Are pregnancy outcomes affected by the lack of legal status? A demographic study based on 850,288 live births in Switzerland.

BACKGROUND: In the context of increased global mobility, it is fundamental to understand migrants' needs and how governments can ensure equal health opportunities for both regular and irregular migrants simply by applying low-cost primary health care measures. To identify health issues in which to intervene, this study analysed the impact of a mother's lack of legal status, together with available biological and socioeconomic characteristics, on four indicators of adverse perinatal outcomes in Switzerland. METHODS: Based on the exhaustive records of the Swiss Federal Statistical Office (FSO) for its Vital Statistics (BEVNAT), different indicators of birth outcomes, including preterm birth (PTB), low and very low birth weight (LBW and VLBW), and small for gestational age (SGA), were analysed using logistic regressions on live births occurring from 2005 to 2018. These four adverse outcomes were defined as dependent variables. Statistical analysis was performed using the statistical package STATA, version 17. RESULTS: Selected pregnancy outcomes were conversely affected by an irregular legal status. Analysis run on the final sample showed that, compared to the neonates of mothers who are non-migrant legal residents in Switzerland, newborns of irregular migrants have higher risks of PTB (aOR 1.18 95% CI [1.05-1.32], p<0.01) and VLBW (aOR 1.43 [1.13-1.81], p < 0.01]). In contrast, we observed that in both irregular and regular migrant groups, the odds of SGA were lowered (aOR .76 [.68-.85] p<0.01) and aOR .93 [.91-.94], p< 0.01, respectively). A similar effect was observed when controlling for any adverse outcome (any AOs) (aOR  .90 [.83-.99] p 0.022; and aOR .93 [.91-.94] p< 0.01, respectively). CONCLUSIONS: Our results, together with those from the available literature, call for a more comprehensive assessment of all pregnancy outcomes as well as of the social determinants of health for which the analysis was adjusted. Given the complexity of the migration phenomenon, future studies should account for local structural restrictions in the organization of care, the extension of a person's network as a means of health care accessibility, diverse backgrounds and cultures and the recent arrival status of migrants. This would allow researchers to understand the long-term impact of social determinants of health on the wellbeing of a mother and child and take them into account in the adoption of health policies.

Irregular migrants' experiences of health disparities while living in informal settlements during the COVID-19 pandemic.

AIMS: The objective of this study was to describe and understand irregular migrants' (IMs') experiences of health disparities while living in informal settlements (ISs) during the COVID-19 pandemic. DESIGN: Qualitative descriptive study. METHODS: Thirty-four IMs originating from different African countries living in ISs took part in this study. Data were collected between January and March 2022 through three focus groups and 17 in-depth interviews. Thematic analysis was used to analyse qualitative data with ATLAS.ti computer software. RESULTS: Three main themes emerged: (1) Extreme vulnerability: ISs and abuse; (2) Inequality in health treatment has increased during COVID-19; and (3) The impact of COVID-19 on the health of IMs: help from non-governmental organizations and nurses. CONCLUSION: Irregular migrants are at a higher risk of exposure to COVID-19 due to their precarious living conditions, administrative situation and access to the health system. It is recommended that specific programmes be strengthened to improve health care for this population. IMPACT: What problem did the study address? This study examines IMs' experiences of health disparities during the COVID-19 pandemic. What were the main findings? IMs are at higher risk of exposure to COVID-19 due to social, health, housing and work inequalities. Community health nurses alongside non-governmental organizations have facilitated the implementation of measures to protect this population against COVID-19. Where and on whom will the research have an impact? With the aim of improving care for IMs, strategies have been suggested for health institutions to address problems relating to accessing the health system, and to promote networking between non-governmental organizations and community health nurses.

Parsing human rights, promoting health equity: reflections on Colombia's response to Venezuelan migration.

