Abstract
Objectives
Access to services for international migrants living in Canada is especially important during the postpartum period when additional health services and support are key to maternal and infant health. Recent studies found refugee claimant women to have a high number of postpartum health and social concerns that were not being addressed by the Canadian health care system. The current project aimed to gain greater understanding of the barriers these vulnerable migrant women face in accessing health and social services postpartum.
Methods
Qualitative text data on services that claimant women received post-birth and notes (recorded by research nurses) about their experiences in accessing and receiving services were examined. Thematic analysis was conducted to identify common themes related to access barriers.
Results
Of particular concern were the refusal of care for infants of mothers covered under IFHP, maternal isolation and difficulty for public health nurses to reach women postpartum. Also problematic was the lack of assessment, support and referrals for psychosocial concerns.
Conclusions
Better screening and referral for high-risk claimant women and education of health care providers on claimants’ coverage and eligibility for services may improve the addressing of health and social concerns. Expansion of claimants’ health benefits to include psychotherapy without prior approval by Citizenship and Immigration Canada is also recommended. Interventions aimed at social determinants underlying health care access issues among childbearing refugee claimants should also be explored. These might include providing access to subsidized language courses, social housing and government-sponsored benefits for parents, which currently have restrictive eligibility that limits or excludes claimants’ access.
Key words: Emigration and immigration, postpartum women, access to health care, refugees
Résumé
Objectifs
L’accès des immigrantes aux services de santé et aux services sociaux est particulièrement important après l’accouchement, quand des soins de santé et du soutien additionnels sont nécessaires au bien-être de la mère et du nouveau-né. Des études récentes ont révélé que les demandeuses d’asile ont un grand nombre de problèmes médico-sociaux non abordés par le système de santé canadien durant la période postpartum. L’étude en cours avait pour but de mieux comprendre les obstacles auxquels font face ces femmes vulnérables devant l’accès au système de santé.
Méthode
Des données qualitatives provenant des notes prises par des infirmières-chercheures sur les services reçus par les demandeuses d’asile durant la période postpartum et les expériences de ces femmes en essayant d’accéder aux services ont été analysées. Une analyse thématique à été faite pour dégager des thèmes communs concernant les obstacles à l’accès aux soins.
Résultats
Le refus des soins aux nouveau-nés dont les mères sont couvertes par le Programme fédéral de santé intérimaire (PFSI), l’isolement des nouvelles mères ainsi que la difficulté pour les infirmières de joindre ces femmes durant la période postpartum étaient particulièrement inquiétants. Nous avons aussi observé d’importantes lacunes dans l’évaluation, le soutien et l’aiguillage des femmes ayant des problèmes psychosociaux.
Conclusions
Une amélioration du triage et de l’aiguillage des demandeuses d’asile à risque élevé pourrait peut-être réduire le nombre de problèmes de santé non abordés par le système, tout comme la sensibilisation des professionnels de la santé à la couverture des demandeuses et à leur admissibilité aux services. L’inclusion de la psychothérapie sans approbation préalable par Immigration et Citoyenneté Canada dans les services de santé assurés améliorerait l’accès aux soins psychologiques. Des interventions visant les déterminants sociaux à l’origine des problèmes d’accès aux soins devraient aussi être envisagées. Il pourrait s’agir d’offrir aux demandeuses d’asile enceintes un accès à des cours de langues subventionnés, à des logements sociaux et aux prestations gouvernementales accordées aux parents, des services qui excluent ou limitent actuellement l’admissibilité des demandeurs d’asile.
Mots clés: émigration et immigration, réfugiés, femmes postpartum, accès aux soins de santé
Footnotes
Sources of Funding: Canadian Institutes of Health Research (CIHR); Immigration et métropoles (Centre of Excellence in Immigration Studies - Montreal); Le Fonds de la recherche en santé du Québec (FRSQ) - Career support for AJ Gagnon. Lisa Merry holds a FRESIQ (Fondation de recherche en sciences infirmières du Québec) doctoral bursary through their MELS Universities’ program and is also funded by the Strategic Training Program in Global Health Research, a partnership of the Canadian Institutes of Health Research and the Québec Population Health Research Network
Acknowledgement: CHARSNN co-investigative team: Cindy-Lee Dennis, Geoffrey Dougherty, Becky Palmer, Jean-François Saucier, Elizabeth Stanger, Donna E. Stewart, Olive Wahoush.
Conflict of Interest: None to declare.
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