Like a gazelle amongst lions

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Like a gazelle amongst lions
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Health and Maternity Care for female
undocumented immigrantsPICUM 28 6 - 2007

• Maria van den Muijsenbergh,
• Vusalja Husejnova, Marianne Schoevers, Toine
  Lagro-Janssen,
• Dept.General Practice / Womens studies
  Medicine Nijmegen, The Netherlands

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Outline presentation

• General information
• Health problems (Nijmegen study)
• General health
• Reproductive health
• Access to Maternity care
• Conclusions

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The Netherlands25.000 50.000 undocumented
women

• No medical insurance possible
• Right to all necessary medical care

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Legal systems in Europe

• 1. Health care provided always on a payment basis
• Austria, Sweden
• 2. Free health care provided only in very limited
  cases and the duty to denounce
• Germany
• 3. Free health care provided under the concept of
  urgent medical care
• Belgium
• 4. Free health care provided almost under the
  same conditions as for nationals
• Spain (Italy)

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Study design ILLEGAALEqual access to healthcare
for undocumented women

• Aims to get insight in
• health problems,
• problems with access to healthcare
• usefulness PHR
• Design 100 women
• Semi-structured in depth interviews
• Medical examination and PHR
• Information Dutch healthcare and GP
• Evaluation use PHR

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Preliminary Results 82 women

• age 19-69
• gt 5 years in Holland
• 34 pregnant while undocumented
• 11 interview maternity care

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Health problems 1 general

• I am in bad health 47
• I am in good health
• Undocumented women 44
• Undocumented asylum seekers 22
• Dutch public 81
• Dutch legal immigrants 61
• (Sexual) violence 46

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Health problems 2 reproductive health

• Problems contraception 58
• Abortion 50
• Not intended Pregnancies (N34) 50
• No prenatal controls 26
• Not aware right to care
• No knowledge healthcare system
• Fear for being caught
• No money
• Refusal hospitals
• Outcome of pregnancies???

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Maternity care Europe

• Belgium 45 no antenatal care
• Europe 19 X inadequate care
• Perinatal death 6 x gt
• Risk Ecclampsia / HELPPsyndrome

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Emotional problems Children

• 33 psychological problems (nightmare, headache)
• Emotional problems parents -gt
• Parenticifation
• Lack of attention
• Children try to avoid stress for parents

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ConclusionsUndocumented female migrants

• Many health problems
• Access to (maternity) care hampers
• Bad outcome of pregnancies
• Negative effect on well-being children
• lt psycho / socio / economic situation
• Fear / violence / poverty / lack of knowledge

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What to do? Establishing access to good quality
of care

• International research on access and outcome of
  pregnancies
• International political pressure
• Migrant organisations
• Womens rights
• Midwives / doctors
• Education migrants and healthcare workers
• Money / insurance

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