortion, and removed some barriers in accessing care. However, it is a fragile solution to a structural problem.
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Contraceptive use among undocumented migrant women seen by Médecins du Monde in the Humanitarian Hub. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
In order to address the growing needs of the undocumented migrant population living in the Maximilian Park in Brussels, Médecins du Monde and 8 other organisations created The Humanitarian Hub in January 2018 where migrants can access medical care among other services. From January to February 2018, only 5 women out of 1483 patients visited The Humanitarian Hub regarding sexual & reproductive health and none asked about contraception. In response, a voluntary demedicalized midwifery clinic was implemented to build trust with the women and offer them contraception.
At our field teams’ request, operational research was conducted. We used a mixed methodology, including retrospective quantitative analysis of patient files and field observations made during participant observation sessions. These observations helped us better understand the barriers women face in accessing contraception and how migration complicates its usage.
By implementing gender-sensitive consultations, the number of women patients rose from 5,4% to 10,6% in 2018. Between March 2018 and March 2019, 144 women consulted midwives regarding their sexual & reproductive health. Quantitative analysis on pre-exposure contraception on 52 files showed that 4 used a contraception, 25 women requested one, 4 refused it, 19 discussed it with the midwife, and among them, 8 agreed to try it. The most common reasons for the 80 consultations analysed were requesting contraception (62,5%), including morning-after pills (12,5%) and fear of pregnancy (32,5%). The most common contraceptive method was the pill (63,6%) followed by injections (30,3%).
Our medical team saw 29 women with unwanted pregnancies, which confirms the importance of focusing on contraception options for migrant women, although addressing this may be difficult in medical consultations. It also supports the need to implement demedicalized midwifery consultations to facilitate sensitive discussions with migrant women.
Key messages
Our research shows that contraceptive use is a particularly sensitive challenge in the irregular migrant women population due to the particularities of their lives. The development of demedicalized midwifery consultations helps professionals give irregular migrant women feasible advice on contraception in regard to their unique situations.
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