Probing the Context of Vulnerability: Zimbabwean Migrant Women’s Experiences of Accessing Public Health Care in South Africa
SIHMA had the pleasure of reading the latest edition of the African Human Mobility Review (AHMR) Volume 7 Number 1 and specifically in this blog post focuses on the first article named ‘Probing the Context of Vulnerability: Zimbabwean Migrant Women’s Experiences of Accessing Public Health Care in South Africa’ by Victoria M Mutambara and Maheshvari Naidu . You can find the article here. SIHMA has also previously written a blog post about this Volume of the journal.
According to International Migration Data Portal, there were roughly 2.9 million migrants in South Africa by mid-year 2020. Of that 2.9 million, 380,000 are believed to be migrants from Zimbabwe . According to UNDESA, roughly 164,000 of Zimbabwean migrants are female.
According to Migration Data Portal, there were roughly 2.9 million migrants in South Africa by mid-year 2020. Of that 2.9 million, 380,000 are believed to be migrants from Zimbabwe . According to UNDESA, roughly 164,000 of Zimbabwean migrants are female . Migrant women are at a higher risk of violence than men . For example, they are subject to sexual and gender-based violence, exploitation, forced labor, and health vulnerabilities. The article further examines the extent to which social and institutional factors of vulnerability impact Zimbabwean migrant women’s access to public health care in South Africa . The negative experiences of migrant women in public hospitals cannot solely be attributed to their identity as foreigners because they are also affected by the ‘crisis of care’ that impacts any patient, no matter their citizenship status, using the public health-care system in South Africa .
While South Africa is believed to be one of the most progressive countries regarding immigration laws and policies, some findings suggest there are contradictions and challenges. Under the United Nations Charter, the Universal Declaration of Human Rights was adopted to strengthen the principle that every human is entitled to inalienable rights . Article 25 of said document explains that “everyone has the right to a standard of living adequate health and well-being of himself and of his family” . So, migrant women, no matter their legal status, have the right to health-care services. The 1996 South African Constitution was created with these principles in mind. Regarding migrants and refugees, South Africa looks to the National Health Act of 1998, the Refugees Act of 1998, the Immigration Act of 2002 . The National Health Act sets forth the principle that health care will be provided to vulnerable groups; however, they do not include migrants and refugees under this principle . The Refugees Act of 1998 follows suit in providing public health services as it emphasizes refugees are entitled to basic health services. The Immigration Act of 2002, however, contradicts the preceding health laws, as it requires health-care workers to demand the legal status of patients before administering care .
South Africa has adopted a two-tier health system, meaning patients can either use the public health care route or opt for the private health-care system . While there is the option for private health care, 84% of South Africans depend on the public health sector . South Africa is known to be one of the countries that invests a substantial amount of money into their public health-care system; however, there is still a lot of room for improvement . For example, hospitals are under-resourced, and doctors and nurses are demotivated because of staff shortages . So, there are prolonged waits for services, abusive attitudes experienced by staff, and expensive treatment of care . Migrant women not only deal with these challenges, but also the challenges of being a migrant in South Africa. Mutambara and Naidu’s paper focused on the theoretical lenses of structural violence theory. As such, they see violence as not always clearly noticeable, but instead invisible in social structures normalized by institutions . So, they use this theory to illustrate the differing forms of invisible violence that create barriers for migrant women to access public health-care services in South Africa. Migrant women have health needs specific to them, since they are exposed to health risks at various stages of migration . For example, migrant women often end up in insanitary conditions which increases their risk of illness . So, migrant women especially need health-care.
Mutambara and Naidu based their paper on a qualitative study with Zimbabwean migrant women in Durban, South Africa. They interviewed 21 female migrants, ages 25 – 49, and all of whom were self-employed . In their study, they found three areas of challenges in accessing health-care services for Zimbabwean migrant women. First, South Africa demands legal immigration documents to access health-care services . So, if undocumented, it is almost impossible to receive care from the public sector; Instead, some women opted for the private sector because they are more concerned with the patient’s ability to pay rather than their legal status . Since not all migrant women can afford the private sector, the need for legal documentation is a direct barrier for migrant women to access health-care services. In relation to COVID-19, South Africa is excluding millions of undocumented migrants, including women and children . Since documentation of citizenship is required at vaccination sites , undocumented individuals are not able to receive the vaccine. Advocate Jason Brickhill, a constitutional lawyer, believes this policy to be unconstitutional since South Africa’s constitution upholds the right to health for everyone in South Africa .
Furthermore, the communication between health-care workers and migrant women resulted in more barriers because the workers communicated to them in the local language, which migrant women cannot understand . This language barrier is a visible marker of difference which leads to xenophobic attitudes from some of the workers. The use of English by the Zimbabwean migrant women oftentimes led to hostility . Even migrants with legal status faced backlash for speaking English .
Finally, Zimbabwean migrant women found it difficult to receive sexual and reproductive healthcare, especially after giving birth . For example, some women received an injected contraceptive without giving consent to it or being aware of it and only when experiencing health problems related thereto were advised that the contraceptive had been administered at the hospital after they gave birth to their child . Findings have shown that migrant and refugee women are frequently not asked for consent before they are administered contraceptives and only after experiencing medical difficulties in some cases learn they were given a contraceptive injection . In another study it was observed that there are also cases in which ‘Somali women are facing a big problem at clinics, as some women are being sterilized without their consent’ . The problem of forcing contraceptives onto women is not bound to just South Africa. In the Xinjiang Province of China, Uyghur women are being forcibly sterilized, . Although regarded as autonomous, the Province is under China’s control. Over a million Uyghurs have been detained and used as forced labour, along with women being forcibly sterilized . Evidence has been released suggest the United States has the same practice in the immigration detention facilities along the United States-Mexican border . With all forced and coerced sterilizations, the coercion has taken primarily three forms: the women’s consent was obtained under duress, the consent was invalid because of lack of information or the women’s consent was not obtained at all . So, women must be provided the right to information, the right to liberty, the right to be free from cruel and degrading treatment, and the right to non-discriminatory practices .
Mutambara and Naidu illustrate the inconsistency in the policies regarding the healthcare of migrants and refugees, and specifically the challenges migrant women face. Along with legislative reform, the power dynamics between healthcare workers and migrant women must also be challenged, as Mutambara and Naidu argue.
James Chapman and Mary Cascarelli
Project Manager Research and Communications Intern
We encourage readers to read the full journal article  and others in this volume and to also look to SIHMA’s previous blog post in our exclusion of migrant women series which related to access to health care accessible at: https://sihma.org.za/Blog-on-the-move/exclusion-of-migrant-women-access-to-health-care
- A. Rachid, October 2015 referenced in AHMR Journal, Turning a Blind Eye to African Refugees and Immigrants in a Tourist City: A Case-study of Blame-shifting in Cape Town: https://sihma.org.za/journals/AHMR%206:1%20-%2002%20Turning%20a%20Blind%20Eye%20to%20African%20Refugees%20and%20Immigrants%20in%20a%20Tourist%20City.pdf