Argentinian Policy for the Protection of Sexual and Reproductive Rights

In 2003, two years after one of the harshest economic crises ever to hit Argentina, the country entered a new stage in terms of social models, characterized by the implementation of actions from the State intended to strengthen inclusion processes. Under this perspective, the National Congress passed in 2004 law No. 25.871 on Migration, according to which the right to free transit of people throughout the national territory is guaranteed. Particularly when it comes to the right to health, the law sets forth in its Article 8 that the right to health (including social assistance and healthcare) may not be denied nor restricted to any foreigner who needs it, regardless of their migration status. Moreover, it delegates to the authorities of health and education institutions the responsibility of providing orientation and advice on the corresponding procedures required to regularize migration statuses.

In line with this political approach of greater observance and respect towards the fundamental rights of the people, in 2002 law No. 25.673 was passed, which brought about the creation of the National Plan of Sexual Health and Responsible Procreation (PNSSyPR, for the acronym in Spanish for Programa Nacional de Salud Sexual y Procreación Responsable) under the Ministry of Health. This program is intended for the general population and its aims are essentially preventive for the most part. Among its goals are the reduction of mother and child morbidity and mortality, the prevention of unwanted pregnancies, and the prevention and early detection of sexually transmitted diseases, HIV/AIDS, and genital and breast pathologies (Article No. 2 of the law).

Also, in Argentina, there is law No. 25.929 on Respected Delivery, passed in 2004 and regulated in 2015 by means of the 2035/15 decree. This regulation protects the rights of the mother and the newborn in the stage of delivery and the rights of the woman in relation to the pregnancy. Among them, the right to treatment that is dignified and respectful of cultural standards, the right to be informed on the evolution of the delivery and the possible interventions that could take place in the different stages of the process, and the protection of the bodily bond between the mother and the newborn (Article 2 of the regulatory decree).

One of the novelty aspects of this law is that it addresses a type of gender violence usually not made visible: that of obstetrics violence understood as that which is imposed by the health staff on the body and the reproductive processes of pregnant bodies. Although this type of violence is considered under law No. 26.485 on the integral protection of women, the law on respected delivery sets forth specific guarantees concerning the autonomy of will and the respect for human dignity during pregnancy and birth processes. Another relevant aspect is that it also includes a flexible perspective on how the delivery and pregnancy processes can be approached. As an example, article 2 of the regulatory decree sets forth that every person has the right to choose the place and way in which labor will take place, as well as the way of birth. Article 2 also points out that regarding pregnancy, labor, delivery, and the postpartum period, all women have the right of being treated with respect and dignity, and to not be discriminated against because of their culture, ethnicity, preferences, or any other factor. From the optics of interculturality, this law calls into question the use of standardized protocols for safe deliveries and provides a regulatory framework that is wide enough to ensure a dynamic approach towards the cultural processes associated with pregnancy and birth.

Teenage Reproduction Among Migrant Women from Neighboring Countries in the City of Buenos Aires

Analyzing teenage reproduction is an exercise not without difficulties, particularly when such analysis covers migrant populations. In the first place, there is the widely known difficulty of undisclosed childbirth among girls and teenagers, likely attributed to the negative connotations that pregnancy and maternity at a young age are associated with. On the other hand, analyzing this factor among migrant women is also difficult as it implies identifying the actual place wherein pregnancy and childbirth took place. There also are differences between births taking place at premature (14 years) and early (15-17 years) of teenage, and those happening at later ages (18-19 years), due to both physiological and contextual factors. In this sense, maternal morbidity and mortality rates in early ages is comparatively greater to that of later ages, and in certain contexts being a mother can be socially acceptable or desirable from 17 years of age and on. Taking the latter into account, premature, early, and late teenage maternity (under the assumption that having a child before 18 years of age is usually undesirable regardless of the country of origin), as well as the fertility rate for teenagers from 15 to 19 years, was analyzed.

