Healthcare Access of Irregularised Families in Germany during the Perinatal Period: Practitioners' Perspectives

Poster presented at the Geneva Health Forum 2026. Introduction: In Germany, irregularised migrants are de facto excluded from the limited healthcare they are entitled to, as welfare offices must report them to immigration authorities when they apply for cost coverage. For families with at least one member in an irregularised migratory status, the time around birth is a critical window to negotiate status: the newborn’s health insurance derives from the parents, while the mother’s residence permit may derive from the child. This study examines how practitioners describe the complexity of timing and coordinating healthcare access in this period. Methods: 11 semi-structured expert interviews (March to September 2026) with physicians, social workers, public health and NGO staff at clinics for people without health insurance, clearing offices and public health offices in six cities: Berlin, Frankfurt am Main, Hamburg, Kiel, Koblenz and Mainz. Interviews were analysed through open coding followed by thematic analysis. Preliminary results: Practitioners described the time around birth as medically high-risk, with particular health needs met by a patchwork of specific rules. Delayed decisions, preterm births, emergencies and registration problems can undo carefully timed steps. Practitioners’ strategies to negotiate care: (1) timing paperwork and contact with authorities, (2) negotiating local funding for birth, (3) building on one family member’s status, (4) prioritising the newborn’s long-term coverage. Conclusion: Status-based legislation in Germany acts as a political determinant of health, making access to care in the vulnerable period around birth dependent on timing, negotiation and chance. Practitioners’ strategic work makes care possible, but it remains fragile, dependent on individual expertise and local arrangements. Implications to improve access to health: Guarantee provisional health coverage from birth until parentage and status are clarified. Replace city-by-city discretion with reliable country-level arrangements. End the duty of welfare offices to report irregularised migrants to immigration authorities, a German exception in Europe. Funding: GRACE (Growing and Ageing in the Shadows: Undocumented Children and Elderly Migrants in European Cities) and its follow-up project SOLACE (Shadowed lives of Older migrants and Little ones: Access to Care and Equity) are research collaborations within the 4EU+ European University Alliance (University of Geneva, Charles University, Heidelberg University, Sorbonne University, University of Copenhagen and University of Milan), funded under the 4EU+ SEED grant scheme 2025/26.