In June, Birthrights and Birth Companions published ‘Holding it all together’, our report into the human rights issues experienced by women facing disadvantage. Our research found that women who were asylum seekers had worse experiences of care than other women facing disadvantage, often describing care as functional rather than supportive. Women told us about living in insecure housing, which disrupted their maternity care. They told us that they lacked some of the basics they needed for everyday life: one woman described leaving hospital with her newborn wrapped in a hospital towel as she had no baby clothes. Others needed help navigating services and form filling. During their maternity care, women told us how they felt isolated and unsupported, and did not understand what to expect of their care. One woman who spoke no English described going through her entire maternity care experience without language support. Midwives expressed deep unhappiness with NHS charging policies and the impact on women who avoided care as a result.
In this guest blog, Olivia Bridge, political correspondent for the Immigration Advice Service; an organisation of UK immigration lawyers, describes the journey to the UK for pregnant asylum seekers and the impact of NHS charging policy on women living in some of the most disadvantaged situations in the UK.
According to UNHCR statistics, women and girls make up 50% of refugee, displaced and stateless persons, of which half are young women and 4% are pregnant. However, while the journey is hazardous for most, for pregnant women it is plagued with additional obstacles – and carries far greater risks.
The first hurdle they face is physically getting into the UK. Being unable to lodge claims abroad and the closure of safe passages has forced asylum seekers to resort to dangerous methods. For pregnant women, clinging underneath a lorry is ruled out, so they risk suffocation by piling inside them instead. The other alternative is a rickety, inflatable and overcrowded dinghy.
The most recent migrant deaths are testament to the terror and violence they are fleeing from – and the sheer desperation they feel that forces them to gamble their lives: this October saw the tragic death of 39 migrants in the back of a lorry while the Channel took four refugees’ lives for the first time only recently, including one teenager, two men and one woman. The Mediterranean similarly uncovered the bodies of 13 women this October, some of whom were pregnant. A dozen more including 8 children and other pregnant women remain missing.
One pregnant Eritrean refugee under the pseudonym Helen explained how she had hidden beneath the floorboards of a lorry to cross into the UK when police searched the vehicle: “It was a dangerous hiding place; unknowingly, the police were walking on top of me. I didn’t think about the pain I felt”. When she arrived to the UK, she was covered in blood and rushed to hospital where she learned she had lost her baby.
Yet staying put in refugee camps is unthinkable for these mothers and mothers-to-be: the squalid conditions coupled with rife sexual and physical violence makes them a markedly scary place. Tents are set on fire – in one case actually killing a mother and baby while a separate incident saw border force staff pepper spray a sleeping infant – belongings are stolen while washing facilities are often mixed-sex. Women have taken to wearing adult nappies throughout the night to avoid crossing sexual predators – but are subjected to sexual exploitation known as ‘survival sex’ where they are paired with a ‘brother’ for physical protection. Many contract vaginal infections and diseases as a result, which is exacerbated among the high majority of women who have also endured Female Genital Mutilation (FGM). The UN discovered 1 in 5 refugee women and girls have faced sexual violence while 60% of preventable maternal deaths take place in these conditions. Camp conditions are reportedly so bad that 10-year old children are driven to suicide.
However, the harrowing experiences pregnant asylum-seekers have endured by the time they finally reach the UK is barely alleviated by the support on offer. While awaiting the verdict of their asylum claim, they receive £37.75 a week in financial aid. Immigration rules prohibit them from working. Pregnant women and those with a child under three receive £3 extra while a baby under one grants £5 more, however delays in payment can leave women going through their entire pregnancy without any financial aid.
Asylum seekers and victims of slavery and/or trafficking should not be charged for NHS maternity care. However, those who do not have permanent residency or status (including many of those whose asylum claims have been denied) receive NHS bills for antenatal care, births and postnatal care that carry a 50% tariff above normal rates in a bid to crackdown on health tourism, with women facing eyewatering £7000 bills which they have no means to repay. And vulnerable women who are eligible for free healthcare can still get caught up in the net and wrongly charged.
Both immigration status and charging rules are hugely complex. Exacerbating the confusion, a recent report by Maternity Action uncovered that midwives – at the forefront of maternity care – had little or no training about charging rules and exemptions – and even those that are aware may not be able to identify a woman who may be eligible for an exemption. Severe budget cuts have decimated interpretation services, leaving vulnerable migrants unable to recall their ordeal or circumstances. Many trafficking survivors are often unaware or don’t identify as victims of this specific crime in the first place, let alone are aware that they may be eligible for free care. Maternity Action highlighted one case in which a midwife recognised a victim of a trafficking and was able to secure an exemption for her while contacting the Home Office on her behalf. Clearly, communication between healthcare professionals and patients is crucial when identifying those at risk and those who may bypass the stringent rules.
Afraid of debt collectors and the looming threat of deportation, refugee and undocumented women steer away from healthcare. The high fees also force them to try to save money by sacrificing food and essential baby supplies while others walk miles to attend appointments to avoid travel expenditure. Debt collectors routinely hound them throughout their pregnancy. Making care inaccessible is made all the more concerning by the fact that migrant women, black women and Asian women are more likely to die during pregnancy or face birthing complications. One 2018 systematic review found that perinatal outcomes for migrant women – especially asylum seeking and refugee women – were “predominantly worse”, particularly for “mental health, maternal mortality, preterm birth and congenital anomalies”.
Maternity Action have recently launched a legal challenge to axe maternity fees with the charity’s director, Ros Bragg, claiming that women are “commencing care later, skipping appointments and in some cases giving birth at home unattended”. Brigg continued, “There’s also the real fear of having the Home Office informed of their insecure immigration status if they do seek care.”
Fear and hostility are woven into the rules. Not only have migrants got to battle for maternity care, but many have died from preventable illnesses and have been turned away from GP surgeries. One woman died of breast cancer only recently after being denied life-saving care.
There should be no human cost to governmental policies, yet the ‘hostile environment’ is responsible for swathes of deaths. Without reform to the entire system, the lives of pregnant women and their babies will continue to be endangered.
For more information about NHS charging and entitlement to NHS maternity care see resources from Maternity Action, including their new Access Guide for NHS Trusts, developed with the Royal College of Midwives to minimise the negative impacts of charging on migrant women’s access to maternity care