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Neglect and fear create a disastrous atmosphere for pregnant migrants

A patient receiving care at a Doctors of the World clinic. Photo by Giorgos Moutafis.

A baby scan is an anxiety-ridden experience for any mother. Is your baby healthy? Are you healthy?

Imagine having no scans at all. None of the vital checks have been done. You have no idea if everything is as it should be, or worse, how to proceed if it’s not.

Serious health risks are a reality for vulnerable people who, afraid of debts they can’t pay or deportation, are deterred from seeking maternity care, according to a report released this week by Doctors of the World UK. Lack of care increases the likelihood of complications, including low birth weight, pre-term delivery and higher rates of perinatal mortality.

The report found that two-thirds of pregnant users of the charity’s drop-in clinic in east London, who are mostly undocumented migrants or asylum seekers, had not received antenatal care until their second trimester. Half had no care for 20 weeks or longer. Compare this to the three quarters of pregnant women in England who receive care in the first trimester.

“These findings indicate an unacceptable inequality in our health system,” Lucy Jones, an author of the study, says. “We must continue to improve access to healthcare for all mothers regardless of their wealth or immigration status.”

The NHS categorises maternity care as immediately necessary treatment, which cannot be denied on any grounds. But multiple mothers-to-be reported that they had tried to register with a GP and were turned away for lack of identification. The NHS does not require specific documents to register with a GP, but confusion and arbitrary requirements among healthcare administrators often leads to rejection of services for the most vulnerable applicants.

Implementation of the 2014 Immigration Act likely means additional confusion and hostility toward undocumented migrants.

Migrants also reported fearing high fees, arrest and deportation if they tried to access care, according to the report. Nearly a third of women in the report were billed for their maternity care, one as much as £6,000.

“Many of these women are already vulnerable and destitute, unable to meet the cost of their own basic needs, but they are asked to pay for general medical care,” Janet Fyle, a policy advisor at the Royal College of Midwives, says. Her organization has urged the government “not to use midwives as ‘gatekeepers’ to determine who is, or is not eligible for NHS care.”

The average time that participants spent in the UK before giving birth was nearly five years – debunking the myth of so-called “health tourism.”

And the pregnant women are not the only ones facing mounting bills. NHS costs also increase when antenatal care is received late and pregnancies become more complicated.

“It makes no economic sense to deny women antenatal care,” says Phil Murwill, who contributed to the study and runs Doctors of the World’s east London clinic. He added that untreated complications can wrench up costs to £50,000, fifteen times higher than if issues are identified and treated early in a pregnancy.

The health concerns are even more staggering than the finances. Two of the 35 pregnancies featured in this report resulted in the death of the baby – a mortality rate eight times higher than the rest of the UK. Although the study’s sample size makes generalisations impossible, both women who lost their babies reported feeling neglected or mistreated by healthcare workers.

“No one is helping or has followed up,” said one woman who lost her premature child after not having any antenatal care for the first seven months of her pregnancy. She was billed more than £2,600 upon leaving the hospital.

In many cases, mothers faced emergency caesarean section or inpatient hospital stays after delivery to ensure recovery or medical treatment for themselves or their babies.

Screening during pregnancy dramatically minimizes the risks of existing conditions and reduces the chances of communicable diseases such as HIV and hepatitis being transferred from mother to baby. Building a trusting relationship with a healthcare professional during pregnancy also allows for the identification of other issues such as domestic violence or female genital mutilation.

“Some of these women have complex health and psychosocial problems, and may be in need of urgent referral to other agencies,” Fyle says.

And the problem goes beyond the UK. Two thirds of the 285 women seen in Doctors of the World’s 28 European clinics had no access to antenatal care before visiting a drop-in clinic, putting themselves and their pregnancies at risk.

But the report’s findings may not be the worst of it. The authors were unable to reach more than half of the pregnant women who had visited the clinic since January 2013, and many of these are likely to be more at risk. “Many of the mothers may be without a stable place to live or access to a phone, putting them in an even more vulnerable situation. Some face modern-day slavery, violence and trafficking,” Jones says. “We can only imagine the stories we haven’t heard.”

Read the report by by Clare Shortall, Jon McMorran, Katherine Taylor, Aliki Traianou, Maria Garcia de Frutos, Lucy Jones, and Phil Murwill here.

For media enquiries contact Nick Harvey on 07565 944042 nharvey@doctorsoftheworld.org.uk For updates on access to healthcare in the UK, sign up to our eNewsletter.