Birthing "Invisible" Children: State Power, NGO Activism, and Reproductive Health among "Illegal Migrant" Workers in Tel Aviv, Israel

BIRTHING "INVISIBLE" CHILDREN: STATE POWER, NGO ACTIVISM, AND REPRODUCTIVE HEALTH AMONG "ILLEGAL MIGRANT" WORKERS IN TELAVIVISRAEL Sarah S. Willen Amina, a Nigerian woman in her early thirties, met Naanah Kofi, a Ghanaian man in his late thirties, at the evangelical church they both attended in South Tel Aviv, just a block away from the city's Central Bus Station . Both came to Israel on an undocumented or illegal basis with the goal of working and earning money, some to save and some to remit home to kin. Eventually the couple moved in together, and Amina became pregnant. Interested in obtaining prenatal care but unable to pay a private Israeli doctor , Amina followed a friend's advice and began making monthly trips to East Jerusalem, over an hour's journey each way and across the invisible but tangible border between Israel and Palestine, to consult a Palestinian physician known within the West African community in Tel Aviv to provide prenatal care at low rates. During Amina's second trimester, the doctor recommended an advanced sonogram. He lacked the technology to provide it, so he referred her to the sole medical facility in Tel Aviv fully accessible to migrant workers: the low-tech, volunteer-run Open Clinic run by the NGO Physicians for Human Rights-Israel (PHR). The clinic itself—equipped with little more than a few donated examination tables, a used EKG machine, and an ill-stocked medicine cabinet containing first aid supplies and an assortment of donated JOURNAL OF MIDDLE EAST WOMEN'S STUDIES Vol. 1, No. 2 (Spring 2005). C 2005 56 JOURNAL OF MIDDLE EAST WOMEN'S STUDIES medications, and little else—could not perform the diagnostic test Amina needed. Through the creative resourcefulness of the clinic's administrative staff, however, Amina was able to obtain the sonogram at an affordable rate through an informal price reduction agreement between PHR and a local public hospital. In addition to the sonogram, Amina's visit to the Open Clinic also linked her into a web of reproductive and infant health services for which, to her great surprise, she was eligible. First, clinic staff explained she could obtain state-subsidized prenatal care at a municipally run Mother-Child Health (MCH) center in her neighborhood instead of traveling to East Jerusalem each month. Second, they explained that since she was working regularly, her employer could register her with the National Insurance Institute (Nil), or Bituakh Leumi, to receive free hospitalization and delivery coverage and even a small delivery grant of about US$450 after the baby's birth. Finally, she was advised to return to the MCH center after her delivery to register the infant for subsidized immunizations and development checkups. Amina's story is a useful backdrop for the present article, which explores a curious, even paradoxical, situation and some of its practical and theoretical implications. On one hand, the declared aim of the Israeli government is to dramatically reduce the number of undocumented transnational migrant workers in the country through a range of increasingly aggressive tactics culminating in a mass deportation campaign initiated in mid-2002. Consistent with these policies, "illegal" (henceforth I will omit the quotation marks for ease of reading, but they are implicit throughout) migrants in Israel—like those in many other post-industrialized host states—are almost completely excluded from the country's nationalized health care system and from other branches ofthe (increasingly threatened) welfare state (2002; File and Davidovitch 2005; Fried 2003; Leventhal et al 2003). Nor can children born in Israel to illegal migrant parents receive citizenship or residency rights as they can in some European and North American host countries. Within this ethnographic context, illegal migrants' eligibility for statesubsidized , or even free, reproductive and infant health care thus presents a bit ofa puzzle. Efforts to resolve this puzzle raise a number of important questions regarding the political economy ofillegal labor migration; the role ofhost societies in generating and facilitating such migration flows; and the responsibilities incumbent upon host societies toward migrants who may not be invited but whose labors are well integrated into local economies, often under conditions that circumvent or violate local laws and prevailing normative ethical precepts. SARAH S. WILLEN 57...