Spain
In Spain, access to healthcare is regulated by "Royal Decree-Law 7/2018, of July 27, on universal access to the National Health System". Among the national legislation, one article refers specifically to the migrant population, both men and women. This is Article 3.b. "Protection of health and healthcare of foreigners who live in Spain but are not legal residents of Spain". Section 1 states that "Foreigners who are not registered or authorised as residents in Spain have the right to benefit from health protection and healthcare under the same conditions as Spanish nationals" (Art. 3.1). Based on this, all migrants (men and women) have access to the health system. They must, however:
· Provide identity documents.
· Prove they have effectively resided on Spanish territory over the last 90 days.
· Show that they are not able to export their right to healthcare from their country of origin to Spain.
· Prove that no third parties are obliged to pay.
Although these legal premises reinforce the universality of health, the health management model in Spain is decentralised. Each Autonomous Community has powers to implement the aforementioned article, as determined in section 3. "The Autonomous Communities, within the scope of their competences, shall establish the procedure for the application and issuance of the accrediting document authorising foreigners to receive the assistance referred to in this article. [...]".
In this sense, although Spanish state regulations advocate universal access to health care (including foreigners), the established procedures make it very difficult for many of them to access health services. An example of this is the language barrier that often makes medical care difficult. The Autonomous Communities usually offer simultaneous translation services (for example, the Linguistic Translation Service,of "Health Responds", in Andalusia), but they involve additional procedures for foreigners. Being unaware of the existence of these services also often means that women do not have access to health care. Pérez-Urdiales, & Goicolea (2018) established that in Spain, immigrants use more emergency services and less specialised care services compared to the native population. In addition, with respect to sexual and reproductive health, immigrant women attend less, and later, to prenatal control visits compared to native women. They also use contraceptive methods less, or more inadequately, and have a greater number of children, present a lower first-pregnancy age and a higher proportion of voluntary interruptions of pregnancy. These authors detected that immigrant women\'s access to public health services and sexual reproductive health was conditioned by factors such as: personal characteristics; the origin of the women themselves (a very strong factor); the attitudes of administrative and health staff towards their care; the functioning of the health system and health policies; and their lack of awareness of their rights in relation to health.
To end this chapter, students can consult the following success story of a migrant woman in Spain, entitled "Surmounting obstacles as a way of life. Crossing borders: Portugal, Venezuela and Spain"," accessible at https://viw.pixel-online.org/case_view.php?id=Mjg= This success story shows how the disabled daughter of one of the migrant women interviewed in Spain gains access to the health system.
References
Pérez-Urdiales, I., & Goicolea, I. (2018). ¿Cómo acceden las mujeres inmigrantes a los servicios sanitarios en el País Vasco? Percepciones de profesionales sanitarias. Atención Primaria, 50(6), 368-376.
Online Resources
Competences in the management of health regions: Germany, Poland and Spain https://academic.oup.com/eurpub/article/31/Supplement_3/ckab164.775/6405274?login=true
This article presents how to manage the health system in Spain compared to other countries.
Supporting immigrant women in an intercultural mediation health programme https://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1135-57272014000200012 This article presents a study where intercultural mediation is a fundamental strategy for quality social and health care for immigrant women.
Ugarte Gurrutxaga MI and Ulla Díez, SM. Barriers to Adherence to the Maternal Healthcare in Immigrant Moroccan Women in Spain. A Qualitative Study. Nurs Health Care Int J 2019, 3(6): 000210. https://www.researchgate.net/profile/Idoia-Ugarte/publication/338043730_Barriers_to_Adherence_to_the_Maternal_Healthcare_in_Immigrant_Moroccan_Women_in_Spain_A_Qualitative_Study/links/5dfca9aa4585159aa48ab17f/Barriers-to-Adherence-to-the-Maternal-Healthcare-in-Immigrant-Moroccan-Women-in-Spain-A-Qualitative-Study.pdf
This article analyses the barriers of access to maternal health services in Spain, through in-depth interviews with Moroccan immigrant women, health professionals and cultural mediators, in the context of the pregnancy care programme.
Bonmatí-Tomas, A., Malagón-Aguilera, M. C., Gelabert-Vilella, S., Bosch-Farré, C., Vaandrager, L., García-Gil, M. D. M., & Juvinyà-Canal, D. (2019). Salutogenic health promotion program for migrant women at risk of social exclusion. International journal for equity in health, 18(1), 1-9. https://equityhealthj.biomedcentral.com/track/pdf/10.1186/s12939-019-1032-0.pdf
This article analyses the effectiveness of a health promotion programme directed towards empowering immigrant women at risk of social exclusion. It concludes that the health promotion programme reduced perceived stress, increased physical quality of life and showed a trend towards increasing self-esteem, especially among migrant women with multiple vulnerabilities.