Pregnant Crossings, Borderland Births:
Morality, Care, and Control in the Migration Encounter
An Account of EU Border Care’s First Annual Conference
by Cynthia Helen Malakasis and Vanessa Elisa Grotti
In the Republic of Ireland, Olena Fedyuk’s Ukrainian research participants accessed maternity care via complex combinations of real, fake, and purchased legal documents, which allowed them to work in Ireland, pay taxes and social insurance, and receive social benefits in return. Women actively sought out the types of legal integration into the public health system available to them – yet the “liminal legality” they were able to achieve generated complex relations of dependence with different people and structures in the host society.
Fedyuk presented her research findings at the EU Border Care’s first annual conference, which took place at the European University Institute, in Florence, on the 27th and 28th of June. A month before embarking on our own ethnographic fieldwork, we brought together scholars whose research on different aspects of undocumented maternity in various parts of the world gave us distinct glimpses into the double straits of unofficial residence and officially sanctioned vulnerability that undocumented migrants that are pregnant or have recently given birth must navigate. Our research focus is the politics of care and control in the encounter between undocumented migrants and different actors providing them with maternity care at the various sites where such care is provided, ranging from hospital maternity wards to mobile medical units in refugee camps. Our multi-sited, comparative, anthropological research will take place on Europe’s most densely crossed borderlands, with a focus on the Mediterranean region and ultra-peripheral borders in South America and the Indian Ocean.
In her keynote speech, senior migration scholar and activist for the right to migration, Catherine Wihtol de Wenden, underlined precisely the unequal distribution of this right. Human beings remain fundamentally distinguished by their citizenship and the ease with which their passport enables them to cross national borders. Borders have different density according to visa requirements – in the European arena, de Wenden noted, Dublin II, the EU-Turkey agreement, and the Balkan border closures evince and intensify the EU’s restrictive, security-oriented policy. The EU Border Care’s objective to follow the routes of pregnant migrants across these closed borders – their experiences, peculiar socialities, and movements through spaces of transit, reception, and containment – represents a powerfully stimulating analytical tool. Pregnant migrants are invisible, absent from scholarly literature on migration and border studies, little explored by anthropologists. Pregnant bodies epitomise families, domesticity, enclosed spaces, and gender imbalances; they may appear unglamorous, difficult to approach, or statistically irrelevant, yet these assumptions are there to be challenged. Pregnant migrants are a challenge to normative social science and public health studies, because they reshuffle existing norms and categories.
“Politics Is at the Heart of the Medical Encounter”
Pregnant women make up one of the most vulnerable, and also most rapidly growing, populations entering Europe without documents today. Around one out of ten refugees travelling through Europe today is pregnant. How does pregnancy interface with their journey, but also with their conditions of reception? The combination of pregnancy and irregular entry into a state’s territory positions them on various spots along the victim-transgressor continuum – they stand out either as vulnerable subjects in need of protection, or as people set to abuse the host state’s resources. High birth rates in Overseas France and the increasing advent of refugees to the Mediterranean have caused intense political controversy as to states’ duties toward vulnerable populations that cross their borders without formal permission. In this charged political context, first-hand accounts of the encounter between migrant women and the variety of actors involved in their care holds crucial insights into the norms of humanitarianism and citizenship (re-)negotiated within this process. In the four EU states in question, the law provides for perinatal care regardless of women’s legal status – yet the interplay between law, policy, practices, and ideologies stands to tell a more complex story.
As most of our ethnographic contributions demonstrated, far from a clear-cut category, legality takes different forms in response to diverse administrative rules and practices, and social perceptions. Women lack formal status for various reasons – in many cases, because they enter states whose migration and asylum rules place legality outside their reach. Or, illegality may result from borders coming to people, rather than vice versa, and disrupting long-established contact and routes. In French Guiana and Mayotte, where EU Border Care’s Chiara Quagliariello and Nina Sahraoui will conduct research, the undocumented cohort consists in part of neighbouring populations who used to come and go freely, until these areas were warded off as French – and European – territories. Further, illegality may be a “choice” – that is, the lesser of two available evils. Lucy Lowe’s Somalian interlocutors in Nairobi chose residence in a suburban ethnic enclave and a legally ambiguous status over encampment as asylum seekers that might, in some uncertain future, attain refugee status.
