FEATURE / Undocumented migrant worker's high-risk birth exposes major medical gap

By Sunny Lai and Jennifer Aurelia, CNA staff reporters

When an undocumented Indonesian caregiver living in Taiwan became pregnant in January 2025, she saw it as a blessing, even though it was unplanned.

Eight months later, her pregnancy had turned into a life-threatening nightmare.

Ultimately, Ellie (a pseudonym) and her baby survived, but her case, and the NT$1.7 million (US$53,886) unpaid bill it left, exposed major flaws in Taiwan's handling of migrant workers and its national health insurance (NHI) system.

Pregnancy without checkups

Ellie arrived in Taiwan in 2019, and the 34-year-old became undocumented in 2020 after leaving her employer.

After working in Taiwan without legal status for four years, Ellie learned she was pregnant in January 2025.

Because she was undocumented, she was not covered under Taiwan's compulsory NHI system, and Ellie avoided prenatal checkups for fear of being reported and deported.

She held out until early September, when she sought help from the NGO Harmony Home Foundation in getting medical attention.

The prognosis was not good.

"The doctor said this pregnancy was dangerous and needed to be delivered at 35 weeks," Ellie told CNA in a recent interview, recalling one of her first checkups last year.

"I was afraid I would die," she said.

Doctors diagnosed her with severe placenta accreta, a condition in which the placenta grows too deeply into the wall of the uterus and can cause life-threatening bleeding during delivery, putting both mother and baby at serious risk.

Complicated and costly

Because of the risks, Ellie was referred to National Taiwan University Hospital (NTUH) for specialist care.

She was treated by Shih Jin-chung (施景中), the division head of obstetrics at NTUH's Department of Obstetrics and Gynecology.

Ellie's case "was very hard to operate on because the invasion was extensive," Shih told CNA in a recent interview.

When the placenta invades a wide and deep area, surgeons have to go further in, where there are more blood vessels, making bleeding harder to control, he explained.

Ellie's son was delivered on Oct. 1 after a two-hour operation.

The mother then spent five days in intensive care and about two weeks in a general ward, while her newborn remained in the neonatal intensive care unit for over a month, until Nov. 9.

If she had been in Indonesia, Ellie said, she would have been sent home without surgery, "and I definitely wouldn't have survived."

'Miscommunication'

When Ellie left NTUH with a Harmony Home staffer in mid-October, however, she did so without addressing her huge medical bill.

The move drew a sharp rebuke from Shih, who wrote in a Facebook post in late October that he felt he had been "cheated" after the NGO could not be reached and the bill remained unpaid.

"At that point, I was really unhappy. You brought her to me and told me to do everything I could to save her, but the huge medical bill still hadn't been dealt with," Shih recounted.

Asked about Shih's reaction at the time, Ellie broke into tears and said it was "maybe just a miscommunication."

A day after Shih's post, Harmony Home contacted him to explain what had happened, including how a mistake in the discharge process led to Ellie not signing a debt acknowledgment form.

A few days later, Ellie also returned to NTUH to explain what had happened in person and express her gratitude to Shih.

After hearing their explanation, Shih decided to move on, and he even helped publicize the NGO's fundraising drive for Ellie's case.

That drew more support after the initial campaign had stalled, including a donation of NT$1.05 million from a man surnamed Wu (吳) to cover the remaining expenses.

"I do not know Mr. Wu, and he does not know the Indonesian migrant worker either," Shih said. "Why would he help her? I honestly don't know. It was probably just an act of kindness."

Happy ending?

Ellie's story had a happy ending thanks to the donations, but hers may not be the last case of an undocumented pregnant migrant worker needing major medical care, according to Harmony Home founder Nicole Yang (楊婕妤).

As of December 2025, Taiwan had 94,542 undocumented migrant workers (out of a total of 866,275 migrant workers), including 38,792 women, according to the National Immigration Agency (NIA) and the Ministry of Labor.

Most of the undocumented female migrant workers are of childbearing age, and Yang estimated about 500 of them have given birth in Taiwan, based on her NGO's years of assisting them and their children.

Yang said some of these women deliver their babies at clinics, "but most are afraid of being caught and end up giving birth at home."

That extends to avoiding prenatal checkups because they lack health insurance and fear deportation, which can have serious consequences.

Citing one case in which a baby was born with one hand that did not develop and became atrophied, she said prenatal care could reduce such risks and give parents a chance early in pregnancy to decide whether to continue.

A ticking time bomb

Although Ellie was the first undocumented pregnant worker Shih treated, he said colleagues across Taiwan have encountered similar cases.

One doctor in Nantou, a central Taiwan county that relies on a large agricultural workforce, told him that eight undocumented workers had given birth at their hospital in just the past month, Shih said.

In most cases, he said, patients are unable to pay.

Hospitals often report the cases to the NIA, which then arranges for the women to be sent home once they are medically stable after delivery.

"The medical bills are usually left unpaid," Shih said, noting that hospitals often end up absorbing the loss.

But beyond the financial burden, Shih said the clinical risks can be even more alarming.

"They have no NHI coverage, no legal status and no prenatal checkups, so when they show up at the hospital, they are basically a ticking time bomb for front-line medical staff," he said.

What can be done?

Yang said the Taiwanese government currently has no specific plan to assist undocumented pregnant workers.

"If the government can help, of course that would be good, but I don't think it is that easy," she said, noting that many people are willing to help undocumented children because "children are innocent," but tend to care less about the mother.

Shih, a supervisor of the board of the Taiwan Association of Obstetrics and Gynecology, said he planned to work through the association to urge the government to set up a cross-ministry task force on the issue.

At present, the labor ministry does not see medical issues as its responsibility, and the health ministry thinks the problem of undocumented migrant workers is not within its scope, he said.

"I hope the government will stop turning a blind eye. The problem will only get bigger, and it needs to be addressed properly," he said.

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