Gender-based violence and social determinants in undocumented pregnant Venezuelans living in Barranquilla, Colombia: a qualitative approach


 Background gender-based violence is considered a phenomenon of importance in the field of public health and social sciences. From a social determinants’ perspective, it seems important to study this topic in social groups considered as vulnerable, in order to establish prevention strategies. This study aims to explore the experiences of gender-based violence and its social determinants in a group of undocumented pregnant women in the city of Barranquilla, Colombia.Methods qualitative study based on 15 semi-structured interviews with undocumented pregnant Venezuelans residing in the district of Barranquilla. The interview guide included various dimensions in order to discover the opinions and experiences of each participant related to their migration process, their health during pregnancy, experiences of gender-based violence, individual and institutional responses to violence and, lastly, the health care they have received in Colombia. Narrative contents analysis was carried out by means of emergent categories from the perspective of the interviewed women. Ethical considerations for gender-based violence studies were taking into consideration.Results interviewed women migrated from Venezuela to Barranquilla in Colombia motivated to improve their quality of life and for their families. In the adaptation process, some women reported having been victims of physical, psychological, sexual and economic violence, which can be associated with their vulnerability conditions related to their pregnancy and motherhood, economic dependency, lack of networks of support and insecurity of the sectors in which they resided. This situation affected their physical, mental and psychosocial health.Conclusion immigrant pregnant women in Barranquilla are in an especial situation of social vulnerability considering their experiences about gender-based violence, and its social determinants related to the migratory process and their adaptations to the Colombian territory.

poses an enormous challenge to public health.
The scienti c literature reports studies on gender violence, or intimate partner violence during pregnancy and its relationship with adverse health indicators for both women and their newborns [10], and qualitative studies that make it possible to describe the experiences of violence experienced by these women during pregnancy and the role of social support networks, among other determinants [11].
However, speci c studies focused on violence against immigrant pregnant women are scarce [12,13].
One of the main limitations found in the studies is the lack of differentiation between immigration status and belonging to a certain ethnic group [14][15][16][17], as a result of which possible inequities and inequalities are not visible in all their complexity.
Speci cally in Colombia, previous research has already been conducted on pregnant Venezuelan immigrants to characterize their health situation [7] and quality of life [18]. However, it is necessary to further explore issues related to the factors and determinants of the different types of violence these women suffer in contexts of social inequality. In view of the above, the aim of this study is to explore experiences of gender-based violence and identify its social determinants in a group of undocumented pregnant women in the district of Barranquilla, Colombia.

Methods
A descriptive qualitative study was undertaken with a primary source collected through semi-structured interviews with 15 pregnant Venezuelans with irregular immigration status in the district of Barranquilla, between June and November of 2019.
The selection criteria for the participants were being a woman of Venezuelan nationality with irregular immigration status (not having a residence card in Colombia), resident in Barranquilla over ve months and being pregnant at that time or having been pregnant in the city in the past year. This selection of participants did not consider whether the participant had suffered gender-based violence (GBV). Women who were surveyed in the quantitative study of the framework project: "Physical and sexual violence against pregnant Venezuelan migrants with irregular migration status in the city of Barranquilla" were invited. The snowball strategy was also used whereby participants invited and provided contact details of other women with a similar pro le.
Interviews were conducted by a sociologist with experience in their application and previous knowledge of gender-based violence and migration. In addition, this professional was responsible for establishing initial telephone contact with potential participants, in which the objective of the study was explained to them and the con dentiality and voluntary nature of their participation were discussed. During this process, 43 women were called, of whom 28 answered the telephone, and 15 were interviewed. Another eight agreed to be interviewed, but the interviews did not take place due to logistics problems on the day of the meeting, since their mobile phones usually belonged to their partners and other relatives who said that they were not close by or with them at the time and lastly, ve said they failed to attend the meeting for health or work reasons. Most of the 28 women contacted did not have their own mobile phones.
In this study, priority was given to the safety of the interviewees and the research team, so that whenever there was communication with their partners or family members who answered the phones or requested information, the activity was described as an interview on pregnant women's access to health and only in private, as part of the consent process, were all the subjects to be discussed explained to the participants. The interviews, which lasted an average of one hour, were individual and conducted in an o ce at Universidad del Norte to make the women feel safe and calm enough to speak. At the same time, their transportation between their homes and the meeting place and back was coordinated beforehand. Throughout all the planning and implementation, the ethical and safety recommendations of the World Health Organization (WHO) and other speci c topics for research on domestic violence against women were followed [19,20].