The causes and forms of illegality may be multiple and ambiguous, yet its costs are usually stark. As Alexandra Ricard-Guay noted, pregnancy constitutes an extended moment that encapsulates aspects of this experience. In Canada, her undocumented research participants’ fear of exposure and lack of information usually directed them toward hardly affordable private care; meanwhile, health personnel often treated them like pariahs, they were forced to deliver without an epidural or leave the hospital on the day of labor to avoid extra costs, and they often faced financial blackmail in the form of being denied a birth certificate if they did not cover the full cost in advance or at the moment of delivery. In Israel, Eritrean and Sudanese asylum seekers studied by Laurie Lijnders have no legal access to the public health and welfare system, unless they work; meanwhile, those legally able to work are often terminated because of pregnancy. Socially, they face humiliating practices of segregation in maternity wards, and the frequent, albeit unlawful, refusal of hospital officials to issue birth certificates or register the father. National legislations also constitute the main barrier to maternity care in Europe, according to 2014 data from nine European countries gathered and presented at our conference by two representatives of the International Network of Médecins du Monde, Dagna Frydryszak and Mabel Nuernberg. More than half the pregnant women seen by Médecins du Monde in those countries were undocumented and had not had any antenatal care before.
Ricard-Guay’s interlocutors felt guilty for the effects of their irregular entry and residence on their unborn children’s health and future overall life prospects. Olena Fedyuk’s research participants also shared the desire to escape this state of legal liminality – to escape the fear of dependency on the people who helped them sustain their ambiguous status and the shame of deceiving people and structures that welcomed them unknowingly, but also to avoid passing down their legally precarious and socially controversial documentation status to their Irish-born children. Women’s subjective conceptions of their own deservingness, and the way such conceptions shape and are shaped by the often hierarchical and gendered encounter between pregnant migrants and health care providers is precisely what EU Border Care researcher Daniela Arias Vargas plans to examine in her upcoming fieldwork along the coastline of Andalusia.
Apart from the internalization of hegemonic norms, such as the legitimacy of state borders, research presented at our conference highlighted the agency women exercised against such norms. In Nairobi’s “Little Mogadishu,” Lucy Lowe spoke with Somalian refugees whose reproductive practices defied the advice of the host state’s medical staff. For these women, childbearing provided a strategy to escape displacement and socioeconomic insecurity. In their social world, existing and, perhaps even more, future children were the anchor that moored them in transnational kinship networks able to facilitate their passage to Europe or North America. Lowe’s interlocutors turned the constraints of their gender roles to their advantage – because motherhood positions a woman more favourably and securely within her husband’s clan even in the case of divorce, displaced Somalians maximized their childbearing to enhance their social capital and related life chances.
Kenyan medical staff, meanwhile, interpreted these women’s concern with safeguarding their fertility, even at the cost of an existing foetus, as irrational and victimized behaviour. The medical staff’s and the women’s interpretations of risk diverged, mainly because medical staff did not look at these women’s views and practices in the context of their socio-cultural meanings, circumstances, and constraints. The dissonance between the usually universalist and highly medicalized reproductive norms of health care personnel and those of migrant women and communities was demonstrated by several of our contributors. Johanna Gonçalves Martín discussed the discord between a paradigm of maternity care taking into account socio-culturally embedded reproductive norms that gained brief global legitimacy in the mid-1990s, and a universalist, risk-focused approach, relating it to her research at an area straddling the Brazil-Venezuela border and the Yanomami people who crossed it. Her Yanomami research participants located risk not in medical factors, but in the broader nexus of social relations that might enhance or harm a baby’s well-being; for this reason, they tended to shirk direct questions related to the pregnancy. Johanna’s struggle to devise a culturally functional mode of communication with her interlocutors lies in the heart of the medical encounter, raising crucial questions about the type of care that is meaningful.
While Gonçalves Martín shed light to the mismatch between practitioners’ and women’s norms by relating the global to the local, Charlotte Grinberg drew equally salient transnational links. Grinberg conducted anthropological research in the capital of French Guiana, Saint-Laurent du Maroni, but is also training as a physician in Pennsylvania. The extension of centralized French institutions following French Guiana’s political incorporation and the advent of usually transitory metropolitan physicians and bureaucrats have resulted in administrative, linguistic, and cultural barriers between pregnant women and the system of maternity care. These newcomers receive little training in the socio-cultural norms, practices, and constraints of the people for whom they come to care – rather, they focus on a strictly biomedical, standardized model of care. Rather than limited to French Guiana’s post-colonial context, Grinberg argued, this strictly biomedical approach also prevails in Pennsylvania, where medical students tend to shirk any training that is not strictly scientific.
