This presentation was designed by Marie Munoz for the sixth annual conference of McGill’s Comparative Health Systems Program. The conference held on March 11th, 2017 was based on the theme of Women's Health.
Research on uninsured migrants: a focus on women's health
1. Research on uninsured migrants:
a focus on women’s health
Dr Marie Munoz-Bertrand MD MSc
CIUSSS Centre-Sud de Montréal
Médecins du Monde
Université de Montréal
3. Retrospective chart review of prenatal care and
perinatal outcomes
Design:
• Retrospective cohort study
• 71 uninsured women/72 control subjects
Key findings:
• Difficult to identify uninsured migrants from charts
• Uninsured women
• presented later for care
• had fewer visits with heath care providers
• had fewer prenatal tests
• We were not able to document perinatal adverse outcomes
Jarvis, 2011
4. Scoping review on undocumented pregnant
women
• 23 articles met inclusion criteria (10 US, 2 Canada, 11 Europe)
• 71-5961 women enrolled
• Undocumented migrants
• Younger, unmarried, working in the domestic sector
• Less access to prenatal care
• Inadequate prenatal care
• Adverse outcomes in 3/6 studies (Low birth weight, prematurity, Pre
eclampsia, bleeding,..)
• Other findings: unintentional pregnancies, low contraception use,
exposure to intimate partner violence
Munro, 2012
8. Montreal
• 20 000 to 50 000 precarious status migrants
• Most of migrants with precarious status are not
irregular
• No public services designed for this population
• Negative impact on access to health care and health
reported, sub standard care by health providers
Brabant 2012, Ter Kuile 2007, Rousseau 2008
9. Uninsured migrants
• Migrants in irregular situation
but also
• Regular migration
• 3 months waiting period
• Student visa
• Persons between two status
• Dependents of migrant with working or study visa
10. Médecins du Monde
• had experience offering health care to excluded
populations
• had become sensitized to the situation of
uninsured migrants
ØAttempt to find a public structure interested in
this population
ØEvaluation process led to the implementation
of a project for migrants
11. Migrant project - Objectives
• Provide care
• Allow access to health care for uninsured migrants
• Help clarify and regularize status if possible
• Work towards a solution
• Document situation of uninsured migrants in Montreal
• Advocate to find solutions to health care access issues
26. Status according to gender
Femmes Hommes
Réfugié accepté 0,3 0,0
Demandeur du statut de réfugié ou demandeur d’asile refusé
(avant date de renvoi)
9,2 11,4
Travailleur étranger temporaire ou dépendants 3,8 3,4
Étudiant ou dépendants 7,3 5,1
Visiteur (long-terme, Super Visa, PVT, etc.) 25,5 17,0
Autre permis de résidence temporaire (ex: en attente de
parrainage)
14,0 10,2
Aucun (application en cours) 18,2 16,5
Aucun (aucune application en cours) 15,6 27,3
Résident permanent 2,9 3,4
Citoyen canadien 0,6 1,7
Ne sait pas 1,3 1,7
Ne souhaite pas répondre 1,3 2,3
33,8 43,8
31. Pregnancy (preliminary results)
• 67% women in childbearing age
• 42% had at least one pregnancy while uninsured
• Mean age at pregnancy: 29
75%
18%
7%
Number of pregnancies while unisured
1 2 3
32. Pregnancy follow up
22%
35%
22%
12%
0 0.05 0.1 0.15 0.2 0.25 0.3 0.35 0.4
1 VISIT
2-5 VISITS
6-9 VISITS
>10 VISITS
number of prenatal visits
73, 71%
30, 29%
Pregnancy follow up
pregnancy follow-up no pregnancy follow up
0
5
10
15
20
25
1 2 3 4 5 6 7 8 9
Timing of initiation of pregnancy follow up
36. Immunization study
Objectives:
• Describe the demographic profile of uninsured women and children
in Quebec
• Promote immunization in this population
• Influence public policy
Design:
• Action research
• Population: women in child-bearing age (15-49yo) and children 0-17
in Quebec for less than 5 years
37. Acknowledgements
• Marie-Jo Ouimet
• Catherine Jarvis
• Vinita d’Souza
• Lisa Graves
• Zoé Brabant
• Véronique Houle
• Nadja Pollaert
• Chloé Cembron
• Katharina Bourgin
• Pénélope Boudreault
• Maude Blanchette-Lamothe
• Laurence Ethier
• Sarah Simmons
• Louis-Thomas Moisan
• Sophie Giguère
• Sarika Beauchamp
• Marianne Leaune-Welt
• Valéry Ridde
• Magalie Benoit
• Amandine Fillol
• Jessika Huard
• Joséphine Aho
• Patrick Cloos
• Jill Hanley
• Marie-France Raynault
• Ke Zhou
• Solène Lagrange
• Veronica Torres
• Ekta Kumar
• all surveyors and participants of the study
39. References
• Caulford, P. et Vali, Y. Providing health care to medically uninsured immigrants and refugees. Canadian
Medical Association Journal. 2006 Apr 25; 174(9): 1253-1254.
• Rousseau C, Ter Kuile S, Munoz M, Nadeau L, Ouimet, MJ , Kirmayer L, Crépeau F. Health care access for
refugee and immigrant with precarious status: public health and human right challenges. Canadian Journal
of Public Heath. Vol 99, no 4, july/august 2008
• Munro K, Jarvis C, Munoz M, D’Souza V, Graves L. Undocumented Pregnant Women: What Does the
Litterature Tell Us? J Immigrant Minority Health. J Immigr Minor Health. 2012 Mar 1
• Jarvis, C, Munoz, M, Graves, L, D’Souza, V, Jimenez, V. A Retrospective Review of Prenatal Care and Perinatal
Outcomes in a Group of Uninsured Pregnant Women. JOGC. March 2011.
• Brabant, Z. et Raynault, M.-F. Health situation of migrants with precarious status: results of an exploratory
study in Montreal – Part B. Social Work in Public Health. 2012, 27: 469-481.
• Brabant, Z. et Raynault, M.-F. Health situation of migrants with precarious status: review of the literature and
implications for the Canadian context – Part A. Social Work in Public Health. 2012, 27: 330-344.
• http://www.equitesante.org/projet-migrants/