Access to abortion of undocumented migrants seen by Médecins du Monde in the Humanitarian Hub

Abstract

As of June 2017, the population of the Maximillian Park (an undocumented migrant camp in Brussels) is mainly Eritrean and Sudanese migrants who intend to continue their journey to the United Kingdom (Depraetere, 2017; Daher, 2018). In response to demanding needs, Médecins du Monde together with 8 organisations, created a one-stop service centre, The Humanitarian Hub, in January 2018 to offer a set of basic services to the migrants. The Hub implemented a voluntary de-medicalized midwifery clinic. The medical team noted an under-representation of women, 40 out of 745 (5,4%), while the coordination team identified a number of complex unwanted pregnancies, many of which relating to violence. Accessing free abortion for undocumented women in Belgium requires the Urgent Medical Assistance certificate. This often takes several weeks, making it unrealistic to obtain in time for an abortion. Accordingly, the women or family planning centres cover the financial cost. The Hub’s midwifery clinic thus focused on building trust with the women, and facilitated referrals to family planning centres. By taking steps to create a more gender-sensitive Hub, the proportion of women seeking consultations doubled. In 2018, 955 out of 8990 (10,6%) patients were women, totalling 324 midwifery consultations. 65 of these women were pregnant, and the 23 who sought abortion were referred to family planning centres. None had Urgent Medical Assistance. It is crucial to consider the particularities of a population and their social determinants of health when implementing a holistic system. For instance, focusing on violent experiences in medical consultations can help better understand women’s situation. The coordination between The Hub and family planning centres helped in reducing barriers for migrant women. The project has seen success, thanks to the flexibility of the family planning centres in quickly receiving these pregnant women, and to the four centres who covered abortion costs. Key messages It is evident that the magnitude of these women’s situation is undervalued, thus it is important to increase sensitization and advocacy in order to offer them greater support. The Hub has provided a number of services for undocumented migrants, notably abortion, and removed some barriers in accessing care. However, it is a fragile solution to a structural problem.