Interviews were conducted using an open-ended question guide (this questionnaire was developed for this study, Supplementary le 1), prepared by the research team and encompassing various dimensions to determine the perceptions and experiences of each participant related to 1) the migration process 2) the experience of pregnancy 3) couple, family and community relationships 3) gender-based violence experiences 4) individual and institutional responses to violence 5) perception of physical and mental health and, lastly, 6) access to and quality of health care during and after their pregnancy. In addition, the following data were recorded for each participant: age, socioeconomic status, type of identi cation document, marital status, place of residence, schooling, occupation, weeks of pregnancy or age in months of their child, city where they lived in Venezuela, length of residence in Colombia, length of residence in Barranquilla and intention to remain. Table 1 summarizes the sociodemographic characteristics of the study participants. The interviews were recorded and transcribed. Narrative content analysis was performed, attributing meanings to the text fragments, in keeping with the discourse of the women interviewed. This made it possible to create mixed categories, some previously established by the research group (related to the migratory process and the adaptation process in the country) and others that emerged from the narratives of the subjects (Fig. 1).

Ethical considerations
This research was reviewed and approved by the Ethics Committee of the Health Division of the Universidad del Norte. The objectives of the study were explained to all the women. All participants received clear information on the interview procedures and voluntarily signed a written informed consent form. Interviewees were referred to health care networks in accordance with the regulations in force at the time of the interview. The writing took into consideration of the standards for qualitative reports [21].

Results
Data analysis made it possible to establish categories and relationships, summarized in Fig. 1 and further explored below: Irregular migration: Motivations, transit and arrival conditions The experience of irregular migration begins with the motivation reported by subjects to make the journey from Venezuela to Colombia. They said that their motivation was to seek better quality of life for their families, due to the economic conditions they were experiencing in Venezuela. They pointed out that, although they had a roof over their heads, obtaining food was extremely di cult since some of them were unemployed or, in other cases, they or their relatives did have a job, but did not earn enough due to the high costs of the products (  Motivations, journey and arrival conditions a) "It was terrible, terrible, that is, the rst time that ... we thought we were going through that, well my husband worked there selling bananas, and sometimes we had something to eat and sometimes we didn't. We ate once a day, but it was very, very di cult ... the price of bananas went up, he bought them but they were small, and you know, small bananas…, so he didn't make much money, so we asked her to help us, my sister called and said Let's nd work here, for her husband, and her. " I-13 b) "Well, as I told you, I am type 1 diabetic, I am insulin dependent. In Venezuela I was ne. What messed me up a bit was not being able to get my medicine, that was what encouraged me to come here." I-5 c) "It was quite di cult to go along the paths and with the baby, well, I was not pregnant yet, because I got pregnant here, so carrying the baby a long way was quite di cult because you have to walk quite fr to get another bus to get here." I-3 d) "Now that was quite a journey. Because I left Maracaibo at three in the morning, when we left we went along the paths and partly, at the entrance, on the way out of Venezuela, there were the undocumented Venezuelans and when I got to Colombia, there were the undocumented Colombians. There was a risk that people would not get along and that there would be a confrontation, or whatever, not to mention the fact that as you go along, there are nasty, dark stretches. You have to pay so they let you through, it is a really di cult part." 1-2. e) "When we arrived, we had nowhere to live, we had some pretty nasty experiences. First, we got to an apartment, we could not stay there, then we went to another one because they gave my husband a chance, they gave him support, but in my condition it wasn't suitable. It wasn't comfortable enough for us to sleep well, so that made us feel uneasy and unstable." I-1 f) "My daughter's food is also a priority, that is, there are so many things, at least this week I will not be able to pay because I need to go to market, the girl ... yesterday what I ate was an arepa, which was the only thing I could give her, and look (crying) there is nothing that hurts more than a child telling you they are hungry and having nothing to give them." I-7 g) "I was working hard. I worked at that store for ve months but I had to leave because I was pregnant, because you know they don't allow that." I-15 h) "I'm motivated by my two children and now by the one that's on the way, because it wouldn't be possible there, my mother says I should even think about going there, that I should stay here despite what is happening here, and not go there." I − 12 i) "I feel better with my mum and dad, I do not know, sometimes I feel I want to go, but then I think here I can buy package of diapers for the child, I can buy it quickly, but there, everything is in dollars, things in Venezuela are horrible." I − 11 Verbatim extracts 2) Experience of pregnancy a) "Yes, lots of things have happened to me, but having traveled in a fairly advanced state of pregnancy, I said OK, I am ready to put myself at risk, but everything was done for a purpose and since I have been here in Barranquilla I have felt much calmer. So I can say that I have not had a full pregnancy because I have had to do without many things, but I have had that peace of mind that comes from knowing at least I am well, my baby is well, and if I need something I can nd a way of getting it and that has made me have a calm pregnancy." I-1 b) "Because of the appointments I have to go here, then I have to go there, that's why, but if not, I would be working because I feel ne." I − 15 c) "I wanted to have an abortion, because I am just eighteen and I don't think I was ready to have a baby, but he did, he was very excited about the rst baby" I − 2 d) At that moment I got pregnant, it was an unwanted pregnancy, as they say because I wasn't expecting it, I did not want it, I really didn't want it and I was desperate because we had nothing." I-10 e) "The di culties involved my health as I said, the swelling I had, the pain in my hands, the urinary infection, I feel that I reached that level of pressure due to the level of stress that I had in my pregnancy. It was the discomfort we had, you know, from not sleeping well, in the heat, it was horrible, the bad smell. So I was worried about my baby and about not having anything, look, there were so many things, so many things and I thank God that well, he arrived, and he had his clothes, and other things and food." I − 7 f) There have been good things and bad things, at least most of the time he is working, that is a big factor because a pregnant woman needs to be more with that person, and be looked after and I have had to be alone because he was working. " I − 1 g) With all the sacri ces you make to go there, you know, with the baby, so early, and then to have them react like that, so my husband says no, don't do any of those things because they will give you a hard time and that and treat you bad, and on top of that, you'll have to pay the fare. He's really disappointed, he wants to know if the baby is ok or not, and it costs fty thousand pesos for a private appointment" I − 12 h) My pregnancy… well, I think that all this suffering could also affect her, I think that she moves a lot because of that, and my thoughts, I can't let off steam with anyone I -14 i) We were there two weeks, and in those two weeks after that problem I did not go down anymore, that is, I did not go downstairs, I did not leave the apartment because I was afraid they would do something to me, my husband was working and I was alone, so I said, I won't go down in case those people do something to me." I -2 Verbatim extracts 3) Social relations: Partner, family, community and other a) I don't like being outside like this ... I'm always locked up, I don't like being outside, nor do they like it ... when they go to play, they go to the eld or whatever." I − 10 b) It has been good, because he and I do not ght, that is, he tries not to ght, especially now that I'm pregnant, he does not let me do anything, he does everything, he washes, he does the cooking, everything." I-2 c) He is very jealous, sometimes aggressive, I am just going to go back to him today because we were separated." I − 3 d) "Once some boys grabbed my hands and I started screaming, I really don't know what they wanted to do with me, but they obviously did not have good intentions. I started screaming and the neighbors came out and a neighbor came out of the upstairs apartments and realized that it was one of those who knew my husband and he came down, when he was on his way down the boys ran away. " I -1 e) "We are not all like that, that is what I want them to understand: if you have any sense at all you should realize that you are not the same as me, and that we are all different, we all have different mentalities and see life differently, because I think if we all thought the same this world would be even more chaotic than it is. I ask for tolerance, not all of us are the same, not all Venezuelan women are prostitutes and not all Venezuelan men are thieves or drug addicts." I − 1 f) "The rst thing they should do, and I say this, not as a Venezuelan, but as a migrant, is to ... get rid all those taboos, and clichés that Venezuelans are prostitutes. Get to know people rst and then judge. Who are we to judge? Get to know them, and as they say out there, the good ones outnumber the bad ones, and use that as an opportunity to know them and know what motivated them to come here strangers to start from scratch. Nobody does it for pleasure, we just do it out of need, so the rst thing they should do is to forget all those stories they have heard about Venezuelan women and sit down and get to know them." I − 5 Verbatim extracts 4) Health care during pregnancy: Care route and quality a) "They took good care of me, the only thing is that every time you have to go to the mayor's o ce for a letter, that's the only thing." I − 4 b) "Well, I have felt alright, neither very good nor very bad, but well, as I said, the attention I liked was in the Niño Jesús and the Red Cross, as I said, they did not treat me very badly and they did attend me, at once, that is, I didn't have to wait that long. The one I didn't like was in Nazareth, I don't know, they don't pay attention to you, they say you have to go somewhere without giving you an explanation or anything." I − 13 c) "I did the test and found out I was pregnant, but after six months I started to get my check-ups