Over the last 7 years, a multidimensional crisis in Venezuela has resulted in massive emigration. Over 7 million have fled the country, with more than 2.4 million seeking to settle in Colombia. Of these, as of 2021, more than 1 million were undocumented, but the situation has started to change with the implementation of an ambitious migrant regularisation scheme. Regularisation promises access to comprehensive healthcare, full educational opportunities and the formal labour market. Securing these social determinants of health is critical because social inequalities produce health inequalities-that is, systematic health differences that are preventable and thus unjust. Social medicine, social epidemiology and international human rights law agree on this, yet law-focused studies of health equity initiatives remain rare. Aiming to reverse this, we examine Colombia's response to Venezuelan migration, including its recent migrant regularisation initiative, which was introduced in part to comply with the country's obligations under international human rights law. The examination foregrounds what we are calling 'legal literacy', testing the hypothesis that advancing health equity involves asking more and better questions about international human rights law.

Existential Displacement: Health Care and Embodied Un/Belonging of Irregular Migrants in Norway.

Drawing on fieldwork and interviews in Oslo and Bergen, Norway, this article discusses irregular migrants' experiences of existential displacement and the tactics they use to try to re-establish a sense of emplacement and belonging. More specifically, it argues that irregular migrants' experiences of embodied unbelonging are a consequence of a violent form of governmentality that includes specific laws, healthcare structures, and migration management rationalities. The article makes this argument by tracing how these experiences translate into embodied effects that feature prominently in migrants' narratives of suffering while living in a country that purports to provide welfare services to all. The narratives of their state of being-in-the-world are ways through which migrants both experience and express the violence and deprivation they face. I argue that these narratives are instances of structures of feeling (Williams 1973), which are shaped by modes of governmentality. The article shows that irregular migrants' coping strategies centrally involve faith, religious communities and friends. Irregular migrants draw on these relationships to get by, access healthcare, and to resist the (health) effects of social deprivation and political violence. These relationships allow irregular migrants to find meaningful ways of being-in-the-world and rebuilding, to some extent, a sense of entitlement and belonging.

Supporting access to healthcare for refugees and migrants in European countries under particular migratory pressure.

BACKGROUND: In 2015 the increased migratory pressure in Europe posed additional challenges for healthcare providers. The aim of this study was to inform the development of a "Resource Package" to support European Union (EU) member states in improving access to healthcare for refugees, asylum seekers and other migrants. METHODS: A mixed method approach was adopted: i) interviews and focus groups were carried out to gather up-to-date information on the challenges the different healthcare providers were facing related to the refugee crisis; ii) to complement the results of the FGs, a literature review was conducted to collect available evidence on barriers and solutions related to access to healthcare for refugees and migrants. RESULTS: The different actors providing healthcare for refugees and migrants faced challenges related to the phases of the migration trajectory: arrival, transit and destination. These challenges impacted on the accessibility of healthcare services due to legislative, financial and administrative barriers; lack of interpretation and cultural mediation services; lack of reliable information on the illness and health history of migrant patients; lack of knowledge of entitlements and available services; lack of organisation and coordination between services. These barriers proved particularly problematic for access to specific services: mental health, sexual and reproductive care, child & adolescent care and victim of violence care. CONCLUSIONS: The findings of this study show that solutions that are aimed only at responding to emergencies often lead to fragmented and chaotic interventions, devolving attention from the need to develop structural changes in the EU health systems.

[Reduce obstacles, promote health-healthcare access for undocumented migrants within a pilot project in Lower Saxony, Germany (2016-2018)]. / Hemmnisse abbauen, Gesundheit fördern ­ Die Gesundheitsversorgung von Migrierten ohne Papiere im Rahmen eines Modellprojektes in Niedersachsen, 2016­2018.

BACKGROUND: In 2014, the parliament of the federal state of Lower Saxony (Germany) implemented a three-year pilot project to reduce barriers to healthcare for undocumented migrants. For this purpose, two counselling centres (CCs) were established (Hanover and Goettingen), where undocumented migrants receive treatment vouchers for the medical treatment of acute medical issues, check-ups, and vaccination. OBJECTIVE: We assessed which medical services were used in order to identify needs and recommend specific improvements to policymakers. METHODS: We analysed CC data from the first two years after starting the project (1 February 2016-31 January 2018). We described demographic characteristics of attendees, reasons for attendance, and medical diagnoses. Additionally, we carried out explorative interviews on the subject of vaccination in one CC (February-May 2018). RESULTS: In total, 236 undocumented migrants received 698 vouchers. The number of vouchers issued increased over time: from 17/month (February-July 2016) to 44/month (August 2017-January 2018); 56% were female and 16% were younger than 18 years. Half of the women (66/132) attended for prenatal care. In 4% (9/236) of attendees vaccinations were given. Of 25 people approached for explorative interviews, 18 participated. All of them were generally open about vaccinations; 12 (67%) had already received vaccinations at some point. CONCLUSIONS: The increasing use of CCs shows the need for low-threshold healthcare access, particularly for vulnerable groups (children, pregnant women). Vaccinations were rarely performed. Strengthening vaccination literacy by providing more information to both physicians and attendees can increase vaccination uptake.

