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With the EU referendum debates ongoing and an increase in the public concern for the refugee crisis, there has been a significant surge in focus on national public policy and discussion with regards to immigration in the UK. Arguably one of the most prominent concerns within the present discussion is that of the rights of migrants to public services, including the NHS. Exemplified in the more recent 2014 Immigration Act, the UK has attempted to create a more hostile environment for migrants including the 150% tariff introduced to prevent ‘health tourism’. [1] Campaigning groups and charities have argued that the impact of such legislation has been devastating, pointing particularly to maternal health, stating that vulnerable migrant women can be charged up to £6000 for a normal birth in the NHS. [2] Therefore, more research is needed to identify the barriers that migrant women face in accessing maternal healthcare in the UK and the impacts of such barriers, in order to provide suggestions on how the situation could be improved. Specifically, it will be important to identify the role that charities and other non-state actors play to bridge the gap. Local governments, the charities involved with migrant health, and the migrants themselves could benefit from this updated information.
In this context, the non-governmental organisation Doctors of the World (DOTW) has established several projects and clinics, mainly in London, to assist vulnerable people. According to their reports, the majority of the patients at their UK clinics are immigrants, often because they lack documentation or are not familiar with the healthcare system. Specifically in relation to maternal health, DOTW are committed to provide free antenatal care to all pregnant women regardless of their ability to pay. Regular family clinics are provided for these patients, who constitute 11% of their cliental. [3] Other than medical assistance, DOTW are committed to providing information on the British healthcare system, specifically working to overcome language barriers through the use of interpreters and translators.
As evidenced in their reports, early access to adequate maternal and antenatal services is essential in safeguarding a pregnancy and to minimising adverse outcomes. In the UK, women are recommended to book in to antenatal care within the first 12 weeks of pregnancy, such that they can receive comprehensive care during the pregnancy. This includes an interview and blood screening, with regular follow-up appointments that allow for the identifications of complications and intervention when appropriate. The multitude of barriers that pregnant migrant women face when trying to accessing antenatal care can exacerbates poor maternal health outcomes. Many of them are unaware of their rights to access healthcare and commonly experience abuse or destitution. Women are far too often turned away due to lack of documentation, despite there being no requirement to provide this for access to primary care. [4] A report from DOTW’s family clinic in London showed that 62% of their patients accessed antenatal care too late, and that 50% had five or fewer antenatal appointments, which is less than the minimum level of antenatal care. [5] Overall, these barriers result in a strikingly higher risk of unfavourable pregnancy outcomes in migrant women in comparison to non-migrants. In the UK, women from ethnic minorities have 50% increased risk of perinatal mortality, as well as 45% higher risk of giving birth to a baby with low birth weight, which is associated with numerous complications. [6]
There is also an interesting legal dynamic in the issue of maternal health of migrants that should be of serious policy consideration for legislators. If a child is born in the UK, even if neither of their parents are British citizens or legal immigrants, they may under certain circumstances be granted citizenship. This has significant implications on state responsibility for the child once they acquire such right, and furthermore it can bolster a parent’s claim of indefinite right to remain. However, there are obstacles to gaining citizenship, such as the requirement that the child be in the UK for a minimum of 10 years after birth, as well as the cost of the application (£749). If the requirements are met, the application is guaranteed to succeed. There is also an option to apply for indefinite leave to remain for the child after 7 years of prolonged living in the country, and it might be interesting to look into the way judicial discretion is used in these cases, [7] Even more crucially, there is still much policy debate about the lack of current protection afforded to non-citizens by the NHS and the ways in which lack of legal status affects the access to the healthcare system.
Especially following the EU referendum, it is crucial to analyse the implications of accessing maternal healthcare, in such a way to provide a comprehensive analysis and informed suggestions to address the issue of migrant healthcare in the UK.
References:
[1] Shearlaw, M. (2016) Migrant women face 6000 birth bill under health tourism law, The Guardian. Available at: http://www.theguardian.com/world/2016/feb/04/migrant-women-face-6000-birth-bill-under-health-tourism-lawsAccessed [07/05/2016]
[2] Ibid.
[3]. Doctors of the World UK, Access to Healthcare in the UK. August 2015. Available online at: https://www.doctorsoftheworld.org.uk/files/2015-09-18_DOTW_Access_to_healthcare_final.pdf Accessed: [05/05/2016]
[4] Shortall, C., McMorran, J., Taylor, K., Traianou, A., Garcia de Frutos, M., Jones, L. and Mur- will, P.; Experiences of Pregnant Migrant Women receiving Ante/Peri and Postnatal Care in the UK: A Doctors of the World Report on the Experiences of attendees at their London Drop-In Clinic. Available online at: http://b.3cdn.net/droftheworld/5a507ef4b2316bbb07_5nm6bkfx7.pdf [09/05/16]
[5]. Doctors of the World UK, Access to Healthcare in the UK. August 2015. Available online at: https://www.doctorsoftheworld.org.uk/files/2015-09-18_DOTW_Access_to_healthcare_final.pdf Accessed: [05/05/2016]
[6] Bollini P, Pampallona S, Wanner P, Kupelnick B. Pregnancy outcome of migrant women and integration policy: A systematic review of the international literature. Soc Sci Med; 2009;68(3):452–61.
[7] Citizens Advice, If your child is living in the UK illegally. Available online at: https://www.citizensadvice.org.uk/law-and-rights/immigration/living-in-the-uk-illegally/if-your-child-is-living-in-the-uk-illegally/ Accessed: 10/5/16
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