here because they said that you had to go there to the Mayor's o ce to ask for a sheet, so that was very di cult for me because I saw those queues, but after spending several months I said I will go there. At the Nazareth they did my exams, they gave me my medicine." I − 3 d) "But there was nothing they could do because it was not long before the baby was born, she had already been infected (HIV) because if I had come in for the check-ups earlier, perhaps that would not have happened. I -3 e) "If you are undocumented, it is harder because you have no bene ts, so if they are going to give you help, at least they should give you proper help. Look at everything I have been through; it took them three months to give me an appointment. It's not fair. I − 1 f) "The only thing the nurses did was (complain) that I was pregnant, and I was screaming and screaming. I was screaming and the nurse says, I was there in the hallway, and she says: Who told you to give birth?" like that, and I tipped my juice onto the oor that day, the soup that my partner brought me I also poured it onto the oor because I was angry at what she said. I -8 g) "To get those appointments I had to follow another procedure, I had to ... I went directly to the mayor's o ce and they said: no, call that in a few days they will give them to you. How much more will I have to call? Tell me, three more months. So, I said ne, thanks. And I really didn't want to do anything else, nor did I call back, nor did I return to the mayor's o ce anymore, because it's kind of annoying, you know? You ask for help and in my condition, I already say that at least if I were beginning my pregnancy, from one to four months I would still have a chance, but at thirty-seven weeks, my God, how much more am I going to call? There must be several others in my condition ... and they should give them a bit more priority"-I-1 5) Experiences of genderbased violence a) "I did not tell him right there, because I was traumatized, all day and all night, I cried and cried and ate nothing at all, I just cried and cried, and afterwards they said what happened "like after three or two days, I told them, I didn't tell them right away". I -2 b) "I really did not say anything at the time, I talked later, over time, because I could not, and then I began to have problems with diabetes and with diabetes I shouldn't have any stress, and I did not sleep or eat because I was afraid." I − 5 c) "The police grabbed him and one takes me to my house because I was like a block away, four houses away from my house and the police took me and asked me, "What was he like" and I explained to him, and he said it was very late at night but it was ten o'clock at night, um ... they grabbed the boy and took him away and the other policeman took me home. That was after four months of being here." I -2 d) "It was a rather long process, because I also led a complaint with him, but when I got there, they passed me with the so-called ... back there at the URI, after I led my Verbatim extracts complaint, they saw me in legal medicine, because there was also ... it was not abuse as such, but he did abuse me, in other words, how can I put it, he forced me and when I led the complaint, the man who was in charge of reading it before giving it to the judge, all he said to me was: This will be led away because you are Venezuelan and they won't believe you "uh-huh, but if I have all the evidence, because I really had the evidence, recorded voice memos he sent me, and so they told me, they are going to le it away because you are Venezuelan" I − 5 e) "Yes, but he forced me, sometimes he left me alone, I said to him, leave me alone, leave me alone because I want to sleep, and he calmed down but, but sometimes he didn't. I − 14 f) "Sometimes I had nowhere to go, and I thought ... no, there was nothing I could do. The thing is that when I worked for up to three and a half months, four months, the bosses told me that I couldn't work, so he worked. I had no place to go, I had more support from his brother and his family." I − 14 g) My pregnancy… well, I think that all this suffering could also affect her, I think she moves a lot because of that, and my thoughts, I can't let off steam with anyone I − 14 h) "He did the same thing to me again and three times, three times, he did the same thing to me again, I came crying to my mom, I can't stand it, I'm scared because I, that is, I was alone and he did that to me, imagine if I am alone in the house, what he'll do to me, what can I do. " I − 15 i) "He kept insulting me and saying nasty things to me, until not long ago here he attacked me, he started beating me because his sisters and mother told him to, and I had to leave at midnight, he wouldn't let me go out from where we were living, I had to pretend that I did not want him to let me out, and just wanted to sleep and said that I would leave the next day, and I just left. It was twelve o'clock at night and I left "1-14 j) "Then the policemen came, asked him some questions there and he gave them his ID and he laughed, "Oh, this is crazy," yes, I am crazy to have been with you, a sister turned up too, threatening me, "If I wasn't pregnant, I would beat you," she said to me and the policemen said respect her, so much, so much so that the policemen came and accompanied me to where I am living now. 1-14 k) "He was even laughing at the policeman, who came and said, "Look, buddy, you're going too far with the girl," he came and handcuffed him and put him in jail for twenty-four hours, in other words, if he kept messing with me, he was saying things to me but I really prefer him to say things than to throw himself on me as