Because if you are not well, your baby will not be well: Maternity care for asylum seekers and refugees in the UK.’

Background:

Asylum-seeking and refugee women face many barriers to receiving adequate maternity care in their host country. A 2015 report in Europe found that 65% of women in social crisis had no access to antenatal care (Chauvin, 2015). The UK is not exempt from this, and while it has an asylum support model in place, many pregnant and postnatal refugee women struggle to receive the services they’re entitled to.


What support are asylum-seeking and refugee women entitled to?

Health Access for Refugees Programme (HARP, 2021), which is part of the Refugee Council, provides guidance about the entitled rights of women throughout pregnancy and early motherhood in the UK. It stresses how maternity care is classed as urgent and necessary treatment; hence it must not be withheld from a woman under any circumstances. Women who are refused asylum may be charged for maternity services under ‘secondary care’, and a payment plan should be put into place, often with support from charities. 


Why do asylum-seeking and refugee women receive less maternity care?

While there is a framework in place, it is harder for these women to access the same support as non-refugee women because of the multiple barriers involved in accessing maternity care. Understanding refugee women’s experience of maternity care and the limit of the current framework is critical for the UK as it responds to increasing global migration. I have categorised these barriers into three distinct ways refugee women face difficulties in accessing maternity services. 


Barrier 1: Communication and understanding.

Refugee and asylum-seeking women in the UK may not speak any English, or won’t have English as their first language, which creates a barrier in communicating with HCPs (healthcare professionals) and understanding healthcare information, such as from leaflets. Women are entitled to be understood when interacting with health services, and yet according to (Small, 2014), 17% of recent immigrant women reported not receiving care in a language they could understand. In the UK, women can request an interpreter or a double appointment and this should be provided. However, women usually are not aware that this is available to them, and when they are, healthcare services may be too overworked to provide this. Also, women have said the interpreters are often not adequate speakers of their first languages, hence the translations are unclear and confused. This lack of clear communication means refugee and asylum-seeking women do not always have a say in their own maternity care or may consent to what they don’t understand. 


Lack of communication also creates misunderstandings, for example, confusion about entitlement to care means many women are afraid of being charged instantly or being turned away. Refugee and asylum-seeking women are often suspicious of healthcare services, because of believed connections with the Home Office, hence women may avoid maternity services for fear of being deported. These women may also have had a bad experience with doctors or other HCPs in their country of origin, which can increase fear and stigma regarding accessing healthcare services. 


Barrier 2: Lack of training for HCPs.

Many working in healthcare don’t know the rights of asylum seekers, which prevents their entitled healthcare needs, including maternity care, from being met. All pregnant women in the UK are entitled to NHS maternity care. Yet, many pregnant and asylum-seeking women get turned away, for example, if they’re not registered with a GP, or if they don’t have a permanent address. Even when able to access healthcare services, such women are often not talked to about extra entitlements such as a one-off maternity payment and are not provided with an interpreter or a double appointment.


Similarly, women have described being forced to move accommodation in the weeks before and after birth, which the Home Office strictly advises against unless it is unavoidable. Much of this is a product of different areas of the NHS and other services having weak communication between each other, as well as a lack of training on changing legal guidelines such as the rights of refugees and asylum seekers.


Clear and informed knowledge from HCPs is necessary for women to feel secure through their maternity experience. Interviews conducted by Maternity Action (Bragg, 2022) found some women felt a sense of resignation at the limited level of support available to them, with one woman saying “I can’t do anything because I am asylum seeker, I don’t have nothing … I just accept it”.


Issues have also been raised by refugee and asylum-seeking women about not always feeling welcome when accessing maternity services. For example, being made to feel anxious when coming to the hospital for labour, or HCPs being insensitive to cultural needs. (Evans, 2019) found a number of studies that illustrated positive relationships between HCPs and refugee women, where they were described as caring and respectful, as well as effectively meeting their emotional and maternity needs. However, others had experiences of rudeness, or cultural and religious needs not being met, for example, Muslim women only having the option for mixed-gender antenatal classes. More training on asylum seeker’s rights as well as cultural sensitivity training has been recommended by charities like Maternity Action, Refugee Women Connect and WAST.


Barrier 3: Practical difficulties. 

Refugees and asylum seekers who are pregnant must balance this with the difficulties of navigating a new country, along with income barriers. Asylum support is currently set at £39.63 per week (HARP, 2021), however, this is dependent on asylum status, and is often not enough, especially for an expecting mother. For example, women who need to attend frequent appointments may have difficulty paying for transport. Access to appointments is also restricted by refugees’ ability to understand the transport system and how often they are allowed to travel if they are living in asylum accommodation. 


Income barriers can also lead to digital exclusion, which restricts refugees’ access to information about maternity care. Booking appointments now often requires internet or a phone, which they may not have. Some refugees have older phones, yet these don’t support the necessary apps. 


Often maternity care is compromised by factors outside maternity care itself. In Maternity Action’s interviews, one woman said “if you are not well, your baby will not be well” when referring to her health troubles during pregnancy. The main cause of this was a poor lifestyle as a result of limited nutrition from poverty, and damp housing. This not only affects refugee mothers, but their children as well, and can cause asthma and other health complications. 


Similarly, issues with accommodation have been noted by a number of studies as affecting maternity care for refugee women. For example, despite the Home Office advising against it, women in Maternity Action’s interviews experienced relocation during and after their pregnancy. This relocation meant refugee women had to get used to new locations with different midwives and maternity systems, along with the stress which comes with the process of relocation. One refugee mother described herself as “going through hell” when discussing accommodation during pregnancy. The mental health of pregnant women is at risk from this, as they are losing established networks of support. 


What is being done to reduce these barriers?

To tackle issues with communication, a stronger effort has been made by the NHS and organisations like HARP to provide clear and concise information in a wide range of languages. This information has been made available not only in hospitals and pharmacies but also places like community centres where refugees may spend more time and feel most comfortable. 

Charities and other third-sector organisations have been paramount in creating a link between maternity services and refugee/asylum-seeking women. They have helped tackle income barriers, such as providing baby clothes and prams, as well as establishing a community where pregnant refugees and new mothers can meet other women in similar circumstances.

A woman interviewed by Maternity Action said, “That’s why when [organisation’s] baby and mother group opened up, I was so happy … you know you could see somebody in your own state at the time and you could relate”. Unfortunately, the impact of such organisations has been reduced by the impact of COVID, which has meant some charities have been forced to close or switch entirely online.


Final thoughts. 

It is clear that refugee women want the same things from their maternity care that any other woman would want: adequate information, an active say in decisions, assistance in receiving care, and caregivers being kind and compassionate. The UK has the funds and the infrastructure in place to provide this. 
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With the proper training for HCPs, and effective means to spread the information of what’s available and how to access it to refugee women, the third-sector believes refugee women’s maternity experiences will become more empowered. While income barriers aren’t the responsibility of maternity services, being aware of these challenges can help HCPs provide the most effective care for refugees and asylum seekers who are pregnant or new mothers.