By Roselyne Sachiti
When Alice Moyo (19), a Zimbabwean illegal migrant in South Africa’s Hillbrow area became pregnant for the first time in June 2017 she was both excited and anxious.
Having gone to South Africa at 16 and working as a shop attendant in a boutique owned by Somali migrants along Small Street in Johannesburg earning a salary of R2 100, she had about all she wanted.
The money would be split to pay rent in a small crowded room in Hillbrow, buy food and clothes and transport costs. She could also save a bit of money to send back home to her parents in Lupane, Matabeleland North Province of Zimbabwe.
Three months into the pregnancy, the reality of what the pregnancy meant sunk in.
“My boyfriend Joseph moved out after I decided to keep the pregnancy which was unplanned.
“He said he could not afford to take care of the baby so I should abort. I am a religious person who does not believe in termination of pregnancy so I refused. We cut ties,” she revealed.
Moyo had to go it alone.
“I was due in March 2018 and realised that I needed a bigger place to stay for the sake of the new baby. Decent accommodation is expensive. I would still need food and bus fare. Joseph said he would not support me,” she told The Herald recently.
She had one more problem. She is undocumented and taking three months maternity leave was no option. Her employer would not pay her salary so she had to go on unpaid maternity leave.
“My boss said he also has to pay the person who relieves me when I am away. To sustain myself, I worked piece jobs like housecleaning to fill the income gap while pregnant,” she added.
At least, she added, her employer gave her her job back when she gave birth.
“I am still worried. I have no one to take care of the baby when I go to work. I enrolled her in daycare which is quite expensive, too. I am in a fix,” she said.
Being undocumented also had its challenges when it came to pre-natal care.
Moyo said she only went to Hillbrow Clinic when she was fully dilated and ready to give birth.
“It was my first time to a health facility since I conceived. I did not receive any ante-natal care for fear of being fished out as an illegal migrant.
“I learnt from fellow undocumented Zimbabweans that if I go there ready to deliver, the health officials could not send me away to other health facilities. That’s what some illegal female migrants do here,” she confessed.
Also in Hillbrow an undocumented Zimbabwean national, Primrose Banga, has just given birth to a baby girl Natasha. She managed to cheat her way into the Charlotte Maxeke Academic Hospital where she delivered.
She has been out of a job for the three months she has been caring for her baby.
Her live-in boyfriend works menial jobs ranging from electrical, plumbing, building, painting, anything that comes his way. He is subcontracted by other foreign nationals like Zambians, Ethiopian, Somalis and Mozambicans who would have struck a good deal.
Sometimes the jobs are not easy to come by. He can go for two months without getting a contract. It makes life harder.
“When things are really hard, he goes to Johannesburg Market where he offers to carry groceries for people doing their shopping for a small fee. He also buys vegetables for resale. The money was not enough especially with a baby on the way,” she said.
She wants to go back to work so that she can supplement their earnings.
She cannot carry the baby to work and they have no one to leave the baby with at home. Their only solution is daycare, which is beyond their reach.
The cheapest daycare costs R700 per month.
“I am travelling home to Harare to leave her with my mother. I will send groceries and clothes,” she said.
Memory Madondo (19) of Chivhu has been in Johannesburg, South Africa, for three years. She migrated in 2014 when she was 15, joining her sister Margaret who has been living there since 2012.
Madondo is pregnant with her first child and lives with her boyfriend Stanely Charakupa (22). Charakupa works for a construction company earning R2 500 per month. Madondo also works in a small boutique earning R1 500 per month. Put together, their salary was somewhat enough to cater for their needs.
Now that she is pregnant, she says, life will change.
“I will be on unpaid leave until when I return to work. I might even be out of a job for longer as I take care of the baby. This means we will have to adjust everything and tighten our belts. We are looking for a cheaper place to stay,” she said.
Another undocumented Zimbabwean young mother, Majory Ndlovu, straps her three-year-old daughter Nandipha on her back every morning as she races to President Street in central Johannesburg where she sells courier bags, toys, bracelets to hundreds of shoppers that pass through that route everyday.
“Bringing a relative from Zimbabwe to care for the baby is out of the question as that person will require food and housing. For now I will just bring the baby to the street. I will send her to my mother,” Ndlovu says.
In her area, daycare is expensive and costs between R700 to R1 000 a month. The charges are beyond many Zimbabweans living in South Africa illegally as they have no regular salary.
But for legal migrants like Martha, a professional accountant who earns R17 000, having a baby in foreign land has been a good experience. Her husband is an architect and also earns R30 000 per month.
Her baby Skylar is a month old. Martha will be on paid maternity leave for the next two months.
“I am enjoying all that comes with being a new mother. My husband and I have started looking around for the best daycare facilities. We have another option of looking for a nanny, preferably Zimbabwean as we want our child to grow up speaking our language,” she said.
South Africa, the economic hub of Southern Africa, has opened its doors to thousands of migrants for many decades.
