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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
2
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
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
Irregular migrants	in	Canada
• Lack of	data
• Canada:	100	000	to	500	000	persons
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
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
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
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
184
1409
670
2729
3290
184
665
865
795
0
500
1000
1500
2000
2500
3000
3500
2011-2012 2012-2013 2013-2014 2014-2015 2015-2016
Uninsured	migrants	having	received	services	at	MDM
Total Persons	seen	at	the	clinic
Médecins du	Monde	2015-2016
Médecins du	Monde	2015-2016
Huard,	2016
Huard,	2016
Huard,	2016
https://www.facebook.com/Sant%C3%A9-des-Migrants-
1758295444410771/
Preliminary results (February 2017)
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
Marital	status
49.5
7.7 6.7 7.3
5.1
23.6
42.9
6.2
2.3
4.5
6.2
37.9
0
10
20
30
40
50
60
Marié(e) Union	libre/conjoint	de	fait Veuf/	veuve Séparé(e) Divorcé(e) Célibataire
%	Femme %	Homme
Income
0
10
20
30
40
50
60
income no	income studying other no	answer
%	Femme
%	Homme
0
10
20
30
40
50
60
70
80
90
Pas	assez	d’argent	pour	payer	les	
frais
Craignait	une	facture	trop	élevée Ne	savait	pas	où	aller Problème	de	langue Peur	déportation/	impact	sur	
statut
refus	de	l'hôpital/clinique
%
Raison
Raison	pour	laquelle	les	soins	n'ont	pas	été	obtenus
%	Femme
%	Homme
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
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
Pregnancy (preliminary results)	
• Place	of	delivery:	93%	gave birth in	a	hospital
• Fees
• Mean	8	000$
• Range:	1	100	to	41	500$
Access	to	immunization:	a	survey at	
MDM
• Convenience sample of	88	facilities
• 31	CLSC
• 55	clinics
• 2	private clinics
• Questionnaire administered
• to	intake clerk or nurse
• by 11	volunteers
Type	of	
facility
n Vaccination	provision
Maximal fees	
Insured	
children
Uninsured	
children
Clinics that	
charge	fees Per	vaccine Per	visit
CLSC 31 26 18 5 205$ 35$
GMF 29 9 4 3 10$ 200$
walk	in	clinics 26 8 3 20$ 140$
private	clinics 2 1 1 100-200$		 80$
the	total	cost	of	complete	immunisation	of	a	child	from	2	months	to	4	years	
old	can	range	from	$130	to	$2	676.18
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
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
Thank you
Questions?
Comments?
Suggestions?
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/
• https://www.youtube.com/watch?v=Zc0gdY022_M&t=82s

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Research on uninsured migrants: a focus on women's health