"Women and girls, especially when forced to migrate or when in an irregular situation, are disproportionately affected by the risks of migration because of their vulnerability to exploitation and violence," says IOM Deputy Director General Ndioro Ndiaye to mark International Women's Day.

"This vulnerability is being exacerbated to unacceptable levels by the lack of access to appropriate maternal and child health services in particular, which can have a long-term public and social cost."

Maternal and child health, often thought of as preventative care, can and does lead to life-threatening situations with tragic results because problems have not been spotted in good time or because the right skills and treatment are unavailable. Babies and children of women who have not had ante-natal care can be more susceptible to problems such as pre-mature births and growth and development issues.

A lack of access to maternal and child health services can also perpetuate poor health among migrant communities which in the long term puts a greater strain on health systems in host societies. Not following an immunization programme can not only impact on outbreaks of communicable diseases, but can also affect a child's access to school.

Those at most risk across the globe are irregular migrant women and those forced to migrate, such as internally displaced or asylum-seekers.

Recent studies in some European countries have shown that a lack of legal status, while increasing irregular migrant women's risk to violence and sexual assault, also reduces their access to pre-natal care. This is particularly worrying given that irregular migrant women are more likely to experience

	A displaced child receives anti-measles shots from doctors of the Japanese Self Defense Force who were helping internally displaced persons in Banda Aceh, Indonesia after the 2004 tsunami. © Jonathan Perugia/IOM/OnAsia 2005 - MID0168

"The fear of deportation is a major barrier for many irregular migrants seeking care as the priority is to stay hidden in society. The best they can hope for in destination countries is emergency care, and maternal and child health doesn't fall into this bracket until it is too late," Ndiaye adds.

Even when in principle migrant women living and working legally in another country have access to health care, it is not always "migrant friendly". Cultural differences, language barriers and xenophobic attitudes can and do impact on a migrant's ability to get the necessary care she needs.

In East Africa, for example, IOM health staff on the ground cite the lack of such migrant-friendly services promoting reproductive and maternal and child health, including pre and post-natal care, assisted delivery and child survival programmes, as the most pressing issue facing migrant women. Such problems are evident in destination regions such as Europe too.

For displaced women, distances to health facilities are the main stumbling block to reproductive and maternal health services, especially in rural areas. In places like the Mekong Delta, Zimbabwe, as well as in Iraq with its 2.8 million internally displaced people, the long distances to the nearest health facility deny many women pre and post-natal help at a time when they are at their most vulnerable due to the lack of adequate shelter, food and sanitation, resulting in preventable maternal and infant mortality and miscarriages.

In some cases, like Colombia, a lack of information among both displaced people unaware of their right to access health services, and health personnel unaware of their obligation to provide these services, can stop displaced women getting the help they need.

Among the solutions is establishing and developing existing midwifery and community health skills among migrant communities. This would help to spot problems and potential problems in advance and build knowledge on when a patient needs to be referred.

In Iraq and Afghanistan, for example, some of IOM's responses have included the training of displaced women as traditional birth attendants to provide these vital midwifery skills.

These kinds of programmes can also be taken into migrant communities in destination countries. A major advantage of doing so would be that these migrant community health workers would understand the social and cultural factors that hinder accessibility to and acceptability of existing health services.

"What will make the greatest difference ultimately is for authorities to provide maternal and child health services, a cornerstone of primary health care, to all migrants. Addressing this need is not just a public health and human rights issue but is also for the common good," Ndiaye concludes.

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