Can you imagine being too afraid to go to the doctor for care you badly need? This is a reality for many pregnant women refused asylum in England.
How has this come about? A raft of rules around charging non-residents for NHS care has gradually grown, and mean that refused asylum seekers and undocumented migrants find it ever more difficult to access medical care they urgently need. For some time, hospital care – including giving birth in hospital – has incurred a large bill. In 2017, charging was extended to include all secondary care, including maternity care in the community. Care deemed “non-urgent” was even made chargeable upfront, meaning that it can be withheld if the prospective patient cannot pay. The inhumanity of this scheme, as well as the danger it poses to public health, have been widely decried by clinicians and NGOs.
In theory, the government acknowledges that maternity care always needs to be provided immediately, and so should never be withheld. But the practice of charging for maternity care creates a huge barrier to those who can’t pay; unpaid NHS debts are reported to the Home Office, and can make it more difficult to regularise immigration status. There is good evidence that women have been, and continue to be, deterred from attending appointments for pre and post natal care for fear of incurring debts. This is corroborated by our experience at JRS UK. We work with people refused asylum in a notoriously problematic determination process. Banned from working and with all support cut off, they are destitute. There is no way they can pay bills of thousands of pounds, and the prospect of being faced with debts can inevitably be very troubling for them. We know in particular of pregnant women who are very worried to hear they will owe money if they attend midwifery appointments. Billing people for treatment prevents destitute people from accessing treatment.
And this barrier is not an accident. Barriers to healthcare for those refused asylum are a “hostile environment” measure – part of a matrix of policy and legislation designed to make life in the UK unbearable for those without immigration status. The hostile environment both renders refused asylum seekers and other migrants destitute, and at the same time extends to them charges for healthcare that no destitute person could pay. Destitution also magnifies health problems – and the dangers associated with pregnancy. A hostile perspective and policy approach creates a need for healthcare that it then withholds.
Insofar as it acknowledges that access to maternity care must be immediate, the department of health seems ready to limit this hostile perspective and policy outlook. If it is serious, it must abolish charging for maternity care altogether.
The policy of charging migrant women for maternity care is currently being challenged in court by the charity Maternity Action. Success in this challenge would not put an end to all hospital charging for refused asylum seekers, but it would help to ensure that people can access maternity care they badly need. Success is vital
Want to learn more about the experiences of people seeking asylum and the role of JRS UK?