The results show that the groups of migrants from Peru and neighboring countries display a greatly larger teenage motherhood (14 to 19 years) percentage than that of the native population (Table 1). The differentials found in premature and early ages of teens are particularly steep, the specific fertility rates of migrants from neighboring countries from ages 15 to 19 show noticeable differentials per country of origin, exceeding in the different instances the level displayed by women born in Argentina (Table 2).

It could be argued that the results presented are not the manifestation of a healthy cultural heterogeneity, but rather represent worrisome gaps that reflect unequal access to resources and rights (including a life free of violence and to make decisions about their bodies, to mention a few).

Access to Contraception Methods

As already stated, the analysis on the use of CCMs and how they are linked to the right of women to decide about their reproductive processes should also consider an essential aspect pertaining to body autonomy: this is, the actual willingness of women to make use of these methods, or otherwise to express their desire to defer maternity, as well as to conclude/prevent reproduction.

As a first step, this section presents a characterization of the sample analyzed by the EMFF, emphasizing migrant women residing in the CABA. Next, the number of children born alive is compared against the stated ideal number of children to get to know to what extent does the fertility trajectory matches the reproductive aspirations of the surveyed women. To obtain the latter information, the EMFF included the question “What is the ideal number of children a woman should have according to you?” Regarding this, it should be noted that there might be a trend to state a figure no lesser than the actual number of living children and that in some instances unquantifiable answers were given (“the number God be willing,” for example). Taking this into account, as well as the influence of the variables of child mortality and mortality throughout life, the unquantifiable cases, and those that declared the death of a child were respectively discarded. Finally, the current use of CCMs by migrants who did not want to have more children or wanted to postpone the next or a first pregnancy was analyzed.

The analyzed sample consists of 451 migrant women, out of which 171 were born in Bolivia, 173 in Paraguay, and 107 in Peru. The age of the surveyed women ranged from 18 to 49 years, the average age being 32 years. Approximately half of the women (48%) arrived in Argentina at ages 20 to 29 years, and only a lesser percentage (16%) migrated after the age of 30. About three-quarters have lived in Argentina for five years or more (296 women), so this is a sample composed mainly of former migrant women. At the time of the survey, most women had attended or were attending the formal education system, being the collective from Paraguay, one with the highest educational level (an average of 4.6 years), followed by Peruvian and Bolivian migrants, whose average level reaches 3.9 years of education. Regarding marital status, 70% of the surveyed women (318 migrant women) are currently in a relationship, out of which more than half live with their spouse (274 women). Also, about 70% (317 women) is or has been a mother.

Upon analyzing the ideal number of children reported by the migrant women from neighboring countries, the data showed that the prevailing aspiration was the two children model (55%), regardless of the migration origin. This preference was mainly stated by women who had not yet started their reproductive trajectory at the time of the survey. The fact stands out that none of the surveyed women aspires to nulliparity. In terms of the number of children born alive per female, the average ranges from 1.4 among Peruvian migrant women and 1.8 among Bolivians, whereas among migrant women from Paraguay, the average is 1.5 children. These results, which express a low rate of fertility, are likely to be because the sample was comprised of young women who are yet to conclude their reproductive phase.

To compare the reproductive aspirations with the fertility trajectory of the surveyed migrant women, Table 3 shows the ideal number of children declared according to the number of children born alive, expressed in percentages (%). From there, we derive that family planning would imply greater deficiencies among those who have a greater number of children. If we take as reference those migrant women who had four or more children, for example, we can see that only a small fraction of that group considers that amount to be ideal.

Now, what happens with those migrant women who have fulfilled their reproductive aspirations? Are those women of bordering origin who currently have a couple making use of CCMs to prevent pregnancy? The information analyzed reveals that out of the total of surveyed migrant women, 40% of them (128 women) fulfilled their reproductive preference, that is, the number of children they have equals or exceeds the ideal number of children stated. Out of them, 65% use some CCM (86 women), and 32% (41 surveyed women) do not use any contraception method, even if they already reached the number of children, they deem ideal. Following these results, the data found shows that when asked, “Would you like to have more children?” 34% of migrant women who have a couple and wish to conclude their reproductive phase (50 cases) do not use any contraceptive method.