According to Stats South Africa 2012, in Gauteng Province, where Johannesburg is located, about 7,4 percent of the population are non-nationals including some who are undocumented.
A 2017 paper by Tackson Makandwa, a researcher at the African Centre for Migration & Society (ACMS) at Wits University, and Jo Vearey titled “Giving Birth in a Foreign Land: Exploring the Maternal Healthcare Experiences of Zimbabwean Migrant Women Living in Johannesburg, South Africa”, confirms some of the challenges faced by Zimbabwean women illegally working and staying in South Africa.
Interviews for the study were conducted with 15 Zimbabwean women aged 18 and above who were living in the inner-city Johannesburg suburbs of Hillbrow and Braamfontein. Inclusion criteria for the study required that participants had been living in South Africa for at least two years and had attended (or were currently attending) public sector ante-natal care (ANC) services and had given (or were planning to give) birth at public healthcare facilities in inner-city Johannesburg.
The study investigated interactions with public healthcare providers and other forms of help-seeking, such as private doctors, churches and social networks within the city. Findings show how the living conditions of the city impact the experiences of migrant women by influencing health- and help-seeking decisions and emphasises the urgent need to acknowledge and better understand how the social determinants of urban health mediate maternal health and the well-being of migrant women in the city.
The survey revealed that more recent Zimbabwean migrants to South Africa were staying longer, returning home less frequently and increasingly viewing South Africa as a place for long-term residence.
“This shift in immigration behaviour towards greater permanence makes the question of access to and quality of healthcare even more significant for Zimbabwean migrants working and living in South Africa — particularly those who cannot afford private sector healthcare,” Makandwa’s paper added.
It further alleged that despite facing numerous access challenges and experiencing discrimination and abuse from healthcare providers when engaging with the public healthcare sector, existing evidence shows that non-nationals have developed ways to successfully navigate the system.
According to Makandwa’s paper, six key themes — reflecting the challenges experienced by participants when accessing public ante-natal and maternal healthcare in Johannesburg and ways of compensating for this through other forms of support — were identified.
These include language as a form of control, the othering of Zimbabwean nationals by healthcare providers, the power of healthcare providers to deny access to care, livelihoods and informal sector employment as determinants of health, religion and church as alternative help-seeking strategies and the role of social networks as mediators of access to care.
“Language was identified as the greatest challenge faced by participants in accessing public healthcare services. This did not relate simply to challenges that may be associated with speaking a different language — such as misunderstandings or miscommunication. Rather, language was used by healthcare providers to “screen” patients based on their identity as a non-national, resulting in the verbal abuse of patients. Healthcare providers were reported to demand that the participants speak in local South African languages — such as Zulu and Sotho — but not in English,” Makandwa’s study found.
Participants in the study also reported significant delays at the healthcare facilities they attended; they felt that they were ignored if they spoke in English and/or staff pretended not to understand what the migrant healthcare user was saying.
According to Makandwa’s findings, some of the participants spoke about being segregated by healthcare providers during ANC visits and when they came for delivery.
“Public perceptions in South Africa generally position migrant populations as undesirable; hostility towards migrants and refugees makes South Africa one of the most migrant unfriendly countries in the world. Such hostility towards non-nationals is in direct contradiction with the South African Constitution and the Bill of Rights when it comes to access to public healthcare,” the study further states.
Participants in the study also described how they felt that they were identified and separated from South African nationals and treated differently.
“This harmful practice of othering based on ethnicity and nationality has negative consequences on the delivery of healthcare services and on the practitioner’s clinical conduct. The most striking trend shared by all participants was that once their identity as Zimbabwean was revealed, they felt that quality of care they received was reduced and they experienced abuse from healthcare providers,” further stated the study.
The study also points out that it is not all gloom and doom for migrants as student nurses were more receptive.
“During the interviews, participants often spoke positively about their interactions with student nurses, comparing them to their negative engagements with more senior, qualified nurses. In addition, comparisons were made between the attitudes of black nurses versus white nurses towards them as migrant patients.
“The experiences reported by participants suggest that a hierarchy of abuse exists within the healthcare system, with the qualified nurses having the power to delay or deny patients healthcare,” Makandwa’s study said.
The role of religion and churches as spaces of support also emerged as one of the central themes in Makandwa’s study.
“As found in other studies, churches played a crucial role in providing emotional, instrumental and informational support to the participants in preparation for childbirth.”
In South Africa, various pieces of legislation have outlined the ways in which both citizens and non-citizens can access public healthcare.
The initiative of the first democratically elected government in South Africa was to remove user fees for all pregnant and lactating women and children under six years of age at public healthcare facilities.
Additionally, the South African national constitution section 27 ((2) and (3)) makes provision for universal access to healthcare regardless of nationality.
The Human Rights Watch 2011 says despite South Africa’s “health for all” policy, challenges still exist for non-nationals trying to access healthcare services in the country but little is known regarding migrants’ maternal healthcare experiences. The Herald