he did before, the policeman told me that that day he wouldn't, "I'm going to leave him locked up for twenty-four hours to teach him a lesson, and if anything happens, if he comes back to mess with you, you come here right away and we'll look for him right away "I − 15 l) "Because of jealousy, because I couldn't look at anyone because it meant I fancied that person, because he said he was looking at me because I had a thing with him." I − 3 m) "Then they began to say that the day I left that if he wanted to le a complaint that if I was stealing the child, they were going to take it from me, and I am not stealing anything because he is my son. And the day I leave, I'm going to take him because I'm not going to leave him, I told her, you don't work, you don't have your own house, and no, that the child is going to give his father his place because his father works, he has his house, so I told him the day I leave he cannot do that, say that I am stealing my son because he is my son and he cannot say that. So I was saying that in front of him, then he laughed and said, "Yes, I'll kill you, chop you into pieces and throw you Verbatim extracts into the river", and I said, "Don't laugh because it is not a game, it is not a game, and he went on laughing and the day I leave you night really want to do it because I don't know if you are going to do so or not" I − 6 n) "He says he is going to change, so let's hope so, it is his last chance" I -3 o) "When I asked him to give me the tickets for the fares it was a nuisance and it was far away, I would get very tired and if I walked I would get a lot of pain on one side or whatever, I would tell him to give me it because I did not even ask him for money for my breakfast, because I would leave without breakfast, so when I was pregnant I would go without breakfast and I would have breakfast when he arrived, because he never had money, he never had money even when he always had money in his wallet, because he said no, I don't have any. And I would wait for him to get distracted and check his wallet to see if it was true or a lie, because he always had money in his wallet I-6 At the same time, seeking health care during childbirth was also mentioned as one of their incentives to move. They pointed out that in order to access health services in Venezuela they were required to bring the material for their treatment, which was hampered by their low purchasing power. For one of them, being unable to obtain medical treatment for her diabetes diagnosis was a crucial factor, as was the fact that whenever she had a pregnancy check-up, she was unable to be attended due to power cuts, as a result of which she decided to migrate (Table 2, 1b).
According to the narrations of the participants, seeking better quality of life due to the social and economic context they experienced in Venezuela, which did not allow them to cover their basic needs or those of their families, led or forced these women to migrate to Colombia. without going through the usual channels and instead taking the "path" on the border between the two countries to reach Maicao. In most cases, these were unplanned trips, from "one day to the next", following the instructions of other relatives or acquaintances who had already made the journey ( Table 2, 1c).
On the journey to Colombia, most of the participants identi ed several risk factors for their safety and lives. In their interviews, they reported that they felt vulnerable on stretches of the roads that were dark and uninhabited. They also came across armed men and others who asked them for money to be able to continue. Some of them traveled during their pregnancy and others with their offspring of various ages. In these cases, they said they felt they were at greater risk. They mentioned having felt afraid, stressed and vulnerable, but did not report having experienced physical or sexual violence on this trip ( Table 2, 1d). At the same time, according to their accounts, the arrival conditions of women and their families in Colombia were precarious in aspects such as housing, food and employment. They experienced greater di culty when they did not know anyone in the city of Barranquilla, where they began living in contrast with the conditions encountered by women who arrived at the homes of their relatives (partners, mothers, siblings), who had already spent months or even years in the city. (Table 2, 1e).
Many women found themselves living in a room with their families and sharing the house with other people. Sometimes these other people engaged in domestic violence, which created permanent stress for the subjects, often during their pregnancy. Regarding food, several participants pointed out that, due to their lack of money, there were days when they were unable to eat properly, preferring to give their children any food they were able to obtain. (Table 2, 1f).
Regarding employment, they mentioned the di culty of securing a job. They also reported having had experiences in which they were asked to work long hours for little money and jobs in which they felt vulnerable. In two cases, their employers asked them to stop working when they found out that they were pregnant and in one case the employer sexually harassed and abused the woman. (Table 2, 1 g) Most of the participants report that they intend to stay. They wish to remain in Colombia, because although they point out the di culties they have experienced in this country and the precarious conditions in which they live, they think that they can get ahead and do not consider returning to Venezuela, where they think conditions are not in place for good quality of life. (Table 2. 1 h, 1i).

