Meet Diogenes Lamarche

Diogenes Lamarche has extensive experience as a researcher and consultant in the management of programs and projects in corporate, academic, social, governmental, and international cooperation settings. He holds a master's degree in sociology from the University of Illinois at Chicago, as well as specializations in Gender and Development (INTEC) and Population and Development (FLACSO).

Review of his "Study of media narratives on access to public health services for migrants and their relatives"

Although there are recurring themes and dynamics, migration narratives in the Dominican Republic are complex and change over time, influenced by national, island-wide, and international political contexts. Within the framework of the MigraSalud Project led by OBMICA, Lamarche studied media narratives about access to public health services for migrants and their families in the Dominican Republic, with a focus on sexual and reproductive health. The exploratory, mixed, and descriptive study analyzed press articles published between January 2020 and December 2023.

As a starting point, three search strings were structured using logical operators and keywords: (1) migration AND health conditions and diseases; (2) migration AND sexual and reproductive health; and (3) deportations AND [sexual and reproductive health OR health conditions and diseases]. These online searches, carried out for each year of the study and segmented by type of media outlet, covered 18 media outlets: 8 traditional, 5 digital, and 5 alternative. This resulted in 36 searches during the entire research period. A purposive selection of articles was then made for qualitative exploration, considering the number of relevant words present in the headline and or highlighted excerpt, theoretical relevance in the researcher's judgment, and variety, so as to include cases exemplifying the different narratives identified in the quantitative exploration, taking into account the year and the media outlet.

The results show that in 2020 significantly fewer articles were found (1,143) compared with subsequent years: 5,605 in 2021, 5,206 in 2022, and 5,564 in 2023, implying a 390% increase from 2020 to 2021. Headlines and highlighted excerpts from the first 50 articles found in each search were systematized, resulting in a total of 1,045 analyzed headlines and excerpts, some articles appeared in more than one search, and 6 sources produced no articles. The multiple coding scheme used revealed several points of interest.

Among the codes used to group the most frequently used terms in headlines and highlighted excerpts, migration appears in 41% of cases, followed by immigrant in 36.3%, social conflict in 24.2%, Haitian in 24.1%, and undocumented or irregular in 23.3%. It is important to note that the codes are not mutually exclusive, since the same article may address different issues, and each article carried an average of 2.5 codes. Given that the searches were designed to find articles about migration and health issues, it is striking that public health, as a possible umbrella term linked to all the search phrases, appeared in only 15.6% of the titles and summaries analyzed, while the specific codes on health, outbreaks and contagion appeared in only 2.6% of headlines and summaries. In caricatured terms, there seems to be a tendency to use some substantive term related to migration or immigrants, followed by a term associated with social conflict, and only then indicate that the subject is Haitians, possibly undocumented, before placing public health in the title.

In addition to the increase in the number of articles found, compared with 2020, 2021 saw a general increase of 219% in the frequency of keyword use in headlines and summaries. Some terms showed sharper relative increases: pregnant migrant woman (1,894%), Haitian (975%), deportation and synonyms (718%), and undocumented or irregular (492%). Taking the media landscape observed in 2020 as a point of reference, this marks a highly significant change and has repercussions throughout the rest of the study period.

The residual narrative

From a qualitative point of view, from January 2020 until early September 2021, most of the articles found that include the terms migration and health rarely analyze the intersections between them. We have called the most common narrative in this period the residual narrative; it includes certain basic elements that persist and are reorganized over time, such as referring to a particular political, social, and or economic juncture in Haiti that motivates migration toward the Dominican Republic, then mentioning some impact, social, economic, cultural, or to a lesser degree health-related, on the receiving country, and then suggesting control measures.

Caption: cover of the book reviewed here

The seed narrative

Based on the qualitative and quantitative explorations discussed, the most important change in the narratives occurs after the "Resolution on measures for the entry of foreign women in a state of pregnancy" in September 2021. From that point onward, "Haitian women in labor" dominate the media agenda. A seed narrative had emerged before the announcement, in February, quantifying the potential health problem on the basis of an EFE report citing IOM numbers and statements by the Minister of Health about the number of Haitian pregnant women who crossed during the COVID-19 pandemic.

The dominant narrative

From late 2021 and throughout 2022, this becomes the dominant narrative: discussion centers on the increase in births to Haitian women and the decrease in births to Dominican women, the costs to the State, and the negative impact on the Dominican public health system, especially in border localities and in the most crowded hospitals of the main cities. In many cases, generalizations are made from specific cases; in few is there evidence that diverse available sources and data were consulted, compared, and analyzed. One of the most cited estimates in the study period, coming from a press conference in which the Minister of Health participated, estimated an average of 100 births per day to Haitian women in 2021. That would equal 365,000 births in one year. According to ENI 2017, the most rigorous and complete official source available at the time of publication of that article, the total number of Haitian women or descendants of Haitian women of reproductive age was estimated at 189,505. To reconcile these numbers, one would have to assume that this population doubled in four years and that each of those women gave birth in 2021.

Alternative narratives

At the same time, there is an increase in reporting about migration operations in maternity wards, and in 2022 the media focus shifts toward a broader analysis of the migration issue. Various articles report complaints by churches, civil society, and international organizations about abuses against pregnant women. Reference is also made to the General Migration Law and to regulations on deportation and health services for migrants, exposing inconsistencies and opening the way to alternative narratives.

The articles analyzed refer mostly to people of Haitian descent. The statistics on "Haitian women in labor" used in them lack conceptual or operational definitions explaining how nationality or place of residence is measured in health records. This makes it difficult to establish whether they concern Haitian women who crossed the border to give birth, Haitian women or women of Haitian descent who have lived or were born in the Dominican Republic in an irregular situation, women in the process of regularization or already regularized, or even women of other backgrounds or nationalities, including Dominicans, classified as Haitian based on phenotype and on the discretion of those keeping the records. This in turn makes it difficult to clearly estimate the health expenditures associated with different sociodemographic groups.

Nevertheless, from both a qualitative and quantitative perspective, the research clearly points to a significant increase in media attention to migration and health during the study period, and the figure of "Haitian women in labor" played an important role in that regard. The issue was placed on the agenda, highlighting diverse challenges and complexities. At the same time, efforts are also visible to link the private health system to health tourism in the international sphere.

It can be argued that what appears in the media reflects narratives expressed by different sectors that influence public opinion, for better and or for worse. The media may reproduce, amplify, filter, soften, highlight, question, influence, and reveal inconsistencies in those narratives. But those narratives also refer to ideological, political, economic, and historical factors from which the media are not necessarily separate. These factors must be considered and discussed in broader spaces, including in education and in effectively implemented public policies, as well as in relation to the economic and political opportunities and costs involved.

Conclusions and recommendations

With all this in mind, and in an optimal context, it is essential to strengthen the national statistical system in order to improve the production and availability of migration data, ensuring that information is accurate and accessible. It is also fundamental to integrate research and academic production, guaranteeing that scientific evidence and relevant studies are taken into account in the analysis and dissemination of information on migration phenomena. In addition, effective mechanisms must be established so that these data are properly used in statements by public officials and in press articles, promoting communication that is informed, responsible, and verifiable. Media outlets must rigorously verify data, offering comparisons between what public officials say and what official and alternative sources show, especially in investigative journalism, which was scarcely represented in the reviewed articles. All of this is crucial to provide the public with a complete, nuanced, and truthful perspective on migration phenomena, and to encourage dialogue and action oriented toward seizing opportunities and finding solutions to the challenges we face as a country. Although these ideals may seem ambitious, they are achievable and realistic.