Caring for the Unseen: Using Linking Social Capital to Improve Healthcare Access to Irregular Migrants in Spain.

PURPOSE: To describe a novel strategy using linking social capital to provide healthcare access to irregular migrants with low literacy, low numeracy, and limited cultural assimilation in a European metropolitan area. ORGANIZING CONSTRUCT: Public data show numerous shortcomings in meeting the healthcare needs of refugees and irregular migrants surging into Europe. Many irregular migrants living in European communities are unable to access information, care, or services due to lack of social capital. An overview of the problem and traditional charity strategies, including their barriers, are briefly described. A novel strategy using linking social capital to improve healthcare access of irregular migrants is explored and described. Information regarding the impact of this approach on the target population is provided. The discussion of nursing's role in employing linking social capital to care for the vulnerable is presented. CONCLUSIONS: Immigration and refugee data show that issues related to migration will continue. The novel strategy presented can be implemented by nurses with limited financial and physical resources in small community settings frequented by irregular migrants to improve health care. CLINICAL RELEVANCE: The health and well-being of irregular migrants has an impact on community health. Nurses must be aware of and consider implementing novel strategies to ensure that all community members' healthcare needs, which are a basic human right, are addressed.

Pervasive irregular migration and the vulnerabilities of irregular female migrants at Plumtree border post in Zimbabwe.

Background: Migration is a common and visible feature of global mobility where the driving factors would be the search for better livelihood opportunities. Due to economic hardships in Zimbabwe, women have also been noted to migrate to neighbouring countries in search of opportunities to look after their left-behind families. However, the COVID-19 restrictions and other state regulations have become facilitators of illicit migration as irregular migrants (including women) devise more complex means to traverse borders and gain access. This paper assesses the vulnerabilities and the lived realities of female irregular migrants between Zimbabwe and Botswana during the clandestine migration journeys. Methods: A qualitative descriptive survey that targeted nineteen (19) participants was conducted using semi-structured and unstructured interviews. The participants included fifteen (15) Female irregular migrants and four (4) Key Informants who worked at Plumtree Border Post. The interviews were recorded, transcribed verbatim, coded and thematically analysed. Results: Four vulnerabilities were reported/experienced by the participants: violence and robbery, Rape and sexual harassment, Psycho-emotional harassment, and health vulnerabilities in detention. The participants reported that these vulnerabilities are experienced at different levels of the migration process and deportation. Conclusions: Female migrants are generally at risk as they are bound to be taken advantage of at different levels during migration and deportation. Therefore, there is a need to relook at the policies implemented at the ports and ensure women are subjected to humane treatment even during the deportation process.

Health Status and Access to Healthcare for Uninsured Migrants in Germany: A Qualitative Study on the Involvement of Public Authorities in Nine Cities.

Non-governmental organisations (NGOs) regularly report data on their work with uninsured migrants (UM) within a (so-called) parallel health care system. The role and involvement of public authorities therein have yet been underrepresented in research. Our aim was to gain a better understanding of public authorities' role in the parallel health care system and their view of the health situation of UM. We conducted qualitative semi-structured interviews with 12 experts recruited by purposive sampling from local public health authorities (LPHAs), state-level public health authorities (SPHAs), and social services offices (SSO) in nine cities, recorded, transcribed, and subjected the data to qualitative content analysis. LPHAs are more often directly involved in providing medical services, while SSOs and SPHAs function as gatekeepers for access to social benefits, including health insurance, and in grant-funded projects. NGOs keep substituting for the lack of access to regular health care from public institutions, but even in settings with extended services, public authorities and NGOs have not been able to provide sufficient care through the parallel health care system: Experts report gaps in the provision of health care with respect to the depth and height of coverage, due to the fragmentation of services and (ostensible) resource scarcity. Our study highlights the necessity for universal access to regular health care to overcome the fragmentation of services and improve access to needed health care for UM in Germany.