The reasons why women brave these barriers to give birth in hospitals when traditional methods and systems are still present are not readily apparent, and will form a part of our inquiry – as our research associate Chiara Quagliariello pondered, they may range from trust in modern medicine to a desire to validate their babies’ political existence. Meanwhile, other conference participants presented the perspective of healthcare personnel struggling to navigate linguistic and cultural gaps. Drawing on his experience in the nursing care of migrants in Tuscany, Abukar Aweis Mohamed stressed the necessity for cultural mediation. In the informal camp of Idomeni, in Northern Greece, healthcare workers interviewed by Anna Arampatzi said they strove to put aside their own cultural, and particularly gender, norms; they also lamented the limited collaboration between state and non-state agents. A French Guiana-based epidemiologist, Anne Jolivet, described the challenges of medical practitioners caught in the middle between centralized immigration rules and policies that often do not account for the reality of remote borderlands. In French Guiana – but also in Mayotte, as our research associate Nina Sahraoui described – the metropolitan rules of universal maternity care often do not apply to undocumented residents under the same terms, because of local administrative barriers or discretion.
The physical and social distance between borders and decision-making centres – between overseas territories and the metropolis, islands and a state’s capital, or even just executive corridors in a city’s centre and the refugee camps at its former industrial outskirts – become evident through the positionality and experiences of medical personnel, called to implement rules designed by policy makers removed from the specifics of border encounters. The subjectivities that these actors form in the course and context of the maternity encounter and their socio-culturally mediated, power-laden interaction with migrants but also people such as state administrators or political activists will be a focal point of the EU Border Care research.
Spaces of Care and Containment at the Border
Apart from contributions focusing on the specific topic of maternity care, our conference hosted research that touched on issues related to migrants’ broader context of reception, where the maternity care-and-control nexus is embedded. Irit Katz invited us to consider how the spatial and social organization of refugee camps caters to the needs of pregnant women or new mothers, and the degree to which it allows them to re-appropriate the space for their own needs. Her work negotiated the tension between state management and refugees’ own agency as they manifest in differences in the organization of refugee camps – a tension that our research associate, Cynthia Malakasis, plans to examine in her field research in Greece, which in recent months has witnessed a strong clash between refugee-housing squats and state-managed camps and between the actors and ideologies fostering each scheme. Drawing from her fieldwork in Calais, Katz contrasted the makeshift camp created by refugees themselves to formal state facilities. The former grew to resemble a small city, with ethnic neighbourhoods, shops, and services, fostering a sense of place and bearing witness to the refugees’ spatial agency. The state facility next door, meanwhile, featured shipping containers organized in a fenced grid, central toilet and eating facilities, and entrance only via biometric fingerprint scanners. The proximity of the two camps reflected the state’s policing agenda – yet was also put to use by migrants themselves, who navigated the two spaces strategically to serve their needs.
While Katz negotiated the agency-management binary, Naor Ben-Yehoyada drew a compelling argument on the contest between justice and compassion, positing that the refugees’ land journey, after their rescue off Europe’s coasts (and before the closure of the so-called Balkan route), has tipped the scales toward the former. Dramatic representations of sea rescues cast refugees in the role of abstract humans in need of humanitarian aid – at the same time, they highlight Europe’s supposed intrinsic humanitarianism, premium on human rights, and moral obligation to save lives. Images of migrants continuing their journey over land, via the so-called Balkan route, however, emphasize their refugee-ness and the causes of their flight, including the culpability of various European actors. Rather than humanitarian benevolence, this framing calls for retributive justice – further, it problematizes “Europe” by underlining the differences between states and institutions according to their role in bringing about catastrophes.
Can humanitarian benevolence, or more specifically the norm of hospitality in its guise as a core European value, do any work toward safeguarding migrants’ fundamental human rights? In the presentation of her ongoing research, Daniela DeBono pondered the obligation of European states vis-à-vis migrants during their stay in hot spots in the period of first reception, when newcomers do not yet fall within a clear legal category.
Focusing on the material culture of humanitarianism and the political work that it does, Tom Scott-Smith demonstrated the depoliticizing effects of material objects (such as personal water-filtering straws, or the durable, short-term Ikea shelter) that mask injustice by briefly alleviating its immediate effects. By meeting basic needs without infrastructure, supposedly innovative humanitarian designs circumvent the state, and foster the neoliberal imagination of a world where the state fails to care, and the market provides public goods.
This tension between supposedly apolitical practices of care and their highly political causes and effects lies in the heart of the EU Border Care’s research objective. In recent years, as our principal investigator, Vanessa Grotti, argued, politics based on humanitarianism have expanded non-emergency health care provisions for undocumented migrants. Yet this expansion has aimed to create apolitical zones of care, whereas in reality politics is concentrated precisely in these spaces, in the encounters between undocumented migrants classified as vulnerable and the diverse actors who provide this care. The nexus of care and control in these spaces, and all that it reveals on matters of universalism and socio-culturally contextualized norms and processes, citizenship and sovereignty, humanitarianism and political rights, and gendered agency and hierarchies will form the crux of our inquiry.