Pregnancy experience
Participants described their experience of pregnancy, initially indicating what it was like to know that they were in this condition. Some of them realized they were pregnant while they were in Venezuela, which was also part of their motivation to migrate, seeking health care and better quality of life. Other women found out in Colombia, which posed a di culty for some since they had planned to work and in a state of pregnancy some realized they would be unable to do so and two of them were effectively red by their employers upon learning of their condition, noting that they could have legal problems because of having an informal job ( Table 2, 2a, 2b).
There were also cases when women wished to terminate their pregnancy, but did not do so, they said, either because their partners wanted to have the child while another subject said that in time, she had come to accept her condition and decided to continue with it. (Table 2, 2c, 2d).
At the same time, most of the participants reported feeling stress during their pregnancy due to their economic conditions. There are cases when they said that they could not eat properly because they could not afford to buy food. Paying rent and sometimes the debts incurred in Colombia were a cause of fear and concern. (Table 2, 2e).
Moreover, the subjects pointed out that during their pregnancy they spent most of the time alone, since their partners were either out working or job seeking, and they had no other people they knew nearby.
In addition, seeking health care was signi cant in their pregnancy experience. In their stories the women said that having prenatal check-ups, knowing about their health and that of their baby, gave them peace of mind, contrary to the experience of subjects who were unable to access this care early and worried about their child's health. Some participants said that they felt anger, stress and frustration in seeking access to health care due to the amount of paperwork, long waits and, in some cases, the treatment they received from nurses and social workers at hospitals. Another important issue was the cost of transport between their home, the Mayor's O ce and the health centers, which also represented a di culty. (Table 2, 2 g).
As for the mental health of women who had been victims of gender-based violence, they reported negative effects such as feeling a loss of the meaning of life, anxiety, fear and stress. Some of these experiences occurred during their pregnancy. (Table 2, 2 h, 2i).

Social relationships: Partners, family, community and others
The subjects have minimal support networks. Some women say they spend most of their time alone at home. Their company has usually been their partners and, in other cases, their family, mainly their mothers. Many of them admit that they do not know anyone else in the neighborhoods where they live, so they do not have any contact with other people. (Table 2, 3a).
Some subjects say that, since their arrival in Colombia, their relationship with their partners has improved. They have grown closer and support each other in the face of di culties and they have focused on solving problems together. Several of them say their partners have taken care of them during their pregnancy. (Table 2, 3b).
In their accounts, several of them have described experiences of xenophobia in the street, in which they have been singled out for being Venezuelan. Subjects perceive that Venezuelan women are associated being willing to offer sex in exchange for money and engage in romantic and sexual relationships with Colombian men who are already in committed relationships. In response to this, they ask people not to generalize. They understand that there are people who have migrated and have engaged in this type of acts, but they are not all are the same. They de ne themselves as people who are only seeking an opportunity to improve their living conditions, who wish to work and progress with their families. (Table 2, 3e, 3f).
Health care during pregnancy: Care route and quality The women interviewed rated the health care they received during their pregnancy, some describing it as good and others as poor. In some accounts, they said that they understood how they could access and carry out the appropriate procedures, which included going to the Mayor's O ce for authorizations, making calls and going to hospital in a timely fashion. In other cases, participants stated that they did not know how to access it or saw it as something di cult. (Table 2, 4a, 4b).
The women's accounts showed that the care path was not clear or perceived as something that was possible to do for all of them. In one case, the woman said that because she did not know how to request the appointment, she waited until six months to begin prenatal checkups. When she went in for her rst checkup, she had a medical test and was diagnosed with HIV. By then vertical transmission had taken place and her daughter was born at seven months with this same diagnosis. The daughter is currently receiving medical treatment and control in the public health network, while the mother only receives antiretroviral treatment from a foundation in the city but is not given a medical check-up. (Table 2, 4c, 4d).
Regarding the care route, some participants also reported di culty obtaining a medical appointment and having to wait several months between one appointment and the next. They associate this di culty with being irregular migrants. In some of their accounts, they say that they think that it would be different if they had permanent residence documents or were Colombian. (Table 2, 4e).