Access to Health Care by Migrants with Precarious Status During a Health Crisis: Some Insights from Portugal.

In March 2020, the Portuguese Government issued a remarkable regulation by which irregular migrants who had previously started the regularization procedure were temporarily regularized and thus allowed full access to all social benefits, including healthcare. The Portuguese constitutional and legal framework is particularly generous regarding the right to healthcare to irregular migrants. Nevertheless, until now, several practical barriers prevented full access to healthcare services provided by the national health service, even in situations in which it was legally granted. This decision is not only remarkable in light of the fulfilling of migrants' rights to health, as imposed by international commitments assumed by, but also in view of the fight against COVID-19. The decision is grounded both on human rights and in public health reasons. The paper is divided in two main parts. In the first one, it analyzes national State obligations with regard to healthcare provision to migrants in irregular situation. In the second part, it analyzes the Portuguese solution, using this case study to discuss the possible mechanisms to comply with such obligations.

Understanding Violence against Women Irregular Migrants Who Arrive in Spain in Small Boats.

African irregular migrants risk their lives crossing the Mediterranean Sea in small boats hoping to reach Europe. Women irregular migrants (WIMs) are an especially vulnerable group that suffer from violence and sexual aggression, but little is known about their actual experiences. The objective of our study is to describe and understand the violence against WIMs who arrive in Spain in small boats. A qualitative study based on Gadamer's phenomenology was used. The data collection included twenty-six in-depth interviews with WIMs. Three main themes arose: "Poverty and discrimination push WIMs into migrating"; "WIMs as a paradigm of extreme vulnerability", and "WIMs in small boats should raise the alarm". WIMs who arrive to Europe in small boats have a history of violence, rape, prostitution, forced pregnancy, and human trafficking. Emergency care must include gynecological examinations and must make detecting sexual violence and human trafficking of WIMs part of their care protocols.

Cultural Issues in the Provision of Emergency Care to Irregular Migrants Who Arrive in Spain by Small Boats.

INTRODUCTION: The European Union receives one third of the world's migrant population who cross the Mediterranean Sea in small boats and arrive illegally in Europe. Irregular migrants (IMs) are persons who do not have legal permission, documentation, or refugee status and are not authorized to enter or stay in a given country. More than half a million IMs arrive in the European Union by sea creating serious public health issues in Greece, Italy, and Spain, thereby needing emergency care. The purpose of this study was to describe and understand the experiences of IMs who arrive in Spain by small boats in terms of cultural issues surrounding the provision of emergency care. METHOD: A qualitative study based on Gadamer's phenomenology was used. Data were collected between 2015 and 2018 using 12 in-depth interviews of IMs. RESULTS: Three main themes arose: "IMs driven by a culture of emigration in countries of origin," "Facing risk in search of a better life," and "The need for cultural adaptation in emergency care." DISCUSSION: Biopsychosocial and cultural needs must be addressed when providing emergency care to IMs who arrive in Europe by small boat. IMPLICATIONS: Nurses can help adapt and restructure cultural practices in the emergency care provided to IMs.

Medical Care, Screening and Regularization of Sub-Saharan Irregular Migrants Affected by Hepatitis B in France and Italy.

Both in France and in Italy hepatitis B is present mostly among the migrant population coming from sub-Saharan Africa and mainly among those migrants having a poor socio-economic background. This article is aimed at assaying the impact of public policies adopted by France and Italy for migrants' health on the treatment of migrants with HBV. The article is based on semi-structured interviews conducted with 30 immigrant adults taken into care by two associations dealing with medical, psychological and social issues of immigrants applying for a residence permit, mainly asylum seekers. The results of this study bring to light specific difficulties relating to national contexts, to the type of HBV (inactive or active) and to the administrative situation of the migrants. In France irregular migrants are screened in humanitarian associations. In Italy the screening is done in public hospitals. In both countries, only migrants suffering from chronic hepatitis B obtain a residence permit for medical reasons. More migrants in Italy than in France abandon HBV treatment. This study describes how specific national immigration and health policies impact in a different way the therapeutic and social path of migrants suffering from hepatitis B. The analysis provides useful material for the development of strategies to prevent and control hepatitis B among the migrant population. It also shows how social determinants affect migrants' health more than values or cultural factors do.

