How Pregnant Asylum Seekers Navigate Birth and Bureaucracy in Germany
- Berlin, Germany
When Sadaf Aziz got married she had a firm idea about how her life would unspool. She knew children would follow marriage, and she imagined giving birth with her mother by her side, guiding her and helping take care of the baby while she recovered. Instead, Sadaf finds herself more than 3,500 miles away from her native Afghanistan unsure of whether her young family will be able to stay in Berlin.
Sadaf was seven months pregnant when in 2014 she and her husband Rohullah left everything they had behind: the new crib for their baby, the three-story home they built, their extended families. His job as an interpreter with American contractors and the U.S. military had put their lives in jeopardy, so they fled with two suitcases, a laptop and his work commendation certificates.
In two months, they were in Europe seeking asylum and 20 days later she was giving birth to their son Elham, with her husband interpreting for her.
It is not known how many asylum seekers like Sadaf have given birth in Europe since more than a million people from countries in the Middle East and Africa came to seek refuge. But in 2015, about 28 percent of those seeking asylum in the European Union were women, according to Eurostat data. In Germany, the share was slightly higher at 32 percent.
Berlin’s state office of refugee affairs doesn’t track the number of pregnant asylum seekers or those who give birth due to the number of other agencies involved throughout the process, said its spokesman Sascha Langenbach. Instead, the organization relies on estimates from shelters and makes educated guesses based on the demographics they do have available. In 2016, the “under 4” group of asylum seekers nationwide was about 80,000—nearly 11 percent of those seeking asylum that year.
About 79,000 came to Berlin in 2015 and 55,000 have asylum claims being processed, Langenbach said, with another 17,000 arriving last year. Out of those, about 25 percent are women, “we then have to deal with the fact that some of these women are going to be pregnant or could get pregnant and the existing medical infrastructure must also be altered to deal with this.”
Two years after the large number of arrivals, those working with refugees are still learning how to best serve the different groups of people coming, including pregnant women, and say there are important challenges unique to this population.
Not speaking the language, a lack of understanding of the healthcare system and, at times, fear prevents them from participating in the system for example. According to a recent report by the aid organization Doctors of the World, almost half of pregnant refugees surveyed in a dozen countries, including Germany, reported not seeking prenatal care.
After a long and painful birth, Sadaf left the hospital and returned to a shelter where they shared a room barely big enough for a bed. There was no crib, no privacy; she couldn’t cook, instead having to wait in long lines in the cold for dinner.
“For me it was so difficult,” said Sadaf, now 24. “I like my country, I liked my house. It was a new marriage; everything was so beautiful.” They had been married about a year.
When Sadaf stopped producing milk after four months, there was no one to tell her what to do. When Elham wouldn’t stop crying, they cried with him too.
“We had no experience,” Rohullah said.
Pregnant women are some of the most vulnerable people in the refugee camps, said Julia Zehavi, a German native and co-founder of a new mentoring group called Welcome Mamas. But in the beginning, no one was prepared for them. There’s still no centralized government initiative to take care of them. It all varies from shelter to shelter.
The idea behind the new organization is to match German women who can introduce new mothers to the system and take them through everything from choosing a pacifier to scheduling checkups and vaccinations.
Someone who can do all the things a mother or sister would normally do, Zehavi said. She had her first son in Israel, where her husband’s from, and where she lived for eight years.
“I know what it’s like to give birth alone in an unfamiliar country.”
Since it was founded last summer, Welcome Mamas volunteers have worked with about two dozen women.
As thousands of people made their way into Germany in 2015, cities responded by trying to find shelters where they could. Gyms were turned into emergency-housing.
When Zehavi first volunteered in her neighborhood gym, one of the first things she noticed was pregnant bellies, but there were no doctors, no midwives. “I started to ask in English and Arabic who was pregnant,” she counted half a dozen women and took charge after speaking with the shelter manager.
She found a gynecologist and occasionally took the women home-cooked meals. She checked in on them, asking “How are you feeling? Is there anything you need?”
She didn’t expect to get as involved as she is now, but a call around Christmas in 2015 changed everything—for her and for the women in the shelter. One of the women was at the hospital, her baby was coming at 23 weeks. She was born weighing less than a pound and died 10 days later.
Zehavi knew that what she was seeing inside this gym was a snapshot of what was going on across the city and the country.
There are now shelters that only house families and pregnant women, although some pregnant women can still end in gyms or other emergency spaces such as the Tempelhof hangars, the humongous communal shelter in Berlin. Langenbach said the city tries to find other accommodations for them despite the tough housing market, but there are also instances where the woman doesn’t want to move because she doesn’t know anyone.
The Die Johanniter emergency shelter in Kreuzberg is one where pregnant women can be sent. Since the emergency shelter opened in August, they’ve had eight women from countries including Afghanistan, Eritrea, Vietnam and Iraq deliver babies, and currently have another four who are pregnant.
