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We are inviting you to sign our open
letter to Jeremy Hunt MP on charging vulnerable migrant women for NHS maternity care.
Vulnerable women face charges for NHS maternity care which start at £4,000 and rise to £10,000 or more. Many of these women have lived in the UK for some years and include destitute asylum seekers and women brought to the UK by abusive partners.
Research by Maternity Action and Doctors
of the World has shown that charging for maternity care reduces the likelihood of vulnerable migrant women receiving essential maternity care. New requirements to produce ID before receiving care are an additional barrier to access for these women.
Vulnerable migrant women are at particularly risk of poor maternal health outcomes. These are women who require additional support not barriers to accessing essential maternity care.
It is unacceptable that the Government is proceeding with new and more aggressive efforts to pursue maternity charging without having undertaken any research into the impacts on the health of vulnerable migrant women and their babies.
The Government announced a small scale general review of the impact of the new charging regulations in November. However this is limited in scope and does not address the impact on the health of pregnant women, new mothers and their babies.
We are calling for the Government to immediately suspend charging for NHS maternity care so that such research can be undertaken. Only when the Government and the wider community has a clear understanding of the impacts on vulnerable migrant women
should any decisions be made about the future of charging for maternity care.
We are keen to get support from a wide range of organisations and individuals so please distribute this message through your networks.
You can sign here.
This letter has been prepared by Maternity Action and the Maternity Entitlement Group. To find out more about this campaign, please email [log in to unmask]
Open letter to Jeremy Hunt
Rt Hon Jeremy Hunt MP
Secretary of State for Health
Department of Health
Richmond House
79 Whitehall
London
SW1A 2NS
Dear Secretary of State
Re: Impact of charging for NHS maternity care on vulnerable migrant women.
We write to express our concern about the impact of charging for NHS maternity care on vulnerable migrant women.
Pregnant women who are chargeable for NHS maternity care include some of the most vulnerable women living in the UK. Research by Maternity Action and other agencies including Doctors of the World, already shows that charging for maternity care reduces the
likelihood of vulnerable migrant women receiving essential maternity care. Maternity Action reviewed 55 cases of women affected by charging and found that those affected included destitute refused asylum seekers, women brought to the UK by abusive partners
or traffickers, and undocumented migrant women who are not entitled to mainstream housing and benefits, but who are in the process of regularising their immigration status. Several women had experienced domestic violence, which is more prevalent amongst vulnerable
migrants and tends to increase during pregnancy. Many had been in the UK for several years.
Vulnerable pregnant migrant women are at particular risk of poor maternal health outcomes, including maternal deaths, and premature birth. Many, if not all of these women, could be described as having ‘high risk pregnancies’ due to the combination of medical
and social factors. NICE guidance recommends additional care, including early booking, more frequent antenatal appointments and continuity of care with a particular midwife.
As Secretary of State, you have expressed your ambition for the NHS to be one of the safest places in the world to give birth. In the light of the evidence that already exists about the association between vulnerable women facing complex social problems, and
maternal mortality and morbidity, we would urge you to consider the consequences of charging in relation to the very issues you have highlighted - rates of stillbirth, maternal and neonatal deaths and birth-related brain injuries in babies.
New requirements to produce ID before receiving care are an additional barrier to access for these pregnant women. Many marginalised women, including British nationals, do not have suitable ID such as a passport or driving licence, or even utility
bills. They may consequently fear that they will be charged.
Charges for maternity care start at £4,000 and rise to tens of thousands for more complex care. Where bills are unpaid for more than two months, the NHS Trust notifies the Home Office and this may result in the refusal of current and future immigration applications.
Existing research confirms that women are deterred from seeking essential care both by bills which they know they cannot afford to pay and by fears of being reported to the Home Office on account of an unpaid NHS debt.
Charging also impacts directly on the health and wellbeing of vulnerable migrant women. Maternity Action’s research found that women were experiencing high levels of stress and anxiety as a result of bills they could not pay and fears that their immigration
applications would be refused as a result of debt to the NHS. Midwives contributing to the research reported that this was of such concern that it had been raised in departmental meetings. Stress and anxiety are known to have adverse effects on fetal development
and pregnancy outcomes.
The safeguards to ensure access to maternity care for vulnerable migrant women, which were put in place after charging for NHS secondary care was introduced, are not working. While maternity care must never be refused or delayed on account of inability to
pay in advance, the rules governing charging are sufficient in themselves to deter women from accessing care. Entering into an affordable repayment plan would prevent debts being reported to the Home Office. However Maternity Action’s research found that
repayment plans were often set at unrealistically high levels for women on very low incomes.
The latest round of regulations and local pilots foreshadow more aggressive efforts to identify and invoice those subject to charging. We are extremely concerned at the impact these will have on women who are already being deterred from seeking essential maternity
care and on their babies. Charging vulnerable migrant women will not bring further income to the NHS, as these women are manifestly unable to pay. A more likely result is that there will be adverse outcomes, or that women and their babies will require more
complex care as a result of conditions which could have been avoided or managed in regular antenatal appointments. In such cases, the cost to the NHS increases.
These changes have proceeded without any research into the impact on the health of pregnant women, new mothers and their babies. While the review announced in November is very welcome, it is limited in scope and does not address this fundamental gap in research.
We ask that charging for NHS maternity care is suspended while these impacts are independently researched and appropriate measures to ensure access are introduced.
Yours sincerely
To support the campaign to ensure maternity care for all women, please
For more information about the rights of women affected by charging for NHS maternity care, see Maternity Action's online
information, telephone and email advice.
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