Undocumented pregnant women experience conflicting socio-political positions. As pregnant women, they tend to benefit from some minimal inclusion through access to perinatal and maternal healthcare services in most European countries. Yet as undocumented persons they are administratively excluded, and as pregnant women they tend to be stigmatized owing to the rights that they supposedly could derive from having a child. I have conducted a qualitative research into the experiences of undocumented Comorian women, who were pregnant or had recently given birth in the French overseas department of Mayotte. Mayotte is an island in the Indian Ocean that became a French colony in 1841. This French department (a status it formally obtained in 2011) of 256,500 inhabitants shares historical and cultural links with the neighbouring Comorian islands, which formed the Republic of Comoros in 1974 after gaining independence from France.
Against the background of a postcolonial territory characterized by much higher levels of social inequality than mainland France, Comorian pregnant women came to embody an unwanted presence. Due to their children’s and their own potential claims to belonging, they are perceived as a threat to the island’s socio-economic stability and French identity. And yet, at the same time, they also represent people deserving of healthcare owing to the vulnerabilities engendered by pregnancies. To explore this tension, I examine in my article migrants’ access to perinatal and maternal healthcare services in Mayotte, through the theoretical lens of deservingness.
With a rising number of births, reaching 9,800 in 2017, access to perinatal and maternal care by Comorians in Mayotte represents a highly contentious issue. While Comorian women are depicted as migrating to Mayotte for the purpose of giving birth to French children, the determinants of their migratory journeys are far more complex. The high proportion of foreign women who give birth on the island is in large part due to enduring barriers to regularisation. This complexity is however overlooked in political and media accounts, and undocumented pregnant women are recurrently portrayed as an illegitimate burden on the island’s social services.
Importantly, the stigmatising framing of undocumented pregnant women has concrete material implications. It led to significant shortcomings in perinatal care delivery and those shortages in turn worsened the quality of healthcare services for the Mahoran-French population as well, exacerbating feelings of resentment towards Comorians. In some local healthcare centres the situation became so dire that healthcare professionals could not ensure basic hygiene as they were lacking even soap and paper towels. Mariele, a metropolitan midwife at one of the local healthcare centres, deplored the crisis that resulted from the intentional underfunding of perinatal healthcare services:
The departmental council considers that it is not its responsibility to pay the personnel and the equipment for people who do not find themselves in a regular situation, that this is on the State. (…) I think that until the State gives us what it costs to attend to people who have no affiliation, the departmental council won’t use its budget.
While undocumented women in metropolitan France might experience difficulties in accessing specific PMI centres, by law these health centres attend all pregnant women and children under six without administrative discrimination. In Mayotte, the significant share of non-registered patients, but above all the detrimental political context, has led to the stigmatisation of the local health centres, associated with servicing allegedly undeserving pregnant women.
Daily interactions in the hospital maternity ward also crystallised these tensions. As Comorian migrants are blamed for many of the island’s social ills, they were also seen as the cause of unsatisfactory care. In this complex setting, Mahoran healthcare personnel, who are French, risk being criticised by other Mahorans for providing care to all patients, irrespective of their administrative status. The following anecdote recounted by Mahoran healthcare assistants shows how the care they provide becomes a contentious issue.
HC 1: Sometimes we have patients, even from Mayotte, Mahorans, with whom sometimes…
HC 2: with whom it doesn’t go well.
HC 1: it doesn’t go well. Not because it doesn’t go well professionally but it doesn’t go well because we’re Mahorans. We have to benefit from everything before…
HC 2: foreigners…
HC 1: foreigners. We work, we pay taxes, we have to benefit from everything. So sometimes they [Mahoran patients] can’t understand us as workers from the hospital. (…) For instance, here, the habit of the ward, every Tuesday when bottles of water are delivered, we give one bottle to each patient. As we can’t give one every day we tell them to fill it up when it’s empty. But there are some, they go ‘Me, I work, I pay taxes, so I demand a bottle of water every day. I won’t bother filling it up over there, I’m not illegal. I don’t drink tap water’. So it’s a bit complicated sometimes.
Maternity care sits at the heart of the political battle as to who deserves to belong and access social services. The shortcomings of the local healthcare centres are not only about access to shared resources but also about the boundaries of who is Mahoran and thus French. This political battle unfolds against the background of a peculiar ‘us and them’ context, in which ‘they’ are recognised as related to ‘us’, owing to the socio-cultural ties that stretch across the Comorian archipelago. But against the background of the island’s relatively fragile position in the French postcolonial assemblage, pregnant women’s access to healthcare services is not only undermined but also politically weaponized.
About the author
Nina Sahraoui is a Postdoctoral Researcher at the Paris Centre for Sociological and Political Research.