Africa: For Migrant Women, The Right to Healthcare Does Not Always Mean Access
Mombasa, Kenya — Over the past year, South Africa has witnessed several incidents in which migrants, asylum seekers and undocumented people have reportedly faced barriers to essential healthcare, including maternal and child health services.
For many migrant and refugee women, vulnerability does not end when they reach South Africa. But those who have been forced to leave their countries due to conflict, persecution or political instability may encounter new forms of exclusion and uncertainty when they arrive, reports Mail & Guardian.
In some communities, hostility towards foreigners can make accessing basic services even more difficult. Migrants may be asked to show their documentation when trying to access healthcare, education, employment and other essential services.
These barriers may be especially serious for women.
A pregnant woman might delay antenatal care because she is afraid of being asked for documents she cannot produce. A woman seeking contraception, HIV prevention or treatment, or support after gender-based violence might fear that seeking help could expose her immigration status.
Nowhere is this clearer than in maternal healthcare.
One woman from Malawi gave birth in an open space inside a deportation holding area, surrounded by strangers, with no medical professional present and no access to the care and testing needed to protect both mother and child.
South Africa has policies and laws that recognise the right to healthcare and protect human dignity. Yet for migrant women, the reality on the ground can look very different.
“It’s about their rights, it’s about protecting their human dignity,” said human rights activist Tsakani Mabasa, whose research examines how migrant women can better access sexual and reproductive health services in South Africa. Mabasa’s research exposes a troubling gap between what exists in policy and what happens when a migrant woman walks through the doors of a health facility.
Mabasa said her work with young people had increasingly led her to focus on protecting vulnerable groups, including migrant women living in South Africa. She said that access to SRHR services is fundamentally a human rights issue, particularly for women who are pregnant or experiencing gender-based violence.
“It’s not like you are doing a favour when a woman who is eight months pregnant walks into a facility and says, ‘I need support, I need Antenatal care (ANC) services,'” she said.
She also placed migration within a broader African context, arguing that movement across borders is a reality of the continent and that health systems need to account for people who cross borders rather than treating migration as a reason for exclusion. The question becomes particularly urgent for migrant women whose need for healthcare does not disappear because they lack documentation. Mabasa said the focus should instead remain on ensuring that women are treated with dignity and can access the services they need.
That vision, she said, is already written into South African law. She pointed to the Constitution as the starting point, alongside the National Health Act, the Refugees Act and a body of sexual and reproductive health policies that together protect access to care and human dignity. “Our constitution is very explicit in terms of how we need to provide services to the vulnerable population,” she said.
The Constitution guarantees access to healthcare services and states that no one may be refused emergency treatment. The National Health Act extends free care to all pregnant women, lactating mothers and children under six, a category that explicitly includes asylum seekers, undocumented migrants and stateless people, regardless of nationality. The Refugees Act adds another layer of protection.
Yet those protections have been tested repeatedly in practice. In December 2025, the Gauteng High Court ordered the authorities to allow unhindered access to the Yeoville and Rosettenville clinics in Johannesburg to people without South African identity documents. This came after vigilante groups had blocked them from entering. In 2025, a Malawian mother of a one-year-old child said Operation Dudula members prevented her from reaching Alexandra clinic before the child later died. Operation Dudula denied instructing anyone to block her. Gauteng Health MEC Nomantu Nkomo-Ralehoko called the blockades unlawful and demanded they stop. The Economic Freedom Fighters ( EFF) laid criminal charges against former Operation Dudula leader Zandile Dabula over the child’s death.
Operation Dudula argued that its actions respond to a health system under strain.
“In our operations we are saying, ‘Put South Africans first,'” one of its members, Tholakele Nkwanyana, told the Associated Press. She argued that the number of foreign nationals seeking care outstrips available medication and staff. Public health researchers dispute that framing. Collective Voices Against Health Xenophobia, a coalition of civil society groups and healthcare workers, has said migrants are being scapegoated for failures that have little to do with them. They argued that “migrants have been made scapegoats for a public health system in crisis” shaped by mismanagement and years of underinvestment.
However, the court recognised that even undocumented foreign nationals have a right to primary healthcare. The incidents show how legal protections can exist on paper while migrants continue to face barriers when they try to access healthcare.
“The law doesn’t say whether you’ve got documentation, you’ve got a passport,” Mabasa said. “These policies, as good as they are in black and white, don’t translate to equitable access.”
