Certain immigrant populations in Manitoba are facing growing challenges in accessing reproductive healthcare, as shifting policies push them into a system of fragmented private insurance coverage.
Lindsay Larios, an assistant professor in the U of M’s faculty of social work, examines how these policies disproportionately affect international students and migrant workers, forcing them to navigate a patchwork of private insurance plans that often fail to provide essential reproductive care.
One of Larios’s recent projects examines access to reproductive care for Manitobans without access to public health insurance. International students, she explained, are the largest group of publicly uninsured individuals in the province and are often forced to rely on private health insurance. Migrant workers with limited work permits, asylum seekers and those transitioning between different immigrant statuses may also be ineligible for public insurance.
While some private health insurance plans are comprehensive, others are not. Many of these less comprehensive plans fail to include reproductive and perinatal care.
“International students […] who find themselves pregnant can be caught off guard when they realize their private insurance plan doesn’t cover this kind of care that they need and then are put in a really difficult position where they need to pay out of pocket if they want to continue on with the pregnancy,” Larios said. “It can be a really difficult and challenging situation to be in.”
While domestic students can manage their pregnancies, attend medical appointments and continue their studies, international students attempting the same face “astronomical” costs. Larios noted that this disparity highlights inequities in reproductive healthcare and education.
Pregnancy, she emphasized, should never be a barrier to pursuing an education.
“I raise this as a particularly important issue, because up until 2018, international students did have access to public health care in Manitoba, and that was taken away,” Larios said. “They were kind of pushed into this privacy system where we’re seeing all these challenges.”
In her doctoral dissertation, Larios examined the reproductive healthcare experiences of immigrant women without access to Canadian public health insurance.
Struggling with overwhelming costs — ranging from $6,000 to $23,700 for prenatal consults and hospital deliveries (excluding ultrasounds) — many women reported foregoing food and heating in the winter, feeling pressure to terminate their pregnancies and working as long as possible even with high-risk pregnancies.
Among these women is Elodie, an immigrant worker living in Canada on a closed work permit tied to a single employer. After becoming pregnant, Elodie found herself in a precarious situation as her visa neared expiration. Losing her work permit meant losing public healthcare coverage, leaving her responsible for the $5,000 cost of delivering her baby. Her once supportive employer refused to renew her work permit, citing her pregnancy.
Desperation set in.
“I was in survival mode,” Elodie said, recounting her search for ways to cut costs, which included considering abortion at 18 weeks.
At one point in her pregnancy, a hospital refused to perform a critical $500 ultrasound unless she paid an additional $2,500 fee to cover half the costs of her future delivery. Elodie underscored her frustration at the hospital’s failure to inform her of the additional costs beforehand and her worry that, without an ultrasound, her baby’s health was at risk.
“It was like my health was depending on money,” Elodie said. “The health of my baby was depending on money. It was not human. It’s not what our society is.”
Ultimately, Elodie paid $7,000, including $2,000 in cash for her ultrasound. The residual effects of Elodie’s experience led to her falling into a deep depression.
“Now you are living that with your baby, and the baby is in good health, and you look fine, but all the pain and the struggle is inside,” she said. “It’s silent pain. I was traumatized.”
Elodie’s story illustrates the vulnerabilities of many pregnant immigrant women in a system where healthcare is conditional, creating financial and emotional burdens for those navigating its limitations.
“We’re at an interesting moment,” Larios said. “We’ve seen some promises to help expand coverage again […] but we still need some, I think, increased pressure.”
“Through research, we can create spaces where communities can have a voice within these broader discussions of policy debates around things like reproductive rights, reproductive health care [and] expansion of health care,” she said.
