Matern Child Health J (2013) 17:292-298 DOI 10.1007/s10995-012-0973-3 Access to Health Care for Undocumented Migrant Children and Pregnant Women: The…
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Access to Health Care for Undocumented Migrant Children
and Pregnant Women: The Paradox Between Values
and Attitudes of Health Care Professionals
Mo
´nica Ruiz-Casares
•
Ce
´cile Rousseau
•
Audrey Laurin-Lamothe
•
Joanna Anneke Rummens
•
Phyllis Zelkowitz
•
Franc
¸ois Cre
´peau
•
Nicolas Steinmetz
Published online: 8 March 2012
Ó
Springer Science+Business Media, LLC 2012
Abstract
Access to health care for undocumented mig-
rant children and pregnant women confronts human rights
and professional values with political and institutional regu-
lations that limit services. In order to understand how
health care professionals deal with these diverging man-
dates, we assessed their attitudes toward providing care to
this population. Clinicians, administrators, and support staff
(n
=
1,048) in hospitals and primary care centers of a large
multiethnic city responded to an online survey about
attitudes toward access to health care services. Analysis
examined the role of personal and institutional correlates of
these attitudes. Foreign-born respondents and those in
primary care centers were more likely to assess the present
access to care as a serious problem, and to endorse broad or
full access to services, primarily based on human rights
reasons. Clinicians were more likely than support staff to
endorse full or broad access to health care services.
Respondents who approved of restricted or no access also
endorsed health as a basic human right (61.1%) and child
development as a priority (68.6%). A wide gap separates
attitudes toward entitlement to health care and the endorse-
ment of principles stemming from human rights and the
best interest of the child. Case-based discussions with
professionals facing value dilemmas and training on chil-
dren’s rights are needed to promote equitable practices and
advocacy against regulations limiting services.
Keywords
Undocumented migrant
Á
Health care access
Á
Children
Á
Pregnant women
Á
Ethics
Á
Human rights
‘‘The health system is not NOAH’S ARK’’
‘‘Health care is not about laws, it is about being humane’’
‘‘One thing is clear, health workers should not bear the burden of (
…
)
refusing or agreeing to offer necessary treatments’’.
Introduction
It is estimated that 50 million people worldwide are living
and working abroad without the appropriate documentation
(‘‘undocumented’’) [
1
]. National regulations on access to
health care for undocumented migrants vary across host
countries yet most limit health care to emergencies and
M. Ruiz-Casares
Á
C. Rousseau
Á
P. Zelkowitz
Department of Psychiatry, McGill University, Montreal, Write my essay for me – CA Essay writer Canada
M. Ruiz-Casares (
&
)
Á
C. Rousseau
Á
A. Laurin-Lamothe
Sante
´ Mentale Jeunesse, McGill University/CSSS de la
Montagne, 7085 Hutchison, Of±ce 204.2.14, Montreal,
QC H3N 1Y9, Write my essay for me – CA Essay writer Canada
e-mail: monica.ruizcasares@mcgill.ca
C. Rousseau
Á
P. Zelkowitz
Department of Psychiatry, Jewish General Hospital,
Montreal, Write my essay for me – CA Essay writer Canada
A. Laurin-Lamothe
Department of Sociology, Universite
´ du Que
´bec a
` Montre
´al,
Montreal, Write my essay for me – CA Essay writer Canada
J. A. Rummens
Department of Psychiatry, University of Toronto,
Toronto, Write my essay for me – CA Essay writer Canada
J. A. Rummens
Community Health Systems Resource Group,
The Hospital for Sick Children, Toronto, Write my essay for me – CA Essay writer Canada
F. Cre
´peau
Faculty of Law, McGill University, Montreal, Write my essay for me – CA Essay writer Canada
N. Steinmetz
Department of Pediatrics, McGill University, Montreal, Write my essay for me – CA Essay writer Canada
N. Steinmetz
Montreal Department of Public Health, Montreal, Write my essay for me – CA Essay writer Canada
123
Matern Child Health J (2013) 17:292–298
DOI 10.1007/s10995-012-0973-3
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infectious diseases; accumulating evidence shows the
negative outcomes of limited access to health care in this
population [
2
–
4
].
