Submission ID 131661
| Issue/Objective | In Québec, migrant women without public health insurance must pay out-of-pocket for prenatal and delivery care, creating systemic exclusion within an otherwise universal system. This qualitative study examined how uninsured pregnant migrant women navigate access to perinatal care, analyzing structural barriers, women's navigational capacities, and factors that mitigate exclusion. The analysis applied Levesque's patient-centred access framework across five dimensions - approachability, acceptability, availability, affordability, and appropriateness - directly addressing the conference's focus on equity within publicly funded health systems. |
|---|---|
| Methodology/Approach | Conducted within PRÉNA-E-COUT, a participatory mixed-methods project, this qualitative descriptive study used purposive sampling to recruit 50 uninsured pregnant migrant women (≥18 years, ≤12 months postpartum) through community-based organizations in Montréal, Québec City, and the Côte-Nord region. Semi-structured interviews explored care trajectories, financial constraints, and clinical interactions. Data were analyzed through hybrid deductive-inductive thematic analysis mapped onto Levesque's framework, with preliminary findings validated by a community advisory committee including women with lived experience. |
| Results | Participants faced interconnected barriers across all five dimensions. Approachability: registration in systems like Ma Grossesse functioned as a formal gateway without ensuring entry, as providers frequently declined uninsured patients. Acceptability: participants perceived shifts in provider attention following insurance disclosure, with some reporting constrained decisional autonomy through persistent clinical recommendations or payment demands during labour. Availability: willing providers were geographically concentrated, prompting some to seek care outside the province or country. Affordability proved central - deposit requirements delayed care initiation, and cost considerations shaped clinical decisions during delivery and post-cesarean discharge, including one provider explicitly linking non-hospitalization to cost. Appropriateness was compromised by fragmented trajectories and financial barriers reintroduced during emergency transfers. Discretionary provider practices and community-based services partially mitigated exclusion but remained inconsistent. High satisfaction with midwifery and community-based care reflected cost-driven access rather than genuine preference. |
| Discussion/Conclusion | Insurance status structurally reconfigures care access, compressing clinical and relational dimensions into cost-driven trajectories. Policy implications include extending provincial coverage to uninsured pregnant residents, standardizing provider obligations across insurance statuses, and scaling community-based navigation models. These findings directly advance the conference's agenda on dismantling systemic exclusion and ensuring equitable perinatal care regardless of administrative status. |
| Presenters and Affiliations | Laila Mahmoudi École de santé publique - Université de Montréal Catherine Jarvis McGill Marine Vasina Médecins du Monde Juliette Begouen Demeaux Doctoctoc Éric Tchouaket Université du Québec en Outaouais Lara Gautier École de santé publique - Université de Montréal |
