International students attending post-secondary institutions in Ontario do not receive OHIP coverage and are required to pay for medical insurance as part of their enrolment. UHIP, the insurance plan used by most of Ontario’s universities, covers all pregnancy-related medical expenses regardless of the date of conception. However, most college insurance plans restrict coverage to pregnancies that begin after the policy start date or up to 30 days before. This means that pregnant international college students whose date of conception is before the cut-off date set by their insurer do not receive coverage for any pregnancy and birth-related costs. Many students struggle with these costs, which can total tens of thousands of dollars, and either delay or avoid going to the hospital to give birth. This causes a disproportionate impact on pregnant people, who are overwhelmingly women.
The Women’s Legal Education and Action Fund (LEAF) and Waterloo Community Legal Services have prepared an advocacy brief that highlights changes that need to be made in order to ensure international students in Ontario have their reproductive health needs met, and rights affirmed.
It is critical that pregnant international college students, who already pay for mandatory health care insurance with their tuition fees, be able to access the healthcare they need without having to pay thousands of dollars out-of-pocket.
We call on the Ontario Ministry of Health to:
- Re-instate OHIP coverage for international students
- Reverse cuts made to healthcare for uninsured people and create a permanent program that ensures people who live in Ontario have equitable access to health care regardless of their insurance or immigration status
We call on the Ontario Ministry of Colleges and Universities to:
- Update the Requirements for Designated Learning Institutions to include a requirement for international students’ health insurance policies to cover all OHIP-covered services, including reproductive health care
We call on administrators of college health insurance plans for international students to:
- Ensure international students’ insurance plans include all OHIP-covered services, including reproductive health care and services related to pregnancy regardless of whether the pregnancy began prior to the start date of coverage
We call on the federal government to:
- Pass and implement a comprehensive and inclusive regularization program that includes access to health care
Kharo’s story
Kharo had a thriving tailoring business in Nigeria. In hopes of improving her business and marketing strategies, she decided to study global marketing at a college in Canada. She got an offer of admission in February 2022, got married in April 2022, and got her student visa in September 2022. Her college program is a two-year program with school fees of about $36,000 excluding housing, meals, and daily living expenses. These fees included a private health insurance plan for international students, which is mandatory for all international students studying in Ontario. She paid all her school fees for the two years.
Kharo found out that she was pregnant a few weeks before coming to Canada. Her husband expressed concerns about Kharo studying abroad while pregnant, but ultimately, a decision was made that Kharo would pursue her studies in Canada, and that if she was struggling, she would consider returning home.
After starting her studies in Canada, Kharo was asked to do a dating ultrasound at the college clinic. She was told that depending on her due date, her student insurance plan might not cover her pregnancy related health care costs. The insurer even initially refused to pay for the dating ultrasound until Kharo wrote to them to ask that they cover the costs, since they requested it. Kharo had also booked an appointment to see an obstetrician, and luckily, a COVID-19 OHIP exemption policy that provided health care for uninsured people was still in place at the time. Kharo informed the obstetrician about the exemption policy, and the obstetrician agreed to bill OHIP and not Kharo. However, a few months later, the obstetrician sent her a bill of about $400 for the initial consultation.
Kharo decided to find a midwife willing to take her as a patient, since midwifery services are covered for everyone in Ontario, regardless of their immigration status. She planned a home birth with a midwife to avoid huge hospital bills. However, during contractions, the astute midwife found that the baby was at risk of dying, and that home birth was not a safe option. Kharo had to be transported to the hospital in incredible pain.
At the hospital, the plan was still to have the midwife deliver the baby. However, Kharo was in severe pain and needed an epidural, for which the specialist demanded payment of about $1000 before administering. At this point, Kharo had endured hours of excruciating labour pain, and decided to put the payment on a credit card, despite not knowing how she was going to pay it back. Kharo’s baby had some breathing complications and was in the NICU for about three days. Luckily, the midwives Kharo worked with applied for OHIP coverage for her baby and got it. Even so, Kharo was left with a $6000 hospital bill for her use of the hospital facilities.
About two months after her baby was born, the college insurance company changed their decision and paid for Kharo’s hospital bills. Kharo is not sure what changed and why they reversed their decision. She had emailed the insurer earlier to let them know a lawyer she was working with at a community legal clinic wanted a copy of the policy that allowed them to refuse her pregnancy care claims, even though she had paid her insurance premiums like every other student.
Kharo’s story is just one of many. There are other cases of international college students in Ontario who have had to go through extraordinary stress during pregnancy and childbirth, but who would rather not share their stories or relive their experiences.
In addition to the high tuition fees that international college students pay, those who are pregnant or have pre-existing health conditions are often denied access to, or forced to pay thousands of dollars out-of-pocket for, essential healthcare. This is a sad reality for a country that prides itself on its universal healthcare system, and that receives tremendous social, cultural, and economic benefits from international students.
This story has been shared with Kharo’s permission.
Fast facts
- International students contributed $10.9 billion to Ontario’s economy in 20181
- In hospital emergency departments, uninsured patients are more likely to be triaged as severe, leave without treatment, and die than insured patients2
- Healthcare is a human right, and Canada has signed an international treaty endorsing the right to health
LEAF acknowledges Women and Gender Equality Canada’s support of the Reproductive Justice Project.
1 Canmac Economics Limited. (2020, August). Economic Impact of International Education in Canada – 2020 Update. Global Affairs Canada. https://www.international.gc.ca/education/assets/pdfs/economic_impact_international_education_canada_2017_2018.pdf
2 Hynie, M., Ardern, C.I. & Robertson, A. Emergency Room Visits by Uninsured Child and Adult Residents in Ontario, Canada: What Diagnoses, Severity and Visit Disposition Reveal About the Impact of Being Uninsured. Journal of Immigrant Minority Health 18, 948–956 (2016). https://doi.org/10.1007/s10903-016-0351-0
Pregnancy as a pre-existing condition for international college students in Ontario (179 KB) - 