Below is a guest post from Maternity Action, the UK’s leading charity committed to ending inequality and improving the health and well-being of pregnant women, partners and young children.
Maternity care is classified as a human right and as such is protected by the European Convention on Human Rights, which prohibits all pregnancy-related discrimination, including making it unlawful for NHS organisations or clinicians to discriminate against pregnant women on the basis of disability, race, religion, immigration status and national origin. In line with this, a pregnant woman’s right to receive maternity care on the NHS is protected in the UK as ‘immediately necessary treatment’, which means it should not be refused or delayed for any reason.
Under current rules, women are chargeable for maternity care if they are not ‘ordinarily resident’ in the UK and do not fall within other exempt groups. Women who are chargeable should receive an invoice for treatment, often early in their pregnancy, but should not be refused care if they are unable to pay. If a woman does not pay, the Home Office may be notified and choose to deny subsequent immigration applications, pending payment of the debt.
Present rules on charging for maternity care are already complex and confusing, poorly understood by migrant women, and poorly implemented by trusts and NHS staff. Government research suggests that NHS trusts have incorrectly classified as many as 30% of the people that were assessed and so charged people entitled to free care.
Recent government proposals in the Immigration Bill are very likely to exacerbate the problem pregnant migrant women already face in accessing maternity care, including in some recent instances of women being denied care because of their inability to pay, despite the rules against this. These provisions are part of a broader programme of changes to migrants’ access to NHS services, proposed in a Department of Health consultation last year. Among other things, the Bill: introduces a ‘migrant levy’ on visa applications, whereby an upfront fee will have to be paid to access healthcare; significantly expands the group of migrants who are chargeable for NHS care; and, extends charging to aspects of primary and emergency care. Crucially, and in addition to this, it identifies and pursues chargeable migrants much more aggressively, including requiring NHS staff to essentially ‘police’ who is chargeable for care based on their immigration status.
Charges at the point of care create additional and unnecessary risks that women will choose not to see a midwife throughout their pregnancy or may even avoid hospitals altogether and try to have their baby at home. For those that do see a midwife, many only see a midwife very late in pregnancy, or try to see a midwife only to be denied access to care because of their inability to pay. This can prevent midwives from identifying and treating health conditions early in pregnancy such as, HIV, Hepatitis, Rubella and Syphilis – leading to significantly worse health outcomes for vulnerable migrant women and their babies, as well as complex, costly interventions at a later date. Furthermore, 20% of all maternal deaths are to women who commenced care later in pregnancy (after 22 weeks), missed more than four antenatal visits, or had no antenatal care at all.
We know that vulnerable migrant women already have significantly worse maternal and infant health than the rest of the population. The National Institute of Health and Care Excellence recognises this and has issued guidance, which identifies recent migrants, refugees and asylum seekers as a distinctive risk group and recommends that care providers take additional measures to promote early engagement with maternity services. Yet these changes are likely to make it much harder for vulnerable and at risk women to access maternity care.
Whilst it is true that under these proposals all pregnant women in the UK will still legally have the right to receive maternity care, the question remains, in practice will they receive it? Will they feel confident to access routine and vital antenatal appointments if they fear doing so will result in costly fees they cannot afford and may be used against their future visa applications? Will they choose not to endanger their life and that of their unborn child, by going to hospital when they are in labour, rather than staying at home, if they fear it will result in deportation? The reality is vulnerable pregnant migrant women residing in the UK are a lot less likely to feel empowered or supported to exercise their human right to maternity care should this legislation, in its current form, become law.
To learn more about the campaign or to get involved, such as through writing to your MP, visit the Maternity Action website here or contact Sarah LaPham, Public Affairs and Campaigns Officer at Maternity Action.
You can also follow this campaign on Twitter: #MatCare4All