Access to Perinatal Care for Undocumented Residents in Ontario, Canada

Background and Purpose: Canada has a universal healthcare system and most citizens and permanent residents access healthcare at no cost through their provincial health insurance. However, undocumented residents are ineligible for provincial health insurance and face multiple barriers to accessing healthcare, including high fees and fear of immigration authorities. In response to the COVID-19 pandemic, between March 2020 and March 2023, the province of Ontario extended free hospital care to uninsured residents through the Physician and Hospital Services for Uninsured Persons (PHSUP) program. This paper examines the experiences of undocumented mothers seeking perinatal care in the Greater Toronto Area (GTA) prior to and during the PHSUP, with the goal of better understanding the barriers faced by this population and how these were impacted by the PHSUP.

Methods: This paper presents research from a larger project examining access to social programs for undocumented mothers with young children living in the GTA. Using narrative methods, the study combined a policy review and 23 interviews with undocumented mothers (n=11) and service providers (n=12), including social workers, family support workers, and healthcare providers. Participants were recruited through partnering community agencies, social media groups and snowball sampling. Mothers identified as Latina (n=7) and Afro-Caribbean (n=4). Relevant federal, provincial, and municipal policies regulating access to healthcare were reviewed. Narrative interviews focused on understanding the experiences of undocumented mothers in accessing social services and healthcare. Interviews were analyzed using a thematic narrative approach through theoretical and inductive coding using NVivo software.

Findings: Findings show that community health centers and midwifery services are critical in providing access to perinatal care for undocumented residents, although there are important gaps in these services. Gaps include: 1) long wait-lists due to insufficient capacity to meet demand; 2) geographic disparities in access to services; 3) insufficient access for high-risk pregnancies needing specialist care; and 4) a lack of information about the services within undocumented communities. As a result, not all participants had been able to access these services, and one participant did not access any perinatal care until going into labour.

Prior to the PHSUP program, mothers were charged high fees for childbirth and specialist services, resulting in large hospital bills that contributed to family poverty. The PHSUP program markedly improved access to hospital care, eliminating these financial barriers. Yet even under the PHSUP, barriers to hospital care remained, including a lack of awareness about the policy, and discrimination and denials of care from frontline hospital staff.

Conclusion and Implications: Findings show that the PHSUP program had a positive impact in eliminating financial barriers to perinatal care for undocumented residents in Ontario. Despite the program’s success, the provincial government canceled the PHSUP in March 2023. These findings underscore the need for the government to reinstate a similar program to ensure access to perinatal care, and highlight the importance of healthcare staff training and outreach to undocumented communities to ensure the effective implementation of future healthcare access policies.