The same countries that severely restrict access to health
care for undocumented migrants are signatories of or have
ratiFed international conventions enshrining the right to the
highest attainable standard of physical and mental health
such as the Universal Declaration on Human Rights (1948),
the International Covenant on Economic, Social and Cul-
tural Rights (1966), and the Convention on the Rights of
the Child (1989) [
5
]. According to the UN Committee on
Economic, Social and Cultural Rights, the human right to
health includes the right to health
care
and the underlying
determinants of health, all of which must be accessible to
all people in a state’s territory without discrimination
[
6
,
7
]. Although, in general, a distinction based on legal
resident status will not be considered discriminatory by the
courts (as opposed to a distinction based on citizenship),
there may be cases where they will recognize that de facto
residence or even simple presence is sufFcient to beneFt
from health care services available to the rest of the pop-
ulation: emergency care is an easy example. The issue of
who is responsible for the cost of health care services is
however inextricably linked to the issue of access to health
care services, and often creates difFculties for foreigners
who are not legal residents. In clinical settings, this para-
dox translates down to health care providers who may be
violating legal and Fnancial regulations if they provide
care, or violating human rights and their own profes-
sional code if refusing to give care. Moreover, it is also
sometimes suggested to them that ‘‘they are somehow
contributing to institutional or structural racism in addition
to being perceived as racist themselves by patients and
potential patients’’ as restrictions to care mostly affect
racial and ethnic minority migrants [
8
], p. 235.
Discrepancies in attitudes among professionals indicate
that the values protected in human rights conventions are
not consistently related to the practices of health care
professionals. In fact, using humanitarian, public health,
and cost-effectiveness reasons, medical professionals and
national associations in the UK, Sweden, and the US have
expressed their concern about increasing restrictions of
access to health care by failed asylum seekers and other
undocumented migrants [
9
–
12
]. This is signiFcant because
strong advocacy from professional associations may be
associated with a shift in policies of access [
10
]. In order to
inform the policies in±uencing health care provision (for
undocumented migrant children and pregnant women),
it is important to identify and examine health care
professionals’ values and attitudes toward access, and the
personal and professional factors in±uencing these.
Although some professionals act as advocates, no data
are available on the attitudes of health care professionals
working in specialized settings such as paediatric and
obstetrical units. This study documents the values dilem-
mas faced by health care providers, administrators and
support staff in the face of diverging mandates of respect-
ing human rights conventions and ethical obligations and
implementing restricted access regulations. SpeciFcally, we
aim to (1) analyze the relation between key values (e.g.,
health as a human right and child development as a prior-
ity) and attitudes vis-a
`-vis entitlement to health care, and
(2) examine the associated personal and institutional corre-
lates.
Methods
Participants
All administrators, clinicians (e.g., physicians, nurses, and
social workers), health researchers, and other support per-
sonnel in 3 hospitals (including the two major paediatric
hospitals in the city) and 2 primary care centers covering
almost 25% of the population of Montreal were invited to
complete an online questionnaire. There were 1,048 respon-
dents to the survey, but 12 were eliminated because they
did not answer more than one item. The remaining 1,036
cases were included in the analysis.
Measure and Procedures
The survey focused on services to undocumented immi-
grant or refugee children and pregnant women not covered
by the universal health system of the province of Quebec.
These include landed immigrants who are within the
3-month waiting period for a provincial health card, refu-
gee claimants who are covered only for emergency care
under the ²ederal Interim Health BeneFt, and undocu-
mented migrants. The questionnaire was developed by a
multidisciplinary group of professionals in the health and
social sciences, integrated input from an Advisory Com-
mittee, and was pre-tested in English and ²rench. The brief
on-line survey consisted of 18 multiple-choice questions
and one open-ended question. Closed-ended questions
recorded: (1) demographics, professional occupation,
and afFliation; (2) exposure to culturally diverse and
undocumented populations; (3) perceived magnitude and
consequences of the access problem; (4) attitudes toward
entitlement (universal access, restricted access, no access)
for undocumented migrant children and pregnant women;
and (5) endorsement of the most common reasons for
restricting and extending services including human rights
and child development that had been previously identiFed
through a review of literature and a qualitative pilot project
conducted in Montreal [
4
]. Attention was given to using
Matern Child Health J (2013) 17:292–298
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RNSG 2230 Maternal Newborn Nursing
Article Review – Structure and Format Guidelines
Notes:
1.
Include each category in a separate section or subsection. Ensure that you discuss each
category! (If a category does not apply, then actually write in that (sub) section that the
category does not apply.)
2.
Use complete sentences and paragraph format.
3.
Your article review should be 2 full pages or more (Remember your APA guidelines)
Your Name:
Jane Doe
Full Bibliography
Background and Introduction
State the objectives of the article.
What is the article’s topic area?
State the articles intended audience.
Research question
Does the article pose a question or was it an idea that was researched?
State how the study was conducted, the setting, etc.
Literature Review
Summarize the article.
Include the results
What is the problem or opportunity being addressed?
View the Answer
Which solution is proposed (the solution could be a new model or a theory that explains
the problem)?
What evidence is put forth that this solution is appropriate?
Metho
d
What is the research philosophy?
What is the research approach?
What is the research design?
What was the data collection methods?
Findings/Results
State the results of the research article.
General Critique
The questions listed are only suggestions. Add more data here that you feel is relevant to your
critique of the article.
What are the articles shortcomings and strengths?
Did the article provide enough background information?
How confident are you with the article’s results?
