Unless they have gone to great lengths to avoid any news media in recent weeks, it is highly unlikely that anyone in the UK will be unaware of the current influx of refugees to Europe, primarily from Syria. This complex issue has ignited numerous debates, ranging from the humanitarian crisis to the potential economic burden on countries in the European Union that accept refugees.
From a health perspective, a key issue faced by migrants—particularly refugees and asylum seekers, but also economic migrants to the UK—is the number of potential impediments to accessing health care. Language barriers, cultural differences and a lack of knowledge or understanding of how the health service works are just a few such issues. Asylum seekers and refugees who are pregnant often experience poor mental and physical health, and are at a higher risk than other pregnant women of perinatal and maternal mortality (Haith-Cooper and McCarthy, 2015).
A further barrier faced by undocumented migrants is that they are not necessarily entitled to health care in their new country. In a recent survey of more than 20 000 people in 10 European countries, including the UK, Doctors of the World found that 20.4% of the individuals surveyed stated that they had given up trying to access health or medical treatment in the past 12 months (Chauvin et al, 2015). Clearly, this is potentially dangerous regardless of an individual's health needs, but in terms of maternity care it is particularly worrying. The same report revealed that 81.1% of pregnant women seen by Doctors of the World across Europe in 2014 had no health-care coverage; in London, a total lack of health-care coverage on the day of their first consultation was recorded for 94.7% of women. Antenatal care for undocumented pregnant women is not free at the point of use in the UK, because it is considered as secondary care. This means that women are often sent an enormous bill for their care—even in instances where their baby does not survive—which they cannot afford to pay (Gardner, 2015).
While some European countries do offer some level of free antenatal care to undocumented pregnant women, it remains difficult for women to access these services. One barrier, which should not be underestimated, is fear—not only anxiety about using services that the woman in question may not understand, but also fear that health professionals might report undocumented migrants to the Government. This is an extension of the social isolation experienced by many migrants; of the pregnant women surveyed in Europe by Doctors of the World, 30.3% said they never or rarely had someone they could rely on in case of need (Chauvin et al, 2015).
The current ‘migrant crisis’ is an important reminder of some of the obstacles faced by foreign-born people in the UK attempting to access health services, regardless of whether or not they are refugees. In this issue of BJM, we have a report on a confidential enquiry into perinatal deaths among migrant mothers in three Trusts in the West Midlands (page 734), which found that a major problem was communication—both between women and health professionals, and within the wider health-care team. The first step to providing high-quality, compassionate care is communicating clearly with those receiving care. This is especially crucial during pregnancy and the postnatal period, when the health of both mothers and infants is at stake.