Damot Hanah, Schafers Shaina, Wiedmeyer Mei-Ling, Machado Stefanie, Tayyar Elmira, Thakore Padmini, Lavergne Ruth, Goldenberg Shira Miriam
Faculty of Health Sciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.
Department of Family Practice, University of British Columbia, 5950 University Boulevard, Vancouver, BC, V6 T 1Z3, Canada.
BMC Public Health. 2025 Apr 28;25(1):1570. doi: 10.1186/s12889-025-22673-9.
Im/migrant women (e.g., non-status immigrants, refugee claimants, students, temporary foreign workers, visitors, and other migrants) face structural barriers to health and social services access. While immigration is an increasingly recognized social determinant of health, there remains a gap in literature on how structural determinants such as immigration policies and practices (e.g., 'status-checking', immigration status) shape im/migrant women's experiences navigating health and social services. This study aimed to examine the ways in which local, provincial, and federal immigration policies shape health and social services access among im/migrant women with precarious status.
Between December 2018 and February 2020, we conducted and thematically analyzed qualitative in-depth interviews with im/migrant women (N = 51), and service providers (N = 10) across Metro Vancouver. Data were collected as part of the IRIS study, which is a community-based, mixed-methods study of im/migrants' healthcare access prior to and during the COVID-19 pandemic.
Despite policies that purportedly aim to grant access to health and social services in Vancouver regardless of immigration status, participants routinely described ineligibility and fear of detention and/or deportation as pervasive barriers to accessing services, including routine, preventive, and emergency health services, and enrolment of children in schools. Women described social isolation and exclusion as key consequences of federal immigration policies that produced precariousness through temporary and undocumented status. Overall, participants recommended for the elimination of immigration law enforcements and 'status-checking' practices in health and social settings.
Sanctuary City policies are recommended to advance im/migrants' human rights, reduce instances of delayed or denied care, untreated illnesses, and social isolation. Full implementation of Sanctuary principles at the local level (i.e., reduced collaboration between local service providers and federal immigration enforcement) is needed to improve access to health and other services based on need, regardless of immigration status. At the provincial level, elimination of 'status checking' in health settings and expansion of eligibility criteria for health, social, and education programs (e.g., Medical Services Plan, subsidized housing, and BC's School Act) to include all im/migrants should be considered. At the federal level, increased funding for programs that address inequities in health and social services produced by restrictive immigration policies and ensure pathways to more secure immigration status are recommended. Together, these policy reforms have the potential to address the structural barriers to im/migrant women's health and social services access, and ultimately improve overall public health outcomes.
移民妇女（例如无身份移民、难民申请者、学生、临时外国工人、访客及其他移民）在获取医疗和社会服务方面面临结构性障碍。虽然移民日益被视为健康的一个社会决定因素，但关于移民政策和做法（例如“身份核查”、移民身份）等结构性决定因素如何塑造移民妇女获取医疗和社会服务的经历，相关文献仍存在空白。本研究旨在探讨地方、省级和联邦移民政策如何影响身份不稳定的移民妇女获取医疗和社会服务。
2018年12月至2020年2月期间，我们对大温哥华地区的移民妇女（N = 51）和服务提供者（N = 10）进行了定性深入访谈并进行了主题分析。这些数据是作为IRIS研究的一部分收集的，IRIS研究是一项基于社区的混合方法研究，关注新冠疫情之前及期间移民的医疗服务获取情况。
尽管有政策宣称旨在让温哥华的移民无论身份如何都能获得医疗和社会服务，但参与者经常将无资格以及对被拘留和/或驱逐的恐惧描述为获取服务的普遍障碍，包括常规、预防和紧急医疗服务，以及子女入学。妇女们将社会孤立和排斥描述为联邦移民政策的关键后果，这些政策通过临时和无身份状态造成了不稳定。总体而言，参与者建议在医疗和社会环境中消除移民执法和“身份核查”做法。
建议实施庇护城市政策以促进移民的人权，减少护理延迟或被拒、疾病未得到治疗以及社会孤立的情况。需要在地方层面全面实施庇护原则（即减少地方服务提供者与联邦移民执法部门之间的合作），以便根据需求改善获取医疗和其他服务的机会，无论移民身份如何。在省级层面，应考虑在医疗环境中消除“身份核查 ”，并扩大医疗、社会和教育项目（例如医疗服务计划、补贴住房和不列颠哥伦比亚省学校法）的资格标准，将所有移民纳入其中。在联邦层面，建议增加对解决限制性移民政策造成的医疗和社会服务不平等问题的项目的资金投入，并确保获得更稳定移民身份的途径。这些政策改革共同有可能解决移民妇女获取医疗和社会服务的结构性障碍，并最终改善总体公共卫生结果。
