Aleksic DLondon: Maternity Action; 2013

Heavily pregnant immigrant carrying dead child wouldn't seek help as she was afraid she'd have to pay NHS under ‘health tourism’ rules. 2014. (accessed 4 December 2015)

Banks E, Meirik O, Farley T, Akande O, Bathija H, Ali M Female genital mutilation and obstetric outcome: WHO collaborative prospective study in six African countries. Lancet. 2006; 367:(9525)1835-41

Bragg R, Feldman R ‘An increasingly uncomfortable environment’: Access to health care for documented and undocumented migrants in the UK. In: Sabates-Wheeler R, Feldman R Basingstoke: Palgrave Macmillan; 2011

Burns FM, Imrie JY, Nazroo J, Johnson AM, Fenton KA Why the(y) wait? Key informant understandings of factors contributing to late presentation and poor utilization of HIV health and social care services by African migrants in Britain. AIDS Care. 2007; 19:(1)102-8

Cantwell R, Clutton-Brock T, Cooper G, Dawson A, Drife J, Garrod D, Harper A, Hulbert D, Lucas S, McClure J, Millward-Sadler H, Neilson J, Nelson-Piercy C, Norman J, O'Herlihy C, Oates M, Shakespeare J, de Swiet M, Williamson C, Beale V, Knight M, Lennox C, Miller A, Parmar D, Rogers J, Springett A Saving Mothers' Lives: Reviewing maternal deaths to make motherhood safer: 2006-2008. The Eighth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom. BJOG. 2011; 118:1-203

Creative Research. 2013. (accessed 7 December 2015)

Mind the migrant care gap. 2014. (accessed 7 December 2015)

Department of Health. The NHS Plan Cm 4818-I. 13: Improving health and reducing inequality. 2000. (accessed 7 December 2015)

London: DH; 2004

London: DH; 2007

London: DH; 2013a

London: DH; 2013b

London: DH; 2014a

London: DH; 2014b

London: DH; 2015a

Department of Health. Overseas visitors cost recovery. 2015b. (accessed 7 December 2015)

NHS charges to overseas visitors, Series: DA (82)10.London: Department of Health and Social Security; 1982

HL Amendment 63, Immigration Bill: Third Marshalled List of Amendments to be moved in committee, 7 March. 2014;

London: Health Protection Agency; 2008

London: Health Protection Agency; 2012

Kelley N, Stevenson JLondon: Refugee Council; 2006

Theresa May interview: ‘We're going to give illegal migrants a really hostile reception’. 2012. (accessed 7 December 2015)

Knight M, Kenyon S, Brocklehurst P, Neilson J, Shakespeare J, Kurinczuk JOxford: National Perinatal Epidemiology Unit; 2014

Lewis G(ed.). London: Royal College of Obstetricians and Gynaecologists; 2004

Lewis G(ed). London: CEMACH; 2007

Lewis G Saving Mothers' Lives: the continuing benefits for maternal health from the United Kingdom (UK) Confidential Enquires into Maternal Deaths. Semin Perinatol. 2012; 36:(1)19-26

Mangham LJ, Petrou S, Doyle LW, Draper ES, Marlow N The cost of preterm birth throughout childhood in England and Wales. Pediatrics. 2009; 123:(2)e312-27

Maternity Action. Entitlement to free NHS maternity care for women from abroad (England only). 2015a. (accessed 8 December 2015)

Maternity Action. Entitlement to free NHS maternity care for women from abroad (Scotland, Wales and Northern Ireland). 2015b. (accessed 8 December 2015)

Monitor. 2013. (accessed 8 December 2015)

Pregnancy and complex social factors: A model for service provision for pregnant women with complex social factors.London: Royal College of Obstetricians and Gynaecologists; 2010

NHS. Implementing the Overseas Visitors Hospital Charging Regulations. Guidance for NHS Trust hospitals in England. 2004. (accessed 8 December 2015)

National Institute for Health and Care Excellence. 2008. (accessed 8 December 2015)

National Institute for Health and Care Excellence. 2010. (accessed 8 December 2015)

London: NRPF Network; 2014

No Recourse to Public Funds Network. Secondary healthcare charging reforms due to be implemented in April 2015. 2015. (accessed 8 December 2015)

PICUM (Platform for International Cooperation on Undocumented Migrants). Bulletin 12 July, Sweden — A new reform will grant access to health care for undocumented migrants. 2013. (accessed 8 December 2015)

London: Department of Health; 2013

London: PHE; 2013

Raouf SA, Ball T, Hughes A, Holder R, Papaioannou S Obstetric and neonatal outcomes for women with reversed and non-reversed type III female genital mutilation. Int J Gynaecol Obstet. 2011; 113:(2)141-3

Redshaw M, Henderson JOxford: National Perinatal Epidemiological Unit; 2015

Scottish Government. A Pathway of Care for Vulnerable Families (0-3) Guidance, Part 4. 2011. (accessed 8 December 2015)

Experiences of Pregnant Migrant Women receiving Ante/Peri and Postnatal Care in the UK: : A longitudinal follow-up study of Doctors of the World's London drop-in clinic attendees. 2015. (accessed 8 December 2015)

Smith A, Dixon ALondon: King's Fund; 2008

NHS charges putting pregnant migrant women in danger. 2013. (accessed 8 December 2015)

United Nations. Convention on the Rights of the Child Article 24(d). 1989. (accessed 8 December 2015)

United Nations. Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) Article 12 (2). 1999. (accessed 8 December 2015)

United Nations. The Millennium Development Goals Report 2014. 2014. (accessed 8 December 2015)

United Nations. Open Working Group proposal for Sustainable Development Goals. 2015. (accessed 8 December 2015)

Maternity care for undocumented migrant women: The impact of charging for care

02 January 2016
Volume 24 · Issue 1


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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