Pregnant women who are immigrants are still being turned away from some clinics in Gauteng, despite an April High Court ruling that pregnant women and children under six must have free access to public health services, regardless of nationality.
The ruling was in response to an application by SECTION27 and three immigrant women, who had been denied access to prenatal services, writes Kimberly Mutandiro in GroundUp.
The Department of Health said staff who violate patients’ rights will be dealt with, but that it has not yet received any complaints.
One of the women recently turned away, who thinks she is eight months’ pregnant, said staff at Jeppe and Hillbrow Clinics in Johannesburg refused her registration for prenatal care when she arrive with no residence permit or proof. She said a nurse told her to “go back and give birth in your own country”.
The Gauteng High Court last month ruled that regulations and a policy introduced by the Department of Health in 2020, denying free health care services to pregnant and breastfeeding women and young children who are asylum seekers, undocumented, or persons affected by statelessness, be declared unlawful. The department was ordered to amend its policy by 16 October.
The court said any such policies or circulars are inconsistent with the National Health Act and are invalid.
A number of pregnant immigrant women from countries like Zimbabwe, Mozambique, Lesotho, Malawi and the Democratic Republic of Congo, struggle to register for prenatal care. Some have no documents at all.
Some end up giving birth at home, risking both the mother and the baby’s lives.
Some have resorted to buying fake asylum permits and proof of residency documents, paying anything between R300 and R400 so they can register for prenatal care. The prices vary, according to how far advanced the pregnancy is. But this does not guarantee acceptance as some clinic staff now have a way of detecting faked documents.
A number of women told GroundUp they were asked to pay bribes to staff at Jeppe and Hillbrow clinic to register without valid documents, and are refused registration if they fail to pay.
In some cases, women with high risk pregnancies have been referred to Charlotte Maxeke, Steve Biko and Tshwane hospitals, and asked to pay lump sums of money upfront and being turned away if they cannot pay.
“We are facing an institutional problem within the Department of Health where staff are the very people chasing undocumented and vulnerable pregnant women from registering at clinics, and making xenophobic remarks,” said Ethel Musonza of the Zimbabwe Isolated Women in South Africa (ZIWISA).
She said this year the organisation had been approached by about 30 women, mostly from Malawi and Zimbabwe, all struggling to register at clinics.
Mbali Baduza, legal researcher at SECTION27, said denial of health care was a violation of the Constitution.
“Section 27(1)(a) of the Constitution states that ‘everyone has the right to access healthcare services, including reproductive health care’. The term ‘everyone’ has been explicitly interpreted by our courts to include foreign nationals.”
High maternity fees
In Pretoria, some immigrants from the DRC whose asylum documents had expired were registered by Doctors without Borders in Marabastad. They had been refused care at Skinner Clinic and Sammy Marks. With their registration cards they were able to attend public clinics and be referred to Steve Biko and Tshwane hospitals to deliver.
But in some cases, hospital staff told them they would have to pay R10 000 for a normal birth and R30 000 for a Caesarean birth, and that it was a requirement for foreign nationals to pay at least half upfront.
One women, whose baby is now a month old, still owes Steve Biko hospital money after having a C-section in April.
Another mother, whose baby is not even a month old, was asked to pay R10 000 at Tshwane Hospital in April and when she failed to pay, she was refused the baby’s birth records, she said.
Health Department spokesperson Foster Mohale said services at clinics and community health centres were free but both South African and foreign patients had to pay for higher levels of care in hospitals. He said everyone, except refugees with valid documents (refugee status permit), had to pay or sign a debt acknowledgment form.
“The department has a policy called the Uniform Patient Fees Schedule which determines what fees and at what level of care these should be paid.
“No patient should be denied treatment because they do not have money, especially emergency patients,” he said.
On whether the Department would comply with the recent judgment, Mohale said the Department was still studying it and would make an announcement on the next step.
See more from MedicalBrief archives:
‘Landmark’ ruling confirms free healthcare right for all pregnant women, children
Medical xenophobia and discrimination widespread in Gauteng health care
NGO takes Health MEC to court for immigrants to access healthcare