The points mentioned before lead to the belief that a large number of the surveyed women lack full access to family planning services or lack information on how to use the CCM that are distributed. Even in those cases where the reason for those women willing to conclude their reproductive phase (or postpone pregnancy) not to use CCMs is due to fear of secondary effects, that which is failing is access to the information on CCMs and their alternative options.

Preventive Care in Reproductive Health

Women tend to leave six to eight years longer than men; however, this difference is not indicative of their health needs being effectively covered. The World Health Organization states that inequality between sexes in terms of their exposure to risks and their vulnerability before them is a limiting factor for their access to health care and information, which in turn negatively impacts the health of women (^{OMS, 2009}).

Likewise, when it comes to the coverage of health services, this international organization recognizes that certain health services are more likely to be available, such as pregnancy care, than others, such as the treatment for cervical cancer. This specific type of cancer is the most frequent one after breast cancer in women from developing regions, and particularly in Argentina. There, the mortality rate from cervical cancer reaches 8.3 out of 100,000 women, which equals to 1,800 deaths annually, whereas breast cancer is the cause of death for 5,600 women annually at the national level (^{International Agency for Research on Cancer, 2012}).

Cervical cancer reflects the severe social inequality that still prevails in the field of women's health, as it is a disease that is almost entirely preventable in the light of current knowledge and technologies. The Nation’s Ministry of Health has acknowledged that this disease affects primarily low-income women who, due to various social barriers, cannot access screening services (^{Zamberlin, Thouvaret, & Arrossi, 2011}). In view of this, screening tests are essential to detect precancerous or cancerous tissue, thus decreasing the mortality rate of this disease. Conventional mammography and cytology (Papanicolau, commonly referred as PAP) are tests that are commonly used to detect breast and cervical cancer, respectively.

The question arises: to what extent do bordering migrants of reproductive age attend gynecology service centers? The specialized literature available on the matter shows that the attendance to health centers in general, and particularly those of SRH, is closely related to the number of years migrant women been living in the destination country (Chen et al., 2001; Carballo, 2006); that is to say, the likelihood of them visiting health service centers increases as the number of years living in the destination increases. Taking this into account, Table 4 shows the percentage of migrants from neighboring countries who have had at least one gynecology consultation in Argentina, in relation to the number of years they have been living in the country. The results show that more than three-quarters of these women attended the gynecologist at least once (86%), thus reinforcing the idea that there is a relationship between the number of years after migrating and the attendance to this type of health service. Among migrant women living in Argentina for more than 10 years, only a small fraction did never visit a gynecologist (6%), whereas, among those women living there for less than three years, this percentage is as high as 46%. Contrastingly, the results do not vary to any relevant extent when analyzed in terms of their country of origin.

Table 5 shows the percentage of neighboring countries and Peruvian migrants between and 49 years who have ever had a mammography performed in Argentina and a PAP in the last years, arranged by years of migration. The data do not allow to point out the time of the last breast care screening, and so it only includes the carrying out of the examination at least once in their time living in Argentina, as a measuring of the attendance to SRH preventive care by migrant women.

The results that the percentage of surveyed women who ever had a mammography in Argentina increases with their years of residence. An exception to this trend can be seen in the most recent migration group. Apart from this variation, it is quite noticeable that an average of more than half of the migrant women has never had this test carried out on them during their stay in Argentina, despite the medical recommendations established for women in this age group. Conversely, the relative frequency of the PAP during the last year is significantly greater when compared to the previous indicator. An average of 68% of migrant women between the ages of 30 and 49 underwent a PAP test in the year before this survey. Likewise, the results show that this percentage does not increase with the years after migration, as it does happen in the previous case.

