Equal access to vital maternal healthcare for vulnerable refugee women across Europe remains a challenge.

Research & policy recommendations published during Safe Motherhood Week – based on direct experience of 14,000 refugee women


Securing equal access to primary health care and maternal health for pregnant migrant and refugee women remains a great challenge across Europe and if pursued can be cost beneficial to national health care systems in the future. That’s according to new research of almost 14,000 refugee women who received care from Doctors of the World (Medicins du Monde) following their arrival in Greece.

The research reveals the significant challenges refugee and migrant women across Europe face in accessing maternal healthcare, and the implications this is having on the health and mortality rates of mothers and their babies. Doctors of the World Greece, an international humanitarian movement surveyed over 14,000 women who received care through the Mother & Child Programme which was funded by a grant from MSD for Mothers, a global initiative which aims to address issues related to maternal health.


The research also explores the economic analysis around providing equal access to regular maternal healthcare for refugees, as opposed to emergency-only care.  Despite widely held views that EU member states can’t afford to provide equal access to care for refugees this research shows that access to quality care is likely to generate long-term cost savings for health authorities and alleviate pressures on healthcare systems across Europe in the future.

The research findings prompted Doctors of the World to develop the ‘Refugee Health Policy Recommendations’ to aid European Governments and EU Institutions in planning to meet the health needs for these migrants who are being relocated to countries across Europe.   The research findings were presented at “Unspoken Voices: Meeting the health needs of women refugees across Europe”, an international conference held in Athens on 3rd October organised by Doctors of the World to highlight the issue as part of Safe Motherhood Week 2017 (2-9th October)

A report from the European Observatory on Health Systems and Policies two years after the first European research, in 2012, showed that for 72% of the health problems refugees faced they received either inadequate or no medical care.  In addition less than 47% of refugee women in the survey had access to reproductive healthcare prior to the intervention by the Doctors of the World Mother & Child programme. Early and ongoing maternal care is essential to reducing death and long term health problems for mother and child.


Access to health care for pregnant migrants and refugees varies between European countries, but has limitations and restrictions in all of them.  The research of women conducted by Doctors of the World has identified a range of barriers these vulnerable women face in getting care including:


  • Prohibitive costs, which in most cases includes 100% of the total cost of their medical care. This has particularly been identified as a barrier in countries such as France, Belgium and the UK.
  • Lack of awareness of their rights and poor understanding of the workings of the healthcare system due to different cultures, expectations, languages and beliefs with a significant number of mothers who are entitled to insurance coverage not being aware of it.
  • The complexity of the health care and/or insurance system.
  • Fear of complaint, arrest, discrimination or denial of medical care.
  • Political barriers, including but not limited to the political pressure to deter migration, which generates fear among women.
  • Limitations on the free maternal care mothers are entitled to receive and cumbersome administrative requirements involved in accessing this care.
  • History of previous abuse before, during and after migration.
  • Living in conditions or geographical exclusion, e.g. living in a camp, which seriously limits access to health care.


In response to the research findings, and the experience of the refugee women, Doctors of the World has outlined a set of policy recommendations designed to address the equity of access issue.  The policy paper entitled, “Refugee Health Policy Recommendations for European Governments and EU Institutions” calls on all EU Member states and institutions to study the research supporting the recommendations and unite in supporting it (see Notes to the Editor).


The conference, research and policy paper also mark the one year implementation of the Mother & Child programme, a two-year initiative aimed at providing quality maternal healthcare services to pregnant women and babies from vulnerable populations.  The programme was implemented by the Doctors of the World Greece and supported by a grant from MSD for Mothers (www.msdformothers.com).  Since launch in 2016 the programme has provided medical services to over 31,000 vulnerable and pregnant women and paediatric services to 5,000 infants and newborns.


Dr. Nikitas Kanakis, president of Doctors of the World Greece, said

“Every mother deserves good care before, during and post pregnancy, their residential status should not affect this basic right, and our research and the experience from our programmes shows providing equal access will improve and save lives, whilst also reducing pressures on hard-pressed healthcare systems around Europe.”

“Doctors of the World facilities (clinics and mobile units) are working hard to address this issue. We are passionate about the provision of good maternity care to vulnerable women and the value it has in safeguarding the long-term health of mother and child and maintaining strong families and communities. We believe all EU member states and EU institutions should put this issue higher on their political agendas. With rising rates of migration, it makes economic sense to act soon.”

“We hope our Refugee Health Policy Recommendations will spur EU institutions and member states to join together to tackle the barriers vulnerable mothers and other migrant women face in trying to get good care.”


Mary-Ann Etiebet, Director, MSD for Mothers, said:

“Access to quality maternal healthcare can save lives, yet across Europe the most vulnerable pregnant women are still facing challenges in accessing this basic care. We must work together to address this issue before it escalates further. Access to maternal healthcare for every mother has to be a priority.  We would like to engage with European Governments and EU Institutions to listen to what women in the research have told us are their challenges and to implement the policy recommendations announced by Doctors of the World today which call for a removal of the barriers and challenges to this vital care.”