Nina Sahraoui, Chiara Quagliariello, and Daniela Arias provided comments and corrections to this report. The conference was generously funded by the European Research Council (ERC), and organized with the invaluable help of Julia Hiltrop, administrative assistant at the European University Institute’s Robert Schuman Centre for Advanced Studies.
Arampatzi, Anna. “Idomeni: A Qualitative Approach to Women Migrants’ Medical Care in the Field.” Paper presented at the EU Border Care annual conference, Florence, Italy, June 27–28, 2016.
Ben-Yehoyada, Naor. “Seas of Brotherhood and Fields of Care: Political Cosmologies of Migration and Interception in the Mediterranean.” Paper presented at the EU Border Care annual conference, Florence, Italy, June 27–28, 2016.
De Wenden Wihtol, Catherine. “The Refugee ‘Crisis’ in Europe.” Keynote speech at the EU Border Care annual conference, Florence, Italy, June 27–28, 2016.
DeBono, Daniela. “Interrogating Reception: A Critical Appraisal of the EU Hot Spot Approach.” Paper presented at the EU Border Care annual conference, Florence, Italy, June 27–28, 2016.
Fedyuk, Olena. “Mothering under a Different Name: Cases of Ukrainian Women with Liminal Legal Status Birthing in Ireland.” Paper presented at the EU Border Care annual conference, Florence, Italy, June 27–28, 2016.
Frydryszak, Dana, and Nuernberg, Mabel. “The Legal Norms and Actual Practices that Determine Undocumented Women’s Access to Maternity Care in the Destination or Transit European Countries.” Paper presented at the EU Border Care annual conference, Florence, Italy, June 27–28, 2016.
Gonçalves Martín, Johanna. “Quests for Fertility: Reproduction and Well-being at Cultural Intersections.” Paper presented at the EU Border Care annual conference, Florence, Italy, June 27–28, 2016.
Grotti, Vanessa Elisa; Arias, Daniela; Malakasis, Cynthia Helen; Quagliariello, Chiara; and Sahraoui, Nina. “Maternity Care and Migration in EU Borderlands: Project Overview.” Presentation at the EU Border Care annual conference, Florence, Italy, June 27–28, 2016.
Grinberg, Charlotte. “Barriers, Training, and Blame: The Gulf between Intentions and Outcomes. Qualitative Research in French Guiana, and how It Translates to Migrant Policies.” Paper presented at the EU Border Care annual conference, Florence, Italy, June 27–28, 2016.
Jolivet, Anne. “Migration, Health, and Care in the Context of Pregnancy in St-Laurent du Maroni, French Guiana.” Paper presented at the EU Border Care annual conference, Florence, Italy, June 27–28, 2016.
Katz, Irit. “Between Bare Life and Everyday Life: The Camps along Europe’s Migration Routes.” Paper presented at the EU Border Care annual conference, Florence, Italy, June 27–28, 2016.
Lijnders, Laurie. “Without Status and Uninsured: Asylum Seekers’ Pregnancy and Birth Experience in Tel Aviv.” Paper presented at the EU Border Care annual conference, Florence, Italy, June 27–28, 2016.
Lowe, Lucy. “Sweet Mothers and Displaced Births: Pregnancy and Transnational Kinship among Undocumented Somali Refugees in Kenya.” Paper presented at the EU Border Care annual conference, Florence, Italy, June 27–28, 2016.
Mohamed, Abukar Aweis. “Migration and Health: Continuity of Care of Migrant Patients in Italy.” Paper presented at the EU Border Care annual conference, Florence, Italy, June 27–28, 2016.
Ricard-Guay, Alexandra. “Undocumented Pregnant Women’s Pathways to Health Care in Quebec, Canada: Seeking Help Strategies or Avoidance of Care.” Paper presented at the EU Border Care annual conference, Florence, Italy, June 27–28, 2016.
Scott-Smith, Tom. “Architectures of Displacement: What Is New and What Is Old about Humanitarian Shelter in Europe.” Paper presented at the EU Border Care annual conference, Florence, Italy, June 27–28, 2016.
 We use the term “migration” (as well as “migrant,” “migratory,” etc.) to denote cross-border mobility in general – NOT to imply a distinction between people with or without claims to international protection.
 Grotti, “Maternity Care and Migration in EU Borderlands.”