Another finding that reflects the results obtained, in consonance with the bibliographic background on the matter, relates to the low percentage of Bolivian migrants who have had the recommended tests carried out on them to prevent breast and cervical cancer, compared to the women of the Paraguayan and Peruvian collective. The EMFF data pertaining migrant women ages 30 to 49 years living in the CABA shows that 53% of the Paraguayan (90 women) and 41% of the Peruvian (59 women) migrant women underwent a mammography in Argentina at least once, yet among Bolivian women, this figure reaches only to 35% (94 women). Similarly, yet not so markedly so, the percentage of migrant women born in Bolivia who had a PAP test done in the last year reaches 63%, compared to 74% and 66% of those born in Paraguay and Peru, respectively.

The results showed so far force us to think of migration as an intersectional phenomenon, according to which the very definition of bordering migration would be too limited to explain the different access to SRH services and preventive care. According to this, both the years of residence after migration and the country of origin of the migrant women would represent factors impacting access. Considering that preventive tests and screening are necessary for the SRH of all women and the fact that they are priority points for the effective implementation of the PNSSyPR, it could be said that the groups with the characteristics mentioned previously are more exposed to vulnerabilities in this area of their health.

Characteristics of the Sexual and Reproductive Health Care of Migrants from Peru and Neighboring Countries, Emphasizing Childbirth Care

Given that there is consensus on the fact that the migrant population represents a group of particular interest in SRH matters, the questions should be asked: How does the biomedical system work in taking care of the health of migrant women in terms of identifying the bordering migrant collective as a social group and the practices implemented for such identification? (^{Aizenberg & Maure, 2017}) How is the current policy in terms of SRR thought of and implemented? What are the main obstacles and enablers impacting the effective compliance of these rights?

One of the first questions arising within the frame of the SRR of migrant women points back at the feasibility and how an intercultural approach to the SRH system can be incorporated, particularly when it comes to childbirth care. From this starting point, we ask ourselves, what is it that we mean by cultural integration to the SRH sector, and what culture are we referring to? Two main lines can be identified regarding this (^{Comelles, 2004}): one that aims at comprehending culture as an ethnic taxonomy, and the other approaching it as meaning, that is, as a wider subjective dimension that, in the case of SRH, is associated to being a woman, to working, to being indigenous (or not), to speaking a certain language, etcetera, and from that basis being acknowledged as a holder of rights. In its part, culture, as understood from ethnicity, tends to go hand in hand with the exoticization of the foreigner, which implies the risk of falling into stereotypical categorizations of what it means to communicate with and addressing the needs of the other.

Peculiar as it is, those who are more sensitive toward migration matters find it harder to notice violence against women. That is in part sometimes due to cultural relativism, that culturalist vision of respecting both the culture of the other and being unable to notice this that, according to some, cultural relativism ends when human rights are violated [...], they say “I don’t want to impose my ideas, because I’m white.” [...] For example, a professional who without prejudice tells a woman, “well, you can plan your pregnancies,” and maybe that woman has 12 brothers and only had one child, and that change took place from one generation to the next. I think we know very little about that [...] Subjectively, what happened to that woman? (Laura, Health and Migration Group of the Ministry of Health of the CABA; personal communication, December 28, 2015).

When health professionals and administrators focus on “what is traditional” or “what is indigenous” and put aside complementary aspects that make up the subjectivity of the individual making use of health services, difficulties may arise in this care service. They range from suppressing information that affects the optimization of the SRH services (for example, not knowing what is the target population on which to emphasize the family planning methods) to even impacting rights and human dignity, for example, by rendering invisible situations of violence.