They have someone on staff who specifically helps them find hospitals and make doctors’ appointments and apply for other services and will add two midwives—one as a volunteer and the other sent by the government—but that’s not required and not every shelter does it. Staff also participates in monthly meetings with stakeholders, including Welcome Mamas, to come up with best practices.
It’s all about working together, said Jennifer Matthiessen, an intercultural psychologist and director of the camp. “You need a very strong network because otherwise you won’t have a chance.”
The Berlin government is adding programs to address the need and looking to make sure pregnant women or those with small children don’t fall behind, Langenbach said. They just launched a German-language course for pregnant women to teach them the vocabulary needed to reach out to doctors or how to ask about breast milk and they train refugees who used to be doctors in their home countries so they interpret for them and address some of the more cultural sensitive issues and family planning. They also now issue pregnant women with a health card they can use to go to the doctor and hospitals, something unique to Germany, he said.
“But after eighteen months, much of our discussion is still the first steps, housing, food, we haven’t begun yet the conversation of integration,” he said.
Pregnant asylum seekers “need special support, medical support, a midwife,” said Benan Kay, a traditional healer who works with the women at Die Johanniter.
But it’s difficult. They have to learn how to navigate the German bureaucracy. Registering a child, normally an easy step for German parents, can be a challenge for refugees who may lack the needed documents and may end up with a stateless child, not recognized by their home or host country. Which means they often aren’t allowed to go to school, see a doctor, get a job or travel.
Women must find hospitals where they can give birth, which especially at the beginning was challenging because most were full and not taking in new patients. There are babies born with medical complications or who need special food.
First-time mothers, with or without a husband are afraid, said Kay. “They are thinking, ‘How I can get clothes for my child, the buggy, essential things?’ It might be very basic, but it’s very important to make a nest for their child.”
Zehavi, a tall, red-headed mother of two, is the type of person who is always running around at all times with her planner and smartphone, which constantly rings, pings and vibrates.
“I just had a family from Afghanistan arrive at my practice who missed a baby checkup and they don’t have a stroller,” reads one Facebook message from an area doctor.
“Can you accompany this woman to her C-section?,” another caller asks.
“We just had a young mother from Iraq arriving alone who is now at the hospital,” a social worker told her. She heads to the hospital where she knows the doctors and nurses by name, stops at a local grocery store to get the woman some cookies, a Turkish yoghurt-like drink and nuts.
In the hospital, she introduces herself. “I have two boys, I was also scared,” she tells the 24-year-old woman from Iraq expecting her first child.
“Is your husband here with you?” she asked. The woman gently shakes her head to the side and looks down. Zehavi doesn’t ask any more questions, she doesn’t need to know. “I don’t live far away, call me at any time,” she said and gave her a newly printed business card. “I can even be with you at the birth if you need a hand to grab onto.”
She offers to talk to the doctors and help her look for prenatal care or yoga classes.
Zehavi is also straightforward. “I don’t sugarcoat anything,” she said, no matter how hard it is. She has a strong personality that has gotten her in trouble but also allows her to get things done.
It’s good for them to have someone who can take their hand, Benan said. “Especially for integration or language, it’s very important to learn from somebody else from the outside. If somebody like Welcome Mamas supports them, that support doesn’t end after the pregnancy, there will be a friendship.”
They can provide a level of attention shelter employees can’t give them. They have a staff of 10 for 109 residents. “It’s a closer relationship that begins with very easy things like explaining the medical system here,” said Matthiessen. “And if it’s coming from another mother, they will trust the information more.”
At one point, Zehavi had an app on her phone to remind her when each woman was due, along with index cards with their names, dates of births and due dates that she used to carry in her backpack. Now, it’s all in her head. Quickly reciting names and dates, medical histories — even if at times she forgets to buy a train ticket or misses grant proposal deadlines.
Still, Matthiessen said, Zehavi and the others are volunteers with their own jobs and families. “There must be from the government people who are well-paid to do this as a full-time job.”
The reasons why women seeking asylum would have a child are as varied as the individuals themselves.
There are those who arrived in Germany in 2015 were already pregnant or got married just before the journey. Some were raped, as it is known to happen in smuggling routes. For others, it’s hope that having a child will increase their chances of staying—at times based on advice from an attorney.
The Azizes were not ready to have a second child. “We wanted to wait five, six years until both of us could go back to school,” Sadaf said. But they heard that if they had a second child in Germany, they could have more time to prove to officials they were worthy of a new opportunity in the country. They are still waiting for a response on their asylum claim.
It’s standard practice that a woman won’t be deported six weeks before the birth date and up to eight weeks after. If it is a high risk pregnancy, such as a case of multiple birth or in case of complications the grace period can be extended on a case-by-case basis, experts say. And Germany, unlike the United States, doesn’t have birthright citizenship. Instead children only take the German nationality at the time of their birth if at least one parent has residence in Germany and has lived here for at least eight years, which doesn’t apply to couples seeking asylum.
