Back to the Future for Migrants: Growing Challenges of Access

Author(s): Manuel Carballo1, A. Sundaram
Affiliation(s): 1International Centre for Migration and Health, Vernier, Switzerland
Key issues: At a time when progress toward the UN Millennium Development Goals is faltering, access to healthcare in general and reproductive healthcare in particular is becoming more of a challenge than ever. Despite the impressive progress being made in medical sciences, accessing quality healthcare is becoming more difficult for millions of people around the world. The problem is not unique to poor countries. In many of the richer countries, the number of people with limited access to healthcare services is growing. One of the contributing factors is migration.
Meeting challenges:

Migration is a complex health process. People move with health profiles that reflect socio-economic backgrounds, the diseases and health problems they may have confronted before they moved, and the experience they may have had with healthcare services and personnel in their home countries. The health of migrants is also a function of the way in which they move, what they had to do in order to move and what the modality of their movement was. Finally their health is affected by the social, political and economic context into which they are expected to insert themselves. Their access to healthcare if and when they need it is determined by all these factors and experiences. It is also influenced by their feeling of security, the extent to which they feel they are allowed to participate in the host health system, and the way in which they are received by and can communicate with healthcare personnel. The process is replete with pitfalls. Cultural perceptions and attitudes on the part of patients and healthcare providers intervene. National and local regulations concerning who is eligible for what and under which circumstances also play a critical role. So does the status of the migrant, the extent to which he or she is eligible for medical insurance, be it individually paid for or a shared responsibility between employers and employees. In many situations the underlying question is whether host societies have a positive attitude to migration and migrants, and whether migrants are seen as necessary. In the area of reproductive health we are on the verge of looking back to the future with patterns of maternal and newborn health that are reminiscent of situations that were obtained fifty or more years ago. Poor use of family planning and elevated requests for abortion are symptoms of the emerging scenario. So are the poor pregnancy outcomes and poor neonatal health, as well as late stage presentation for diagnosis of gynecological problems. In some countries of Europe, there are also signs that the incidence and prevalence of sexually transmitted infections may be becoming higher among migrant populations than others, and that women migrants may be especially vulnerable.

Conclusion (max 400 words): As we move into the 21st century and an era of growing mobility within and between countries, the question of access to healthcare in general and reproductive health in particular by migrants will weigh heavily on national policy makers, healthcare providers and the public at large. Everyone stands to gain from equitable access to quality care and ultimately everyone, be they migrants or non-migrants, stands to lose if inequities are allowed to emerge and persist. As migration continues to grow and become an even more indispensable part of social and economic development, it will become increasingly incumbent on all stakeholders to take up this issue and redress these inequities. Medical insurance coverage for all, more training of health personnel on multi-cultural health, greater focus on health promotion and disease prevention among migrants and their social insertion will go far in redressing the problem.

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