- The UK Government must immediately and permanently suspend NHS charging regulations for maternity care
- Healthcare professionals must have consistent access to high quality interpretation services that can provide translation in the specific context of maternity care
- The Home Office should take steps to ensure newly-arrived pregnant women and women who have just given birth are housed in appropriate asylum accommodation.
The RCOG has today published a position statement calling for urgent action to tackle the barriers facing refugee, asylum seeking and undocumented migrant women accessing NHS maternity services in the UK.
Current practices disrupt care and contribute to worse maternal and perinatal outcomes contradicting stated UK Government ambitions to address ethnic and socioeconomic disparities in maternity care and halve rates of stillbirths, neonatal and maternal deaths by 2025.
With the recent humanitarian crisis in Afghanistan, and the war in Ukraine causing the fastest growing refugee crisis since the Second World War, there has never been a more important time to address the barriers impacting on vulnerable pregnant women and their families seeking asylum or living in the UK without official immigration status in the UK.
Depending on a woman’s immigration status, barriers to care include the UK government policy of charging some women for NHS maternity care, pregnant women seeking asylum being moved around the UK, and inconsistent provision of high quality interpretation services able to work within the specific context of maternity care.
Pregnant women who miss out on recommended maternity and antenatal care are at increased vulnerability, and this can disproportionately influence maternal and perinatal outcomes. Confidential enquiries into maternal deaths in the UK frequently highlight the need for appropriate interpreting services, and have found that reluctance to access care due to NHS charging may have been a factor in three women’s deaths.
For women who have faced charges, bills commonly start at around £7,000 and can be tens of thousands of pounds for more complex care. Unpaid debts can also be reported to the Home Office, which can threaten future immigration applications. Fear of receiving these unaffordable bills and of being reported is deterring women from seeking essential and time-critical care. The true impact of this programme extends far beyond those eligible for charging, due to limited understanding of eligibility amongst both health services and service users.
The RCOG is calling for the UK government to immediately and permanently suspend NHS charging regulations for maternity care, due to the harm this system causes to the health of women and their babies, particularly during the perinatal period. Until this is the case, NHS Trusts in England must review and improve their charging practices to ensure that pregnant women are not deterred from accessing maternity care, or have care refused or delayed
The current system not only deters pregnant women and people from accessing care for fear of charging, but also reinforces racial discrimination by using ethnicity, name, and country of origin or accent as markers to identify patients who could be liable to pay.
The RCOG has also expressed concern about the UK Government’s decision to go ahead with offshore processing of asylum seekers, including pregnant women. It is likely that pregnant women detained offshore would be at greater risk of poor birth outcomes than if they had been accommodated in the UK during the asylum process.
The RCOG’s policy statement identifies key areas where collaborative support from the Department of Health and Social Care, the Home Office, and healthcare professionals can make maternity and perinatal services more accessible for migrant women, and improve women’s experiences of pregnancy care.
Dr Ranee Thakar, Senior Vice President for Global Health at the Royal College of Obstetricians and Gynaecologists, said:
“We want to ensure that all pregnant women and people can access high-quality and timely maternity care and minimise the risk of adverse outcomes, regardless of their immigration status. We should be offering sensitive support to accommodate the often complex needs of these vulnerable women, not restricting access to essential NHS services.
“It is vital pregnant migrant women and women who have just given birth who are seeking maternity and perinatal services can be provided with ongoing and sustainable support, to improve engagement with these essential services. Without action on these issues, we will not end the UK’s persistent inequities in maternal and perinatal outcomes.
“Healthcare professionals have a duty of care towards these women, and the issue of delaying or denying care based on their immigration status, or ability to pay, goes against our aim of providing inclusive and high-quality women-centred care.”
Jill Benjoya Miller, Perinatal Lead at Happy Baby Community, said:
“Today's statement by the RCOG is entirely on point. Essential medical care for people who are already at much higher risk during pregnancy and the first months of a baby's life is a human rights issue. Many pregnant women and families have lived through horrific trauma and made treacherous journeys seeking protection in the UK. Then, terrified of being charged by the NHS, they often come forward late or not at all. This endangers themselves and their babies even more. It is critical that they can receive medical care and appropriate accommodation to ensure the safest outcomes in birth and the best start in life for their babies.
“Being able to communicate through effective interpretation at every appointment, and throughout every labour and birth, must be facilitated. This protects dignity and informed consent, and is the key to maximizing healthy births while avoiding further trauma.”
ENDS
For media enquiries please contact the RCOG press office on +44 (0)7740 175342 or email pressoffice@rcog.org.uk.
Notes to Editors
- Read the RCOG’s position statement: Equitable access to maternity care for refugee, asylum seeking and undocumented migrant women
- Find out more about Happy Baby Community
- Access the Royal College of Midwives’ Caring for Migrant Women toolkit
About Happy Baby Community
Happy Baby Community works across London with women who are seeking asylum while pregnant or with very young children. We provide individualised perinatal education, advocacy and support for hundreds of women each year. The perinatal programme sits within the larger community of women who find solace and healing through each other's company, plus wellbeing, welfare and personal growth activities. We are committed to being a charity that is led and managed by women with lived experience of migration into the UK.
About the RCOG
The Royal College of Obstetricians and Gynaecologists is a medical charity that champions the provision of women’s healthcare in the UK and beyond. It is dedicated to encouraging the study and advancing the science and practice of obstetrics and gynaecology. It does this through postgraduate medical education and training and the publication of clinical guidelines and reports on aspects of the specialty and service provision.