Maternity care for undocumented migrant women: The impact of charging for care
Maternity care in the NHS is chargeable for most women without indefinite leave to remain in the UK, despite evidence that recent migrants face higher risks of adverse pregnancy outcomes than the general population. Maternity care must be offered regardless of a woman's ability to pay but, in practice, charging deters many pregnant women from accessing maternity care, or results in late booking and missed appointments. Standard midwifery policy stresses the importance of early booking and continuity of midwifery care, especially for women with high-risk pregnancies due to underlying medical conditions and complex social factors. The government has justified charging ‘overseas visitors’ to prevent ‘health tourism’ and to save costs, but there is no evidence to support the claim of ‘health tourism’ or that charging actually saves the NHS money. Midwives need to be well-informed about women's entitlements to maternity care and the importance of ensuring that care is provided.
Migrant access to public welfare, including health care, has become increasingly contested throughout Europe. In the UK, public services in particular, but also private citizens and civil society institutions, are being enlisted to complement border controls in order to exclude ‘unwanted’ migrants and, in the words of Home Secretary Theresa May, ‘to create a really hostile environment for illegal migrants’ (Kirkup and Winnett, 2012).
However, several legally binding instruments, including both the Conventions on the Rights of the Child (CRC) and on the Elimination of All Forms of Discrimination against Women (CEDAW), to which the UK is a signatory, oblige states to provide appropriate antenatal and postnatal health care for women. CEDAW specifically requires states to ‘ensure to women appropriate services in connection with pregnancy, confinement and the postnatal period, granting free services where necessary, as well as adequate nutrition during pregnancy and lactation’ (United Nations, 1989; 1999: 2).
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