At the same time, in various accounts, subjects mentioned the inhumane treatment they received from health personnel. In some cases, the nurses berated them for being pregnant. One of the women told of her experience with a social worker who treated her cruelly. (Table 2, 4f).
The participants' narratives revealed that barriers to accessing health care include the procedures required to request an appointment, long waits at health centers and the treatment from health personnel. For some of them, this caused stress, anger and frustration during their pregnancy and, in some cases, these barriers led them to give up seeking care and prenatal controls. ( Table 2, 4 g).

Experiences of Gender-Based Violence
Some study participants reported that they had suffered gender-based violence while living in the Barranquilla district. The types of violence identi ed are sexual, psychological and economic. Sexual violence in one case was in icted by an employer, in another by an unknown man on the street and in yet another by the woman's partner. Physical violence was committed by the woman's partner and, in another case, by an unknown man on the street. In all cases, psychological and economic violence was perpetrated by their partners.

Sexual violence
These experiences affected the women's mental health. In the case of sexual violence, as a result, subjects who were victims subsequently felt disgust and impotence and that their lives no longer had meaning, cried for several days, were unable to tell their relatives about it, and isolated themselves. One of them suffered diabetic decompensation and was hospitalized. (Table 2, 5a, 5b).
One of these cases occurred on the street. During the assault, the police arrived and only took the woman to her home but did not activate a care route or initiate a judicial process. Instead, they suggested she should stop going out late at night and look after herself since the sector was dangerous. (Table 2, 5c).
In another case, the violence was in icted by the woman's employer. According to her account, the woman subsequently went to an Immediate Reaction Unit (URI) in Barranquilla, visited the legal medicine department, and led a complaint. However, after reading it and handing it to the judge, the person in charge told her that they were going to close the case because she was Venezuelan and that it was best for her to solve it by asking for money and bribing the rapist, as a result of which she desisted from the process. (Table 2, 5d).
In the third case, sexual violence was in icted on several occasions by her partner, who forced her to have sex without her consent. (Table 2, 5e).
In the rst two cases, the women received the support of their relatives. One of them was taken to a private psychologist and the other woman was accompanied by the pastor at her church.
In the case of sexual violence by her partner, the woman did not tell anyone and said that she needs psychological support. Due to the physical violence the rapist also subsequently in icted on her, she was helped by the police and his family to leave him and they allowed her to stay at his brother and his wife's house during her pregnancy since she has no money or family in Barranquilla, which was one of the reasons she gave for staying in the relationship. (Table 2, 5f).
One woman was pregnant during the experience of violence, another thinks that she was, although she does not know for sure, and one of them became pregnant shortly afterwards. All of them said that the negative effects on their mental health continued throughout their pregnancy. ( Table 2, 5 g)

• Physical violence
The experiences of physical violence against women happened during their pregnancy. In one case her partner beat her and, in another, a stranger on the street lunged at her three times to grab her. The women said that this caused permanent fear and stress yet did not report consequences for their physical health.
In the case of the physical violence exerted by the partner of one of the women, the day he assaulted her, her partner's family called the police and together they went to take her out of the house to prevent further mistreatment. Her partner's family has supported her and allowed her to stay with his brother and his wife during her pregnancy. (Table 2, 5j) In the second case, the woman went to the police, who arrested the man assaulting her on the street and put him in jail for 24 hours. After that, she saw the man on the street another time. He never lunged at her again, although he continued to insult her. ( • Psychological violence Some subjects reported that they were continually verbally assaulted by their partners, which made them feel sad and cry during their pregnancy. In these cases, violence is related to the fact that their partners begin heated discussions for various reasons, such as jealousy, in addition to controlling what they do and where they go. In one case, during their arguments, the woman's partner has said that he would rather murder her than have her leave with her son. (Table 2, 5 l, 5 m).
In these cases, the women have not received support from others, or relatives, people from the community or institutions. One of the women says she hopes her partner will change the way he treats her at some point. (Table 2, 5n) • Economic violence One participant described how her partner limits her ability to meet basic needs such as food. The woman says that even though he has money and she asks him to buy food or care products, he does not give it to her and leaves her without food during the day knowing that she has no way of solving the problem. This happened during and after her pregnancy. Because the woman was hungry and had no money to travel to her appointments, she stopped attending her prenatal checkups. She thinks that she has no options to leave the relationship because she does not have a job and must look after her son. (Table 2, 5o) In the accounts of the different experiences of violence undergone by women while living in Barranquilla, it is possible to identify their vulnerability due to the insecurity in the sectors where they live in the city, in the case of violence on the streets. These accounts also revealed their vulnerability during their pregnancy and motherhood, related to their economic and emotional dependence on their partners and the lack of support networks in the city, in cases of violence from their partners. As for the sexual violence in icted by the employer, the woman's need for a job may have encouraged this man to control her until he reached the point of sexual abuse.

