The cause of the death of a three-month-old infant at the emergency shelter in Ter Abel on Wednesday is not yet known. A spokesperson for the Central Agency for the Reception of Asylum Seekers said: “We are doing everything we can to get all vulnerable people through the gates and provide care, but death has shaken us again.” The death underscores the vulnerable position of pregnant asylum seekers and children at asylum reception. On paper, asylum seekers have the same rights to care around and after birth, from obstetricians to maternity and child health clinics. Researchers say maternity care for asylum seekers is often inadequate in practice.
“Actually, at the moment we don’t know what happened. Sometimes newborns and infants die, and there can be a natural cause for that,” says Simon Gossen, refugee health care advisor for the Johannes Wehr Foundation for Health Care and Human Rights. At the same time, it is clear that there is still much room for improvement in the care of pregnant women and newborn refugees.”
For example, more children of asylum seekers die at birth than Dutch children. In 2020, researchers saw that 3.6 percent of children born between 2012 and 2016 in asylum seeker centers in Ter Apel and Muslcanal had died. The mortality rate for children born to mothers in northern Holland was 0.6 percent in the same period. After adjusting for birth weight, the infant mortality rate of asylum seekers was seven times higher. The risks are also increased among pregnant women themselves: In 2011, researchers concluded that the maternal mortality rate at childbirth is ten times higher among asylum seekers. compared to Dutch women.
Low birth weight
Pregnant asylum seekers also score worse in other aspects of health. For example, asylum seekers give birth to babies with a lower birth weight, often have complications related to delivery such as bleeding or rupture of the uterus and are more likely to develop postpartum depression.
How do these differences arise? This is partly due to the conditions under which people arrive. Asylum seekers often experienced health arrears during the trip and the stress of an uncertain stay. “If you don’t feel safe, pregnancy doesn’t come first,” says Anuk Virshorin. She studies pregnancy care for asylum seekers at the University Medical Center Groningen and is a co-author of the study on perinatal mortality.
If you don’t feel safe, pregnancy doesn’t come first
Anouk Vershoren Check into pregnancy care for asylum seekers at UMC Groningen
Social isolation is a risk factor for pregnancy complications. In addition to friends, neighbors, and family, pregnant women asylum seekers often lack a partner. In another study from 2021, Verschuuren saw that 45 percent of women who gave birth in an asylum center between 2016 and 2021 did not have a partner at that time. Of the 72 teenage mothers during that time, nearly 70 percent were unaccompanied minors.
Then there is inequality in access to health care. Asylum seekers in the Netherlands begin prenatal care at a later time, according to interviews with midwives. “Dutch care is organized on the basis of patient responsibility: If you don’t go to the midwife, the midwife won’t go after you either,” Verschoren says. An asylum seeker who does not know the system and the language cannot navigate it. So you don’t understand that blood should be drawn. So you don’t know who to call on the weekend.”
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And each transfer means a new transition between midwives, GPs, and other health care providers. Of the asylum seekers who were born in an asylum center between 2016 and 2021, 70 percent were transferred at least once during their pregnancy. 28 percent of pregnant women were transfused at least twice, and in some cases the woman was transfused five, six, or seven times. The Dutch directive on maternity care for asylum seekers states that pregnant asylum seekers should not be transferred six weeks earlier than the scheduled date and six weeks after that in order to ensure continuity of care.
Simon Jossen of the Johannes Wehr Foundation says relocations have been a problem for years. “Pregnant women and newborns should be moved as quickly as possible to a reception site where care is well arranged, and which COA is sure to remain open. A place where you can meet other pregnant women, and that provides tremendous support.”
Communication often goes wrong between caregivers and asylum seekers. The use of an interpreter is compensated for in the care of asylum seekers, but caregivers do not always use it. The Health Care Inspectorate concluded in 2014 that interpreters were underutilized in maternity care for asylum seekers. And again: the translator is not the cure. If you know what someone is saying, it doesn’t mean you fully understand the patient,” says Verschoren.
Moreover, there is still a lack of informational materials in different languages. “This year, we quickly collected information on pregnant Ukrainian refugee women for the College of Perinatal Care,” Gossen says. “With a heavy heart you should conclude: We should have had this for all these other pregnant women for years.”