Getting pregnancy care before your health card or status is sorted

Terms used

• Padrón — The padrón is your town hall's register of residents. Its certificate proves your address and is needed to register for health care.
• Centro de salud — The centro de salud is your local public health centre, where you register and get prenatal check-ups.
• Urgencias — Urgencias is the hospital emergency department, which must treat you in labour or in an urgent situation.
• Hoja de reclamaciones — The hoja de reclamaciones is the official complaint form you can ask a health centre for.

Key rules

• Right to care: Pregnancy, birth and postpartum care are covered without a residence permit or health card.
• Billing: You should not be billed for prenatal check-ups or the birth.
• Emergencies: Hospital emergency care is always given, whatever your status.
• Refusal: If registration is refused, ask for it in writing and file a complaint.

You have a right to care, even without a card

Pregnancy, birth and the period after birth are covered by the public health system. This applies even if you have no residence permit and no health card. You are treated on the same terms as people who are insured. You should not be billed for check-ups or for the birth.

There are two conditions. You need to be registered at your town hall (the padrón), and you must not have coverage from another source, such as home-country insurance.

Emergency care is always given, whatever your status.

What to do, in order

1. Register in the padrón at your town hall and ask for the certificate. The timeline below shows the steps.
2. Go to your local centro de salud and ask to register for pregnancy care. Bring the documents in the list below.
3. Ask for the document or temporary registration that covers your pregnancy care. Keep a copy.
4. Go to your appointments. Do not wait for your residence paperwork to finish.

Centres usually ask for your passport or other ID, the padrón certificate, and a signed declaration that you have no other health coverage. Bring proof of pregnancy too, such as a medical report.

If you are not a resident but have lived in Spain for 90 days or more, some regions also ask for proof of that. Rules and forms differ by region and even by centre, so ask your regional health service what your centre will want.

Avoid being billed as a private patient

Bills happen when you are not registered and a hospital treats you as a private patient or an unregistered foreigner. Registering at the centro de salud before you need the hospital is the best protection. If you get an invoice, do not ignore it. Use the complaint steps below.

If the centro de salud refuses to register you

Work through these steps:

1. Ask for the refusal in writing. Say that pregnancy care is a right whatever your status.
2. Go to the centre's patient services (Servicio de Atención al Usuario/Paciente). Ask for the complaint book (hoja de reclamaciones) and file a formal complaint (reclamación).
3. Escalate to your regional health department or regional ombudsman, and to the national Defensor del Pueblo. Each region sets its own complaint channels, so ask patient services which one to use.
4. Ask an organisation that helps migrants with health access. Médicos del Mundo, Red Acoge and Cruz Roja give advice, and they often go with you to the clinic.
5. If you are in labour or have an urgent problem, go straight to hospital emergency (urgencias). They cannot refuse you.

Do not delay care

Your paperwork may take time, but your pregnancy will not wait. Start the padrón and the centro de salud registration as soon as you know you are pregnant. Go to emergency if something feels urgent.

Timeline and deadlines

• Register in the padrón at your town hall to get your address certificate: before you go to the centro de salud

• Register at your local centro de salud with your passport, padrón certificate and signed no-coverage declaration: as soon as you know you are pregnant

• Show proof of 90 days of residence in Spain if your region asks for it: once you have lived in Spain 90 days or more

• Go to hospital emergency (urgencias) if you are in labour or have an urgent problem and are not yet registered: at any time, without waiting for the paperwork

Documents you need

• Passport or other identity document, shown at your centro de salud.

• Padrón certificate (empadronamiento), the municipal registration issued by your town hall, showing your address.

• Signed declaration that you have no health coverage from another source, such as home-country insurance. The centre usually provides the form.

• Proof of pregnancy, such as a medical report confirming it. In urgent situations some centres accept it in place of other papers.

• Proof that you have lived in Spain for 90 days, asked for by some regions if you are not a resident.

What to watch out for

• Being billed as a private patient: If you are not registered, a hospital may treat you as a private patient and send you an invoice for prenatal care or the birth. Register at your local centro de salud with your passport, padrón certificate and proof of pregnancy, and ask for the document or temporary registration that covers pregnancy care.

• Registration refused at the centro de salud: Some centres refuse to register you without a card, even though pregnancy care is a right whatever your status. Ask for the refusal in writing, file a complaint with the centre's patient services using the complaint book, then go to your regional health department or ombudsman. A migrant-support group can come with you.

• Delaying care while the paperwork is pending: Waiting until your papers are complete can leave you without check-ups. Start with the centro de salud now, and if you are in labour or have an urgent problem, go straight to hospital emergency, which cannot refuse you.

Frequently asked questions

Will I be billed for prenatal check-ups and the birth if I have no health card?

No, you should not be billed for prenatal follow-up or delivery if you are registered at your local centro de salud. Billing usually happens when a hospital treats you as an unregistered private patient and sends an invoice.

Do I need to prove I have lived in Spain for 90 days?

Some regions ask for proof of 90 days of residence in Spain, and others do not. If you have been in Spain 90 days or more, expect to be asked. If you are in an urgent situation, some centres accept a medical report confirming the pregnancy instead.

Can a centro de salud refuse to register me because I have no card?

No, pregnancy care is a right whatever your status, so ask for the refusal in writing. Then ask for the complaint book (hoja de reclamaciones) at the centre's patient services desk. Groups such as Médicos del Mundo, Red Acoge and Cruz Roja can also come with you to the clinic.

Who can help if my complaint at the centre goes nowhere?

You can take it to your regional health department or regional ombudsman, and to the national ombudsman (Defensor del Pueblo). The names of the offices differ by region. Migrant-support organisations run health-access advice services and can guide you.