Régie d’assurance-maladie du Québec

Multi-party campaign calls for wider access to prenatal care

Ruby Pratka, Local Journalism Initiative reporter

editor@qctonline.com

In 2021, after years of pressure from immigrant and refugee advocacy groups, the Coalition Avenir Québec government passed a law allowing children born in Quebec to access public health care through the Régie d’assurance-maladie du Québec (RAMQ) regardless of their parents’ immigration status or RAMQ eligibility. However, that coverage only kicks in once they’re outside the womb.

On Dec. 4, Québec Solidaire (QS), the Quebec Liberal Party and several advocacy groups launched a renewed push to expand RAMQ eligibility to cover prenatal, labour and delivery care for all pregnant women, regardless of immigration status. As it stands, a woman who gives birth in a Quebec hospital and doesn’t have a health card or private insurance must pay thousands of dollars of hospital bills out of pocket – up to $100,000 or more if there are complica- tions, according to Médecins du Monde (MDM) Canada.

“If we want to protect our children, we have to protect their mothers, throughout their pregnancies and through- out the prenatal period,” QS immigration critic Guillaume Cliche-Rivard told reporters after tabling a bill that would expand coverage. “It’s a ques- tion of human dignity, equal opportunity, public health and prevention. A child, from the moment of birth, will be covered by the RAMQ, but during pregnancy, neither the child nor the mother is covered. We need to correct this incoherence which has a major impact on the lives of women and on society as a whole.” Cliche-Rivard and MDM national director Pénélope Boudreault, whose organization has long advocated for expanding RAMQ eligibility, argued that covering prenatal care would save the province money, because complications would be detected and addressed earlier. Boudreault said some new mothers at risk leave hospital earlier than they should to save money.

Not all Quebec residents without health coverage are undocumented – homeless people, people waiting for an immigration decision and some work and study permit holders are among those who may not have valid health cards. “More than half the women who come to see us for prenatal care work in health, social services and education and have work permits,” said Fernanda Gonzalez, a formerly undocumented mother who is now a peer support worker at the SPOT community health clinic in Saint-Roch. “We’re not tourists – we’re workers, students, spouses, mothers … and participants in Quebec society.”

“I had a lot of difficulties during my pregnancy because I didn’t have access to health care and because the immigration system is very complicated,” she said. “The financial burden and the stress that we have when we come out of hospital with a bill of thousands of dollars is unjust and it impacts our own health.”

Quebec City resident Andréa Mataragba-Nguiasset is a work permit holder who gave birth in August. She said she had a single prenatal care appoint- ment during her pregnancy – doctors generally recommend one per month during the first five months of pregnancy and more frequent appointments thereafter – and had to work until the day before giving birth because she was unable to see a doctor to be signed off work. “The government needs to realize that it is recruiting human beings abroad, and not just ‘labour’ – what I experienced is inhumane,” she said.

A petition launched by MDM with nearly 3,200 signatures was tabled in the National Assembly the same day by Liberal immigration critic André Fortin.

“Médecins du Monde welcomes the tabling of the petition and the bill, which reinforce the social and medical consensus of a hundred organizations and institutions in Quebec. Refusing pregnant women access to perinatal care because of their migratory status endangers their health and that of their children. We need concrete and immediate solutions for the health of all women in Quebec, without exclusion,” concluded Boudreault.

MNAs agreed to consider Cliche-Rivard’s bill. During Question Period, Health Minister Christian Dubé told MNAs he planned to establish a working group to “look at what was possible” in terms of expanding RAMQ access.