On the opposite side, when culture is understood as a constitutive part of subjectivity (as an episteme), the necessary conditions for an equal exchange among the different cultural sensitivities arise (^{Fernández Juárez, 2011}). This view, characteristic of the intercultural approach, demands the deconstruction of monolithic thinking and essentialization, of the retreat into oneself and of the disregard for “the other” (ibid.), all of these being characteristics of the hegemonic biomedical system. This view is intended to incorporate the Respected Delivery equipment of a CABA Public Hospital through the implementation of a delivery care model that echoes the law No. 25.929:

We use straps, balls, we have this stool, the salt lamp, essential oils. They [the ones giving birth] decide, and we also assess that they can stand it. They deliver with a bath, in showers in they want, with the person they want. Sometimes the people with them take turns because they are tired or because it takes many hours. And then they can deliver there on the dilator, or if they prefer, they can be taken to a gurney so they can push more easily or whatever they need along the way. What is more important, I believe, is that they can choose and have someone with them. [...] We also try to provide as much comfort as possible for a public place. The main thing is to always treat them well, the smile, the eye-to-eye look [...] Look for what your body is asking you for (Adriana, obstetrics practitioner of a Public Hospital of the CABA, personal communication, January 6, 2016).

Upon implementing this initiative, the cultural dimension is reflected in the possibility of choosing, that is, by understanding that not all women can or wish to go through delivery and childbirth in the same way; moreover, it is about choosing among different options that were thought of from the experience of taking care of different bodies.

From this perspective, being a migrant is not ignored, but rather it is pointed to an articulation of the different aspects that constitute women, migrant women, workers, and indigenous; all of these fields on which the transgression of rights also operates.

This intersectional approach is particularly useful when analyzing the phenomenon of obstetrics violence in the context of the SRR of women. Among other aspects, this type of violence implies physical or verbal abuse, the lack of care or consideration towards women, unjustified medical interventions, and not asking for informed consent. Even if all women who go through a process of labor, delivery, and postpartum in health institutions find themselves exposed it, being a migrant implies an additional axis of vulnerability that tends to reinforce unequal interactions in this field:

As a migrant, you are facing something entirely unknown. You will experience a truly asymmetrical relationship in most instances, and you come from a different country on top of that. And if the color of your skin and your features stand out... Right there and then, you are more disadvantaged than someone born there (Marina, Obstetric Violence Observatory, personal communication, December 14, 2015).

In this way, gender would not be the only dimension involved in determining the effective exercise of SRRs, as such is also conditioned by the other categories also involved, such as migration, race, sexual orientation, among others. Wherefrom should we approach this “additional vulnerability”? Does it imply segmenting the demands of SRR compliance? Given that this a transversal phenomenon, the answers to these questions given by our informants point at upholding the construction of guarantee practices not only from being a migrant but also from being a woman, acknowledging from this global frame that exclusion, discrimination, and oppression situations mainly affect women under additional axes of subordination.

When it comes to the main characteristics of the migrants’ SRH care, it can be noted that although the informants are aware of the hegemonic model of biomedical care, they also notice gaps and obstacles that upon manifesting make health professionals a highly heterogeneous group. That is why it would not be precise to talk of a single collective of health professionals.

Some have a special sensitivity for this matter, people who have been working with migrants for several years and who are crafty about interculturality; that is, in the lack of policies, they are crafty finding out, learning, and incorporating words in their language, they translate, they make signs [...]. It is up to each one, of the standing of that health center, of that service, on its administration (Laura, Health and Migration Group of the Ministry of Health of the CABA; personal communication, December 28, 2015).

Two important questions arise from this. First, while State policies with an intercultural focus aim at expanding and improving SRH care, these often tend to be insufficient and only cover a small fraction of care services. Secondly, and as a result, many of the strategies alternative to the traditional biomedical model implemented from the health system depend on the willpower of those able to apply them. As a matter of fact, and in terms of the latter, a practitioner member of the Respected Delivery team of a Public Hospital of the CABA explains:

We buy everything ourselves. The ball, the straps, the net where we put the tennis ball and the big one, where we hang the straps. ADOM, which is the Association of Municipal Obstetrics Clinics, donated the stool. They designed this stool and donated it to hospitals that work as we do (Adriana, obstetrics practitioner of a Public Hospital of the CABA; personal communication, January 6, 2016).

