Canadian government-assisted refugees are less likely to receive adequate prenatal care than privately sponsored refugees, a new study has found.
The research, published in Canadian Medical Association Journal Monday, included nearly 2,800 government-assisted refugees and nearly 2,400 privately sponsored refugees who settled in Ontario between 2002 and 2017.
“Refugees are vulnerable, but a pregnant refugee is especially so,” said Dr. Andrea Evans, a pediatrician and researcher at the Children’s Hospital of Eastern Ontario.
The researchers used the public medical system’s billing codes to identify participants in the study and what kind of visits they paid to doctors and nurses.
Adequate prenatal care was based on three professional guidelines: whether it began within 13 weeks of gestation, whether pregnant women received a minimum number of prenatal care visits, and if they received an ultrasound at a key window in their pregnancy.
After adjusting for the influences of education, language ability, income and any comorbidities, researchers found a seven per cent gap in prenatal care separating the two refugee groups — a “significant” difference.
“There's something about being in a sponsorship group that allows those refugees to get the same care as long-term residents,” Evans said. “I think that speaks to the strength of the relationships between those citizens and those refugees.”
A ready-built community
Government-assisted refugees arrive in Canada with support from the federal or a provincial government. Social services are often accessed through non-profit service providers working with government funding, according to Immigration, Refugees and Citizenship Canada.
When privately sponsored refugees arrive in Canada, on the other hand, a group of volunteers helps them adjust to their new life. That means offering at least one year of help to find a place to live and gain access to food and clothing. The private citizens groups also back the newly arrived immigrants with financial, social and emotional support.
More than 350,000 refugees have been resettled under the plan since it was launched in 1978. Last month, Minister of Immigration, Refugees and Citizenship Sean Fraser announced the program would be increased to 13,500 individuals in 2023, a 10-fold increase from 2012 levels.
The program is expected to further balloon, with the federal government planning to bring in 83,500 privately sponsored refugees over the next three years. That would account for almost 60 per cent of the 144,000 expected to be settled over that period.
It’s a made-in-Canada model other countries — including the U.S., several European countries, Argentina, Australia and New Zealand — are just starting to pilot. Evans says her and her colleagues' study provides evidence that it could have some real benefits.
“It’s really important to look at the strengths of this private sponsorship program as another avenue to resettle refugees in a world where there's an increasing amount of refugees,” said Evans. “Canada has been a leader. And we're the only ones that have any studies and data.”
Evidence Canadian-made solution should be scaled up
Despite not coming out on top, the researchers found government-assisted refugees still appeared to be benefiting from settlement services that help them navigate the health-care system.
The study also found all immigrant groups were more likely to receive adequate prenatal care than long-term Canadian residents. That could be because refugees are coming into contact with the Canadian medical system for the first time and many refugees might require more counselling.
What needs to happen next, added Evans, is to scale those relationships up so asylum seekers can overcome their own, more significant barriers to medical care.
Asylum seekers claim refugee status when they arrive in a new country. But in Canada, they don’t land with the same kind of provincial health coverage as government or privately sponsored refugees. That combined with language barriers and a lack of understanding about how things work in a new country can lead to real obstacles to accessing health care.
Evans said that's especially important for pregnant mothers. Prenatal care, said the pediatrician, is one of the highest priority health-care services a government can provide vulnerable people.
“[It's] essential care,” said Evans.
“Prenatal care affects the health of not only the person who's pregnant, but also that future baby.”
