In Quebec, according to an estimate by the SHERPA University Institute, about 50,000 people do not have access to health insurance because of their precarious immigration status.
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Among them are women like Paula, for whom pregnancy has become a nightmare. Paula lives, works and pays taxes in Quebec, but she is waiting for a sponsorship that will not give her access to care covered by the Régie de l’assurance maladie du Québec (RAMQ). The joy of the first moments with her baby soon turned into fear. How do you pay for every clinic or emergency room visit if you live on minimum wage and already have a family to feed? How do I raise $10,000 for the deposit required for delivery? How to pay off debts related to childbirth billed three times higher – up to $20,000 and even more?
Recognition of this critical situation after the adoption of Bill No.Oh 83, the Minister of Health and Social Services, Christian Dubé, has commissioned an interdepartmental working group led by the RAMQ to identify possible solutions for pregnant women without health coverage.
However, the right to health of women cannot be limited to the moment they are pregnant. They should also have access to the other essential sexual and reproductive health services they will need throughout their lives: family planning, termination of pregnancy, gender-based violence, prevention, screening and treatment of sexually and sexually transmitted infections of the blood (STBBI) and cancers of the reproductive system.
Every year, nearly 300 migrant women – pregnant or not – who do not have health insurance or cannot afford to pay for care, find themselves in a critical situation at the Médecins du Monde clinic in Montreal. This was the case of Angelina, 54 years old and from Grenada, who had lived and worked in Canada for 30 years without a domestic status. In 2019, she was diagnosed with advanced cervical cancer, which took her away two years later. She would still be alive if she could have received care in time.
So these women are even more insecure. They carry a disproportionate economic and social burden that affects other determinants of their health, such as access to housing, healthy food and social inclusion, as well as impacts on public health. For example, risk of development and spread of infectious diseases and STBBIs.
For this reason, Doctors of the World and a coalition of health organizations have made recommendations in a short1 sent to the Ministère de la Santé et des Services sociaux (MSSS) and the RAMQ on March 17 to demonstrate that all women should have access to health services related to pregnancy, as well as other essential sexual and reproductive health services.
An economic, public health and solidarity issue
Unlike many US states and European countries, Quebec leaves out many women who work and live here. Denying them access to health care makes no sense from a medical, economic or public health point of view.
Ensuring coverage of Quebec’s public health and drug insurance plans for all women living there, covering essential sexual and reproductive health services, could ease the strain on the health system.
On the one hand by reducing the work of the care teams, on the other by avoiding late and therefore more difficult and more expensive care. This is a humane and effective solution that should be part of the plan to overhaul the health care system between now and the next election.
Last year, the Quebec government showed political courage by giving all children living in Quebec access to health care. As professionals committed to the right to health, we hope the government will continue its leadership by ensuring access to essential sexual and reproductive health services for every woman living in Quebec, regardless of her immigration status. It is a fundamental right, the implementation of which will clearly benefit society as a whole.
* Co-signers, volunteer doctors: Noémie Johnson, Loree Tamanaha, Nicole Seben, Charles Giroux, My Lan Graziani, Marie-Claude Goulet, Minh Thi Nguyen, Vanessa Bombay, Louis-Christophe Juteau, Anne-Sophie Thommeret-Carrière, Suzanne De Blois, Agnès Cailhol, Clairelaine Ouellet-Plamondon, Marie-Hélène Marchand, Christine Arsenault, Audrey Cournoyer-Roy, Carole Balthazard, Marie-Claude Moore, Maude Bernard, Élise Gonthier, Myrill Solaski, Sara Vadnais-Dionne, Sophie Poissala, , Sophie Poissala, Lucie Maynard, Samir Shaheen-Hussain, Caroline Grégoire, Eve Blais, Delphine Boury-Simoes, Juan Carlos Luis Chirgwin