The court case did not end the problem. In March 2026, SECTION27, representing the Treatment Action Campaign, Médecins Sans Frontières and Kopanang Africa Against Xenophobia, returned to court after monitoring found that vigilante groups were still present, particularly around Rosettenville clinic. The parties subsequently reached a settlement requiring state authorities to take steps to ensure safe and unhindered access to both clinics.
Mabasa said documentation should not determine whether a migrant woman is treated with dignity. “Those things are not relevant,” she said. “It’s about making sure that human dignity is respected.”
But legal protections do not necessarily translate into easy access to care.
Similar findings to those of Mabasa were found in research conducted in Ekurhuleni, where barriers reported by migrant women and health care workers included language, discrimination relating to migration status, and challenges in relation to documentation and referrals. The study also highlighted challenges faced by health care workers themselves when providing SRHR and HIV services to migrant women.
Mabasa also identified several barriers confronting migrant women.
Migrants whose permits or other documents have expired may find themselves unable or unwilling to seek care because of uncertainty over their status. “Some are sitting somewhere with expired documents, and that becomes a barrier,” she said.
The challenges facing migrant women do not exist in isolation.
Language can create another layer of exclusion, particularly when women struggle to communicate with healthcare workers or understand the services available to them. One woman told her plainly: “Sometimes I don’t understand what the nurse is trying to say.”
The health system itself can also be a barrier, Mabasa said, with facilities sometimes lacking the capacity to meet demand.
South Africa’s public health system is already under pressure, with healthcare workers expected to serve large numbers of patients with limited resources. “Sometimes we don’t have enough capacity,” she said.
For migrants without legal documentation, simply walking into a health facility can carry its own risks.
Mabasa said the inconsistency is also evident in how individual facilities apply the rules. At one clinic, a nurse might demand a passport and ask about visa status before offering care; at another nearby, staff assists without question. “Someone would say, ‘ No, before I assist you, I need to see your passport,” she said. “And then you go to another place… someone is willing to say, ‘ Let me provide a service without even asking that information.”
For migrants already facing economic hardship, private healthcare may not be a realistic alternative. Mabasa rejected the assumption that foreign nationals can simply turn to medical aid or private facilities. “Someone is in an economic crisis. They can’t even afford private services,” she said.
Fear can be an equally powerful barrier. Migrant women with expired documentation may worry that visiting a health facility could expose them to authorities and result in deportation.
“My documents have expired; I’ll be deported to my country,” Mabasa said, describing the fear that can keep migrants away from health facilities. For pregnant women, the consequences of delayed care can be particularly serious. She said fear of stigma and discrimination could discourage women from seeking antenatal services early in pregnancy, leaving some to arrive at facilities only when they are close to giving birth.
Distance and transport costs add another obstacle, particularly for migrant women living far from healthcare facilities. She also pointed to another challenge: the mobility of migrant communities. Women and families who cross borders or provinces for work could have implications for access to healthcare, education and support networks.
If a woman is on HIV treatment, contraception, antenatal care or other services, she may find herself in a different province and health facility, and this may disrupt continuity of care.
Leaving no one behind
Denying migrants healthcare can have implications far beyond the individual. Some may feel pressured to disclose their HIV status in an effort to access care, breaching their confidentiality and exposing them to stigma and discrimination. Delayed access to treatment can worsen illness and increase the risk of transmission of infectious diseases such as HIV and TB, and preventable complications can place additional strain on an already-overburdened health system.
The impact can be on livelihoods, as untreated illness can mean migrants are unable to work or run businesses, affecting their families and communities.
It’s about dignity, it’s about equality. Turning people away when they need care most risks deepening vulnerability and undermining the values South Africa’s Constitution seeks to protect.
Mabasa cautioned against placing the entire burden on healthcare workers.
She called for standardising facility-level protocols so that access doesn’t depend on which nurse is on duty; training healthcare workers not just clinically but on migrants’ actual legal rights, so that staff aren’t the ones improvising immigration policy at the point of care; integrating services so women aren’t forced into multiple costly visits; and building coordination between health departments, home affairs and civil society rather than leaving each to work in isolation.
South Africa has made progress toward the UNAIDS 95-95-95 HIV targets, but gaps remain. Mabasa said that excluding migrant women from healthcare also threatens progress made in the wider HIV response.
“We need to make sure that we leave no one behind,” she said.