NHS midwives are speaking out against the government’s ‘hostile environment’ policy that sees undocumented and overseas pregnant women submerged in prohibitively exorbitant maternity fees.
A new report released this September by Maternity Action and supported by the Royal College of Midwives (RCM) assesses – for the first time – the impact such fees are having on the welfare of patients, newborn babies and midwives’ “professional duty of care”.
Since 2017, hospital trusts have been required to verify the immigration status of patients and bill them an estimated charge for their care upon arrival, unless if it is urgent or an emergency. Women unable to pay within a two-month timeframe are subsequently reported to the Home Office, contributing to an atmosphere of hostility, fear and distrust towards midwives and the authorities.
Antenatal, pregnancy and postnatal care can start at £7,000 for these severely vulnerable women, which not only can cause “severe mental distress” according to the report, but can even rise much higher if there are any complications in the pregnancy or birth. The result is that many women are refusing to attend vital appointments out of fear of the costs – and out of fear of being detained or deported.
The fees apply to those who are not deemed ‘ordinarily resident’. This includes overseas visitors, British citizens who normally live abroad and undocumented women. Even those with British spouses, partners or children are forced to pay the fees.
Undocumented women are normally visa overstayers who have been unable to renew their visa or status – a common reoccurrence in Britain today as fees have hiked astronomically in just the past five years alone.
Maternity Action note further that the fees even apply to trafficking survivors who have been starved from their rights to services and welfare benefits, which is only exacerbated further by language and cultural barriers.
Although those with Refugee Status or those in the process of claiming asylum receive financial aid from the government, refused asylum seekers must prove that they are destitute for support which can only be obtained at 34-weeks gestation. Undocumented women who do not qualify for welfare support, however, are crucially prohibited from working and renting in the country which makes them particularly vulnerable to destitution and even homelessness.
Fifteen midwives were consulted in Maternity Action’s report and found that “strict government regulations” are contravening with midwives’ ethical duties and their wider responsibility to “reduce health inequalities”.
They found that the high fees are deterring women from accessing the healthcare they need, putting both themselves and their babies at profound risk. This is particularly concerning for midwives since migrant women pose a significantly higher risk of maternal death and “adverse pregnancy outcomes”.
One midwife said: “I am not here to enforce immigration rules, I am not here to enforce people’s entitlement, I have a duty of care as a midwife and I need to fulfil that duty of care.”
A further several voiced discomfort that the checking system was leading to increased racial discrimination since white, British women who do not qualify for free NHS care fail to be identified as billable by Overseas Managers. One midwife was concerned that the checking system was targeting women on the basis of their name and/or skin colour.
Maternity Action and the RCM are now calling on the Government to abolish the fees. They also want to prevent fines being piled up for these women since outstanding NHS debts have a domino-impact on their later immigration claim.
The director of Maternity Action, Rosalind Bragg, told the Guardian:
“NHS midwives provide brilliant care to the destitute women they see, but the policies of charging for maternity care make it hard for them to do effectively. The charges put them at risk of avoidable harm.
“Antenatal care is intended to identify the conditions that arise in pregnancy, so women can receive appropriate care. If they don’t receive proper care, they can encounter problems from high blood pressure to HIV to infections, which can result in premature births”.