Reporting mental health problems of undocumented migrants in Greece: A qualitative exploration.

BACKGROUND: Mental health problems are highly prevalent amongst undocumented migrants (UMs), and often part of their consultations with general practitioners (GPs). Little empirical data are available of how GPs and UMs engage around mental health in Greece, a country with a lack of balance between primary and secondary care and limited healthcare provisions for UMs. OBJECTIVES: To acquire insight in the barriers and levers in the provision of mental healthcare for UMs by GPs in Greece. METHODS: This was a qualitative study using semi-structured interviews with 12 GPs in Crete, Greece with clinical expertise in the care of UMs. All interviews were audio-taped and transcribed verbatim and were analysed using thematic content analysis. RESULTS: Greek GPs recognized many mental health problems in UMs and identified the barriers that prevented them from discussing these problems and delivering appropriate care: growing societal resistance towards UMs, budget cuts in healthcare, administrative obstacles and lack of support from the healthcare system. To overcome these barriers, Greek GPs provided UMs with free access to care and psychotropic drugs free of charge, and referred to other primary care professionals rather than to mental healthcare institutions. CONCLUSION: Greek GPs experienced substantial barriers in the provision of mental healthcare to UMs and political, economic and organizational factors played a major role.

Migration as a social determinant of health for irregular migrants: Israel as case study.

More than 150,000 irregular migrants reside in Israel, yet data regarding their utilization of and perceived barriers to health care services are limited. Drawing on semi-structured interviews conducted with 35 irregular migrant adults between January and September 2012, this article analyzes the role of migration as a social determinant of health for irregular migrants, and especially asylum seekers. We analyze two kinds of barriers faced by migrants when they attempt to access health care services: barriers resulting directly from their migration status, and barriers that are common among low-income communities but exacerbated by this status. Migration-related barriers included a lack of clear or consistent legislation; the threat of deportation; the inability to obtain work permits and resulting poverty and harsh living and working conditions; and discrimination. Barriers exacerbated by migrant status included prohibitive cost; poor and confusing organization of services; language barriers; perceived low quality of care; and social isolation. These findings support recent arguments that migrant status itself constitutes a social determinant of health that can intersect with other determinants to adversely affect health care access and health outcomes. Findings suggest that any meaningful effort to improve migrants' health will depend on the willingness of clinicians, public health officials, and policymakers to address the complex array of upstream political and socio-economic factors that affect migrants' health rather than focusing on narrower questions of access to health care.

Causes of death among undocumented migrants in Sweden, 1997-2010.

BACKGROUND: Undocumented migrants are one of the most vulnerable groups in Swedish society, where they generally suffer from poor health and limited health care access. Due to their irregular status, such migrants are an under-researched group and are not included in the country's Cause of Death Register (CDR). OBJECTIVE: To determine the causes of death among undocumented migrants in Sweden and to ascertain whether there are patterns in causes of death that differ between residents and undocumented migrants. DESIGN: This is a cross-sectional study of death certificates issued from 1997 to 2010 but never included in the CDR from which we established our study sample of undocumented migrants. As age adjustments could not be performed due to lack of data, comparisons between residents and undocumented migrants were made at specific age intervals, based on the study sample's mean age at death±a half standard deviation. RESULTS: Out of 7,925 individuals surveyed, 860 were classified as likely to have been undocumented migrants. External causes (49.8%) were the most frequent cause of death, followed by circulatory system diseases, and then neoplasms. Undocumented migrants had a statistically significant increased risk of dying from external causes (odds ratio [OR] 3.57, 95% confidence interval [CI]: 2.83-4.52) and circulatory system diseases (OR 2.20, 95% CI: 1.73-2.82) compared to residents, and a lower risk of dying from neoplasms (OR 0.07, 95% CI: 0.04-0.14). CONCLUSIONS: We believe our study is the first to determine national figures on causes of death of undocumented migrants. We found inequity in health as substantial differences in causes of death between undocumented migrants and residents were seen. Legal ambiguities regarding health care provision must be addressed if equity in health is to be achieved in a country otherwise known for its universal health coverage.