Undeserving mothers? Shifting rationalities in the maternal healthcare of undocumented Nicaraguan migrants in Costa Rica

Abstract

The case of Nicaraguan migrants in Costa Rica is emblematic of the issues that immigration generates in host countries. Undocumented Nicaraguan women seeking maternal care constitute a key challenge to the universal coverage of Costa Rica's health system. Can the long-standing commitment to universality, solidarity and equality expressed in the legislation be translated into practice? Discourses of health professionals in Costa Rica reveal a contradiction between merit and prejudice in prenatal and delivery care. Here, I present qualitative research based on semi-structured interviews with physicians and nurses at a Costa Rican National Hospital. The data show that migrant women, rejected from primary care, do find help in emergency services, but not without difficulties, as they must engage in individual negotiations centred on their bodies. The discourses of health providers reflect an ambivalence between the perceived undeservingness of undocumented migrant women and the medical realisation that two lives are at risk. While the foetus often evokes compassion, the mother commonly provokes repression, as specific and shifting rationalities reflect new moral regimes that are applied to this population. Women are perceived as being ‘illegal’, ‘immoral’ and ‘irrational’, and the baby, although legally Costa Rican due to jus solis policy, embodies ‘the other’. Ultimately, otherness frames perceptions of deservingness of maternal care for undocumented migrant women in Costa Rica.