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.

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

2. 2

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

7. Irregular migrants in Canada
• Lack of data
• Canada: 100 000 to 500 000 persons

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

13. 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

14. Médecins du Monde 2015-2016

15. Médecins du Monde 2015-2016

17. Huard, 2016

18. Huard, 2016

19. Huard, 2016

22. https://www.facebook.com/Sant%C3%A9-des-Migrants-
1758295444410771/

23. Preliminary results (February 2017)

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

28. 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

29. Income
0
10
20
30
40
50
60
income no income studying other no answer
% Femme
% Homme

30. 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

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

33. Pregnancy (preliminary results)
• Place of delivery: 93% gave birth in a hospital
• Fees
• Mean 8 000$
• Range: 1 100 to 41 500$

34. 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

35. 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

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

38. Thank you
Questions?
Comments?
Suggestions?

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/

40. • https://www.youtube.com/watch?v=Zc0gdY022_M&t=82s