One of the main obstacles when trying to widen the coverage of the strategies aimed at incorporating cultural concerns into health practice, or at making more flexible the standardized care model, is the fact that they depend to a large extent on the willpower of health professionals and administrators. That is why this type of initiatives tend to be an exception and not the rule. At a macro level, we find the next reflection, complementary to the voluntarist character analyzed:

Everything [the system] works as an emergency. Everything that has to do with thinking seriously on long term follow up involves a more interdisciplinary way of working, that can consider other aspects besides the merely biomedical ones oriented to solving emergencies (Laura, Health and Migration Group of the Ministry of Health of the CABA; personal communication, December 28, 2015).

When inquiring on the main obstacles emerging when trying to incorporate strategies that guarantee the rights of migrant women within the scope of SRH, and particularly in the field of delivery care, we noticed that the infrastructure arises as an “objective” argument to distancing from the commitment of ensuring those rights:

Before adapting the dilator for this type of deliveries [respected deliveries], our patients were always accompanied by someone. We cannot put it in the room as the room is a shared space and they could be with someone, but it had to be women, the husbands stayed outside [...] What does the law say? That the patient has to be accompanied by someone and all else, always that there is room for such, and we have the delivery rooms all completely apart from each other. There are hospitals where they are only divided by curtains. Then you have the father of one patient caressing her head, and right in front you, have another one, right there (Adriana, obstetrics practitioner of a Public Hospital of the CABA; personal communication, January 6, 2016).

From this description, we may ask to which extent is it possible to address the argument pertaining to material conditions when that which is at stake is guaranteeing the rights protecting the users of the SRH system; where is the limit that determines the point at which said conditions prevent complying with a basic right such as having someone with you during delivery and childbirth? On that matter, one of the interviewed informants ponders:

There are places where they tell you […] that respected delivery cannot be implemented because the facilities would not allow for it. They say, “well, first we would have to modify the facilities, change places, because there are many women in one single room, there is no intimacy, the delivery cannot take place as such.” You hear that a lot. It is as if any innovation in terms of user rights are resisted with different arguments […] So, how motivated can the health teams be to modify the practices in terms of the rights of users? How right are they? (Laura, Health and Migration Group of the Ministry of Health of the CABA; personal communication, December 28, 2015).

Yet another obstacle that arises in the process of intercultural communication relates to linguistic and idiomatic differences. This is particularly true when it comes to naming parts of the body and describing its physiological processes, aspects that are profoundly immersed in the culture. In this sense, one of our key informants warns of the differences arising in the field of the SRH of migrants from neighboring countries:

Sometimes there were ways to name parts of the body or diseases that they would have a hard time understanding because they called them differently in their home countries. For example, for the campaign, we talked about sexually transmitted diseases, and the health teams went mad at us. If I talk about sexually transmitted diseases, this lady will not understand a thing. If I put up the sexually transmitted diseases spot, then she will understand. There we have a misunderstanding. There are constant misunderstandings in the dialog. What we have to do is making that dialog possible from different positions (Mar ^í a, CAREF; personal communication, January 14, 2016).

Finally, from the interviews, we come to understand that one of the main challenges in matters of intercultural health is overcoming the idea that health is an individual task instead of recognizing it as a collective participation system. This is particularly relevant when it comes to SRH, wherein the focus of responsibility tends to be upon the user:

Something that happens a lot is that the users are blamed for their illnesses, because they came here late, because they came here too early […] Not reading about inequalities and taking health as a matter of individual responsibility […] Professionals will tell you “this is not a matter of being a migrant or not, it is a matter of mothers caring for the health of their children or not.” That moralizing way of talking that blames and personally makes the migrant woman responsible for not coming here at 5 in the morning to take a turn for her child, just to end up having to come the day after […] impacts on that person coming back again or not (Laura, Health and Migration Group of the Ministry of Health of the CABA; personal communication, December 28, 2015).