The decision to have a child speaks to the desperation of those who come from so-called “safe countries,” and whose asylum claims are more likely to be rejected, Zehavi said, such as Senegal or Albania, and there’s a recent agreement to send back Afghans who didn’t qualify for protection. “They are very afraid. Some people sold their houses, all they had to come here. For some their lives are in real danger and they can’t go back.”
The Azizes arrived in Berlin in December 2015, after a year-and-a-half fighting their case in Holland. At the end, the government ordered them to go to Italy.
Waiting to be deported to Afghanistan was not an option and they heard that in Germany you could work, learn the language and were less likely to be rejected.
“We didn’t come here for money,” Rohullah said, they had a good life back home. At the peak of his time as an interpreter he made more than $1,000 a month, more than enough to support his family living in exile in Pakistan and his new wife in Kabul.
But Afghanistan also means war.
“My dad lived through war, I lived through war and I’m not very hopeful it will end soon,” he said.
Rohullah’s family fled to Pakistan when he was seven when the Mujahideen went after his father, a former military officer and government employee.
He went back to Afghanistan in 2006 to become an interpreter for contractors working for the U.S. military and training for Afghan forces. Initially no one thought it would be dangerous, he said. As the Taliban gained ground things started to change. One day in August 2014, four months before he planned to leave his job and start a business, he noticed an SUV following him. His bosses told him to keep driving. They were on their way.
“Thoughts of family and what’s going to be of them” ran through his head, he said. His wife was seven months pregnant. The SUV sideswiped his Toyota Corolla which caused it to roll on its side.
It was time to leave, just like his father before him. “If it wasn’t this, at some point someone would blow himself up or shoot me or kidnap me or torture me and cut my head off,” he said.
All of this—almost losing her husband, the journey itself and the uncertainty of it all has been too much for Sadaf. Last year, Rohullah quit an internship at a German company to take care of her, afraid of what she could do to herself or their unborn child.
She would constantly cry and pick fights, “I was depressed,” she said.
That’s when the Azizes and Zehavi’s paths crossed.
“I tried to assure her and hope for the best,” Zehavi’s said. Above all “my aim was for her to have a good birth because the first was very bad and she did.”
By the time Sadaf and Rohullah had their second baby in November, things were different. When she started to feel the contractions, Rohullah called Zehavi who met them at the hospital. Zedna was born four hours later.
A few days later, before taking her home, Rohullah changed Zedna into her brand-new pink and white outfit—with matching shoes and a hat too big for her tiny head—with an easiness that only comes with experience.
“My baby girl,” he said in Farsi as he rocked her in his arms, “You are now ready to go home.”
They had a new white and lilac bassinet, a crib and a changing bed. They had a two-child stroller, they understood when the nurse instructed them in German to buy painkillers at the pharmacy.
The Azizes know that compared to other asylum seekers, their new life in Germany is not bad.
Since the baby was born, they have two rooms in a shelter that used to be a nursing home. A couch, television and breakfast table furnishes one of them. Blue-gray curtains hang from the windows and balcony door. A photo of Rohullah’s parents hangs on one of the walls. In the other, they have their bed and two cribs. Everything is spotless.
But after many false promises and people taking advantage of them, they still live in a shelter. The last landlord told them they don’t rent to refugees, Rohullah said. Finding an apartment in Berlin is among the biggest challenges for asylum seekers due to the high demand and landlords not knowing how long their tenants will remain in the country.
“Imagine losing everything all of the sudden,” Rohullah said as they played videos of their wedding on a laptop. Sadaf wearing a colorful traditional dress, before changing into a puffy white gown, hair and makeup perfectly done.
“Mein Mann was happy,” Sadaf said, as she turns her gaze down. “We used to be happy.”
“It’s a reflection of our old selves,” he added. They sold their new house, the car, Sadaf’s wedding gold jewelry, everything, he said, to start over in Europe.
Rohullah is quickly learning German but his lack of a passport has complicated his opportunities in Germany. “I heard what Merkel said that if you work hard there will be opportunities for you,” he said. “I want to find a job, so we can pay rent, pay taxes, to live like any normal German family.” But the road ahead is still full of obstacles.
Sadaf can see herself building a new home in Germany, but she also thinks of the life she left behind. She thinks of her mother when she’s nursing the baby in the middle of the night. She thinks of her old home when she’s dragging the basket full of clothes seven stories down or when she’s cooking in the communal kitchen down the hall while trying to keep Elham under control and the baby quiet.
Life is challenging but “kein problem,” Sadaf said mixing the English she learned during their stint in Holland and the German she is learning now. It seems more as a statement to convince herself than an affirmation, but she turns to her children now.
“This is our little doctor,” she said as she holds Zedna in her arms. “And him,” she said looking at Elham, “He can be an engineer or anything he wants.”
This story was produced with support from Robert Bosch Stiftung
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