The social determinants of maternal and congenital syphilis at the Colombia-Venezuela border: A qualitative study of twenty mothers of newborns with congenital syphilis

Abstract

Humanitarian crises and resulting out-migration have created contexts in which treatable diseases such as syphilis have expanded in prevalence. Untreated syphilis can have potentially irreversible and devastating consequences, especially for infants born with congenital syphilis. Our study aimed to understand the experiences of postpartum mothers whose newborns have been diagnosed with congenital syphilis and explore the social determinants of maternal and congenital syphilis. The setting of our study is the main public hospital in Cúcuta, Colombia, at the border with Venezuela, which provides emergency care to everyone regardless of documentation and thus receives a high share of Venezuelan migrants. We conducted twenty in-depth interviews with women who had their newborns hospitalized with a diagnosis of congenital syphilis. Sampling was conducted purposively at the hospital, between March and June 2023. Study participants were mostly Venezuelan migrants and Colombian returnees, from their teens to their forties. We used a grounded theory technique to conduct thematic analysis. Four major themes emerged: 1) experiencing a pregnancy in the context of a lack of resources, violence and ignorance; 2) guilt with and reinfection of syphilis; 3) challenges and limitations in accessing health care; and 4) limited support networks and machismo. Reported challenges were intertwined with the high costs of health care in the country of origin, the lack of knowledge of sexually transmitted infections, the limited public health education targeting this population group, and the absence of Colombian public policies that promote care for the non-regularized migrant population.