Pertaining to the perceptions of the interviewed migrant women coming from neighboring countries and Peru, the question arises: to which extent do these women have actual access to SRH services, and what is the quality of the care they receive from local health centers, according to their own experiences? A common characteristic is the positive assessment of access and quality of services in Argentina, particularly at CABA. The interviewees highlighted as positive the cost-free nature of the care they receive and how diverse is the scope of preventive care, especially in terms of pregnancy, delivery, and care for the newborn. Contrastingly, the SRH services in the countries of origin are perceived as precarious, hard to access, and not sufficient in satisfactorily addressing their demands. Likewise, they notice how in their contexts of origin the matters involving female sexuality are taboo territory. The latter is related to the fact that for the greater part of their lives in their original societies these women had limited and informal access to methods to prevent pregnancy, care to avoid sexually transmitted diseases, or the need to carry out periodic preventive checks.

Regarding sexuality, I found that the government here gives out condoms, contraceptives, besides health being free. If you have doubts about some sexually transmitted disease, you can get checked directly. There are no taboos here […], and that’s not the case in Paraguay; they don’t have that (Elsa, Paraguay, 24 years old; personal communication, December 12, 2015).

Along the same line, Antonia (Bolivia, 43 years old) stated:

Over there in Bolivia, I wouldn’t stay in a hospital, at least not in the border where I am from [Villazón], because there are doctors but not very professional. I’m sure there are in the city, but not in small towns, no (personal communication, January 14, 2016).

One additional aspect coming from the discourse of our interviewees is the apparent relationship there is between living in Argentina and their access level to the SRH services, and the extent to which they can demand the SRR that correspond to them. Maria, born in Paraguay (35 years old), who was pregnant at the time of her migration, narrates this:

When I just arrived, everything was new. As I didn’t have the precariousness paper [a document crediting proving one’s temporary residence in Argentina] I didn’t have any pregnancy checks [for her third child]. Only by the end of my pregnancy as I was in so much pain. […] They treated me well and didn’t ask me for the paper. […] Now [pregnant with a fourth child] I began to get checks since I found out about it (personal communication, January 6, 2016).

In general, the interviewees did not find in the pregnancy and delivery process between their country of origin and the place that received them, except that the service is not entirely free in their original country as it is in Argentina.

It’s the same thing, they demand checks from you but because of the risks, in case the baby comes horizontally, in case they have to perform a c- section. In Paraguay, it is quite normal [to give birth] at home. Now less so. Now there are small clinics and from there they take you to larger hospitals (Inés, 28 years old, Paraguay; personal communication, January 6, 2016).

The midwife, your mom, or your husband, there are differences. Not so in the hospital, no; you go to nurses or obstetrics practitioners. […] Over there, if a doctor treats you, that same doctor will take care of the delivery. He will lead you through the process (Fernanda, 42 years old, Peru; personal communication, January 6, 2016).

Access to clear, complete, and factual information by the comprehensive health team is one of the fundamental principles of National Law No. 26.529 of Patient Rights and the National Law 25.929 for Respected Delivery. Among the guarantees set forth in the last legislation are the right of all women to be informed on the different medical interventions that might take place during delivery and postpartum, as well as to actively participate in the decision making on the different intervention alternatives. Among the different delivery experiences narrated by the interviewed migrants, the transgression against their right to information is a constant:

Interviewer: Did you have an episiotomy?

Paula: Yes. I was anesthetized but I did notice when they cut me open […] it didn’t hurt. I asked the obstetrics practitioner how large the cut was, how many stitches, and she told me, “we don’t release that information here” (Paula, 30 years old, Paraguay; personal communication, December 3, 2015).

Summarizing, and under the light of the goals set by the PNSSyPR, the interviews carried out allow us to state that migrants perceive their demands in this field as properly covered, particularly when it comes to care during pregnancy and delivery. It is overall agreed that the health system in Argentina, and specifically in the CABA, can provide an effective response to the needs that arise in the field of SRH. However, when asking about the elements that make up this perception, the answer is not so encouraging, that perception mainly comes from comparing own experiences with SRH services in Argentina with those in their country of origin.