Discussion
The ndings show the vulnerability experienced by pregnant Venezuelan immigrants with irregular migration status participating in the study. This situation is permeated by multiple social determinants related to the economic, political and social situation of the country of origin, together with the scope and di culties of the migratory process into Colombia and the possibilities of adapting to the country of destination. Speci cally, in Colombia, conditions were found in health care during the pregnancy process, as part of social support. Likewise, experiences of violence were found in different areas of social life, intimate partner violence and other manifestations of physical, psychological, social, and sexual violence. To the best of our knowledge, this study is one of the rst to be conducted in Colombia to understand the experiences of gender-based violence in a population with a major social burden.
The migratory process experienced by these women shows a pattern characterized by many di culties related to their social adaptation to the destination country, in terms of nding a stable job, food insecurity during pregnancy, social and job insecurity, and di culties accessing health services [7]. This situation is exacerbated by their irregular migratory status and is consistent with the studies reported on the subject in question [22], although it should be noted that the majority of published studies have been conducted in high-income countries. All this suggests that South-South migration displays new forms of con guration, since the immigrant population bears a signi cant epidemiological and social burden from the country of origin. This statement contrasts with that expressed by the scienti c literature, which in some contexts has drawn attention to the "healthy migrant effect", caused by the selective migration of people with better health status to destination countries [23]. Studies in the South American context show how this effect does not occur [24]. Our study, and the experience of the participants, suggest that a person's health status is an expression of their living conditions before and during the migratory process.
Pregnancy, either before migration, or during the process of adaptation to the destination country, creates new individual, familial and social experiences for these women, which in turn impacts their quality of life. These women hope to adapt to the destination country and therefore social systems should provide a response that impacts their physical, mental and psychosocial health. As previous studies in the country have shown [7], these women experience unstable employment conditions and di culties accessing health care services due to their irregular status. This situation has been observed in other studies conducted on the immigrant population, con rming the vulnerability of this group [25]. Being pregnant, together with economic di culties and their status as irregular immigrants, hinders their empowerment and places them in a situation of social and emotional dependence on other people and sometimes their partners.
Gender violence must be analyzed based on multiple individuals, social, contextual and structural factors.
Speci cally, in this case, the women interviewed in this study reported situations of violence that transcend couple relationships and have been seen in the workplace and the communities where they live. This is compounded by the discrimination experienced in everyday spaces. These situations of violence have implications for their physical and mental health, as experienced by women immigrants with irregular migratory status in other geographical contexts [26]. For decades, women have been subjected to social inequality, explained by clearly de ned patriarchal structures that have in uenced the situation of violence against women [27]. These situations are more problematic because of their immigrant, pregnant and irregular status, as evidenced by studies conducted on similar populations [28].
At the same time, subjects reported situations that compromise the care routes that should be offered in the country to guarantee timely, effective access for these women not only to health services but also to social, legal and psychological support, which are not guaranteed by their irregular status. This situation has been discussed in the literature, where there are driving and inhibiting factors ranging from aspects related to the empowerment of women (which is reduced in conditions of high vulnerability), cultural factors characteristic of their individual condition, and factors related to the availability of formal support services [26,29]. In many cases, there was a lack of knowledge regarding the way the system works to provide care not only among these women but also among the personnel responsible for social and health institutions across the country.
Although this study does not attempt to generalize, due to its qualitative nature, it provides important input to generate new knowledge on aspects related to gender-based violence from a public health perspective. It is necessary to further explore aspects related to structural factors that could be analyzed in actors involved in social and health care services.

Conclusion
Given the current situation, a coherent social response based on the needs of the immigrant population at various levels of society is required. Incorporating the gender perspective into the implementation of public health strategies guarantees comprehensive, equitable approaches that deal with the particularities of women and in this case the immigrant population [30]. Guaranteeing timely access to social and health services for this population should begin by improving the technical capacity of the institutions that provide care, with greater social sensitivity, and nally, gender violence regulations should guarantee the inclusion of aspects related to particularly vulnerable groups.