France
In France, migrant women’s access to health services and the social security system depends mainly on whether they have a residence permit or their working situation. All foreigners, including asylum seekers, can have access to the social security system through several measures:
1) AME (Aide médicale d’Etat- State Medical Assistance) is a social assistance program intended to cover the medical expenses of foreigners living illegally on French territory. The access to this measure is under conditions of residence (>= 3 months) and resources (ex. < 9041€/year for one person). The dependents (person with whom you live as a couple and children under 16 or under 20 if they are doing studies) can also have access to this measure. It’s delivered in general for one year and the renewal should follow the same procedures two months before the expiry date. The children, whose parents have no access to AME and have no residence permit, can unconditionally have access to social health care through AME.
2) CSS (Complémentaire santé solidaire - Complementary health insurance) covers French residents and foreigners having a residence permit (including asylum seekers who are waiting for the decision), under conditions of their revenues (same as for AME).
3) If the migrants’ income exceeds the limit, they can benefit from a general regime of the social security system for which they paid the social security contributions.
For several years, the access to health care coverage for migrants are tightened:
- Since 2019, for those whose residence permit expires, or the asylum seekers whose demand is rejected, their access to health protection is maintained for 6 months, instead of 12 months as it used to be. They should apply in this case the AME whose delay takes 2 months.
- Since January 2021, certain non-emergency care and treatment are only covered after a period of 9 months after admission to the AME for all new beneficiaries or for those who have not received the AME for more than one year.
- Administrative supporting documents proving the 3 months’ stay in France are now necessary, while it used to be declarative. And a physical presence is required if you apply for it, while the postal delivery of the demand’s file was sufficient.
For those whose access to the health care is not (yet) delivered, they can only count on help from the state or associations and NGOs via special measures such as the PASS (permanences d\'accès aux soins de santé - Health care access offices) providing an unconditional reception and support in accessing the health care system for people without medical coverage or with partial coverage. Medecin sans frontier and Medecin du monde offer health care services for all those living in a precarious situations and in need. Daycare centers for the homeless run by the Paris City hall for example have free doctors’ consulting. During the Covid-19 crisis, the access points of vaccination were implemented in emergency centers or on the street by the associations and supported by the state, so that those in the precarious situation can get the Covid vaccination for free.
The migrant women can also rely on associations specialized either in health care for all women or in health care for migrant exiles.
For example:
- Agir pour la Santé des Femmes is one association that aims to improve the care of the most precarious women (homeless, isolated, victims of violence or victims of human trafficking). Their actions try to detect psychological problems or violence related to their gender (violence, rape, sexual practices, genital mutilation, forced and early marriages, etc.). Prevention and screening are one of their focuses. They provide also easier access to contraception and raise awareness on women’s rights.
- SOLIPAM network brings together medical and social professionals in order to ensure and optimize this care for pregnant women (with the desire to keep the pregnancy or not), young mothers and their children, until the 3rd month after the birth. Their target public is mothers and children in very precarious situations due to a lack of coordinated care adapted to their needs (somatic and psychological danger and a mother-child relationship that can be seriously disrupted with often irreversible consequences).
- COMEDE (Comité pour la santé des exilés - Committee for the health of exiles) has activities of reception, care, and support of exiles, as well as information, training and research. They give support in social, legal, medical, mental health, and prevention areas.
Still, we can observe the barriers that need improvements:
- the language barriers for migrant women to access health care represent a high cost either in terms of translation fees for health services or in terms of no seeking for care. There is also a lack of culturally competent and sensitive services;
- the lack of psychological health care services taking into account of the special needs of migrant women. It means a long waiting time for migrant women to have access to these services;
- social and cultural stigmas relating to health, especially mental health, prevent women from seeking help.
References
Unmet healthcare needs in homeless women with children in the Greater Paris area in France
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0184138#references
This article identifies unmet healthcare needs in homeless women and analyzes associated factors.
Access to healthcare for undocumented migrants in France: a critical examination of State Medical Assistance
https://doi.org/10.1186/s40985-016-0017-4
This article argues for the necessity of health protection for undocumented migrants, especially during the political debates tending to make their access to health care more difficult.
Discrimination in healthcare as a barrier to care: experiences of socially disadvantaged populations in France from a nationally representative survey
https://doi.org/10.1186/s12889-019-8124-z
This study presents how the experiences of discrimination within healthcare become a barrier for people that are socially disadvantaged due to gender, immigration, race/ethnicity, or religion.
Immigrants’ Health Status and Use of Healthcare Services: A Review of French Research
http://www.irdes.fr/EspaceAnglais/Publications/IrdesPublications/QES172.pdf
Through a review of French research on immigrants’ health status, this article notices a deterioration of immigrants’ health status and lower use of health care services. It calls for an adapted health policies aimed at improving access to healthcare for migrants.