Abortion has been largely decriminalized in Colombia since 2006, though women face significant barriers—from social stigma to being turned away from health structures—when requesting safe abortion care within the health system. In Milagro’s case, she says her life was at risk. Having received three Caesarean sections for previous deliveries, she’d been warned by a doctor in Venezuela that to become pregnant again would be dangerous. If she hadn’t found MSF, she said, she would have ended the pregnancy one way or another. Milagro was at risk for both complications during delivery and unsafe abortion—two of the biggest causes of maternal mortality around the world.
In Colombia—in La Guajira, as well as in Arauca and Norte de Santander departments—MSF is working to fill substantial health care gaps for Venezuelan migrants. While public hospitals are legally required to provide emergency care to whomever needs it, those services are limited to immediate lifesaving treatment, vaccinations, and deliveries. This leaves a lot of essential health needs unmet, including for women, which is why MSF has made sexual and reproductive health care—services that prevent maternal deaths and injuries—a major focus of our response to the migration crisis.
One key strategy to preventing maternal deaths is providing contraception—not just condoms, but a variety of methods that fit the needs of the individual woman and give her control of their use. This service has been well received by Venezuelan women in La Guajira, said MSF Project Coordinator Elsa Soto. “The demand is so huge that in only four months just one of our (three) teams … has tended to more than 750 family planning consultations,” said Soto.
The long-term subdermal implant, like the one Milagro received, is the most requested method, according to MSF’s Dr. Helen Aragón. “Many of them come only to see us and go back to their country, or they are constantly in and out of the country,” she explained. Contraception is unaffordable for many people in Venezuela, who are often primarily concerned with being able to buy food. MSF provides the five-year implants, three-month or monthly injections, pills, and IUDs, as well as condoms.
The demand is so large, said Soto, because women who’ve fled their country and have no stable income, no safe place to live, and may already be struggling to care for their existing children, often aren’t ready to become pregnant again.
Providing preventative care
Nevertheless, MSF is also responding to a high demand for antenatal care in La Guajira. “There is an incredible amount of pregnant women (coming from Venezuela),” said Soto. “ Most of them being in their second [or] third trimester without having had any kind of antenatal care, which creates more mortality; more complications.”
MSF teams at two hospitals and four different mobile medical clinic locations in La Guajira see pregnant women for regular antenatal check-ups, providing prenatal vaccinations and testing and treatment for tetanus, anemia, malnutrition, and sexually transmitted diseases. Patients are also checked and treated for high blood pressure, which can cause life-threatening problems for mother and baby. They receive prenatal vitamins and discuss their birth plan.
Every MSF team responding to the Venezuelan migration crisis in Colombia also includes a social worker, in part because many patients report being denied emergency care in government hospitals, including for deliveries. Social workers make certain that pregnant women receive the care they are legally entitled to so they are not left with nowhere to deliver safely, while already in an unfamiliar and challenging environment.
“(The pregnancy) was a surprise,” said Zoreima Terán, a Venezuelan migrant who has teenage children and is struggling to get by. “I never imagined that I'd go through this here.” She takes a two-hour bus ride to Riohacha from another town in order to get free, high-quality antenatal check-ups from MSF. Terán wants to go back to Venezuela, but being pregnant makes it more complicated. She can’t count on getting this care, or delivery care, in her home country right now.
At the Riohacha hospital, the government-run maternity ward is often overwhelmed with women in labor. “I would say that 95-98 percent (of the women giving birth) are Venezuelan patients,” said Maria Suárez, a doctor with the Ministry of Health. “Eighty percent of the [Venezuelan patients] we see have had no prenatal check-ups.” That means neither the patients nor the medical staff know whether there might be dangerous complications until labor is underway.
Suárez is Venezuelan; in her home country she worked in a large government-run hospital where health care was free and everything pregnant women needed was provided. But there came a time, she said, when if the patient did not bring the necessary supplies, the doctors could not provide medical care. “We didn't have a pair of gloves, we didn't have gauze, we didn't have the syringes or the painkillers for patients who arrived in pain. ... I mean, it fell apart.”