Pregnancy can be a nervous time for all women. But for migrant women living in Britain, the worries are manifold. Increasing numbers of female migrants are not seeking antenatal care because they fear high costs or being thrown out of the UK. In turn, the rates of maternal morbidity and mortality among pregnant migrant women are rising fast.
Since the 2014 Immigration Act, NHS charging has been extended to a far wider range of migrants. In turn, hospitals are billing already destitute women up to £6,000 for their maternity care. What’s more, in some cases, women are being wrongly refused antenatal care because they cannot pay up front.
To put this into context, Doctors of the World, which runs a specialist clinic for migrants in east London, has seen over 200 pregnant women who have not received any maternity care because they’ve been denied treatment or because they’re terrified of running up extortionate bills. They have also seen two migrant women pursued for four-figure fees even though their babies had died in hospital. If this wasn’t bad enough, one woman, a 34-year-old Nigerian migrant, was informed about her bill just hours after her baby died.
Infant mortality is considerably higher among the migrant population. Out of 35 women surveyed for the Doctors Of The World report, two had lost their babies. When you compare this to the national UK neonatal mortality rate of seven in 1,000, the health inequality is stark.
Many of these deaths and other complex health problems could have been avoided if they had received proper and essential antenatal care. Dr Clare Shortall, author of the report, says, “It’s horrific when bad things happen that could’ve been avoided by better antenatal care. You can’t put a price on a child’s health.”
For migrants, the threat of a healthcare bill is extremely daunting because it’s very rare for the Home Office to even consider an immigration application for anyone with an NHS debt exceeding £1,000. In turn, the deterrent effect of charging can have severe health implications.
Undocumented migrants face an even tougher challenge. If they go to the doctor, they risk being sent back to their country of origin, which could be a dangerous place to bring up a child.
Rather than looking forward to the birth, the experience of pregnancy is plagued with uncertainty. When faced with limited options, women can often fall through the cracks, compromising both themselves and their child’s health.
Despite the fact that many migrant women are already living in destitution and have no surplus income, the NHS continues to aggressively chase maternity bills. After all, if hospitals are discovered to not be billing foreign nationals, they themselves face hefty fines. Commissioning bodies also hold the power to withhold money to ensure hospitals pick up the bill for migrants’ healthcare.
According to Shortall, “the difficulty often comes when women are trying to pay for these bills while they’re bringing up their baby. Hospitals will end up chasing someone that’s destitute and that person is pushed further into destitution”.
This often forces NHS health professionals to act as de facto border officials instead of doing their job and caring for pregnant women. In turn, we have witnessed a growing bitterness among health professionals and midwives about charging for antenatal care. After all, Britain is one of the only European countries that does so.
While the tabloids might scaremonger about women expressly travelling to the UK to gain NHS maternity care, there is no empirical evidence from government data to verify this. On the contrary, the crackdown on health tourism stems from meager guesstimates and suppositions. In Shortall’s own words, “I know a lot of people’s stories and the vast majority, if any, aren’t playing the system. They’re genuinely in need”.
A Department of Health spokesperson comments:
“International visitors are welcome to use the NHS, provided they pay for it – just as UK families do through their taxes – but we have clear exemptions in place for those at risk such as refugees and asylum seekers. No woman will be refused hospital maternity care if they haven’t paid in advance.”
But I hear from my research that not all NHS health professionals are fully aware of the rules, which ends up with some women being denied maternity care because they can’t pay up front.
Regardless of immigration status, mothers-to-be should never be denied maternity care. Pregnancy is a particularly vulnerable time for women in which they require support, not uncertainty and additional anxiety. For many of these children, inequalities only begin at birth. Poor antenatal care continues to have serious physical and psychological repercussions on the child throughout their life.
You cannot put a pricetag on childbirth. In a civilised society, all maternity rights should be respected. Nevertheless, until antenatal care is exempt from charging, we will continue to put both mothers and their babies’ lives at risk.