The Royal College of Obstetricians and Gynaecologists has called for the immediate suspension of charging for NHS maternity care for migrant women because members say this government policy is harming the health of pregnant women and their babies.
The RCOG has urged the government to change its policies towards charging some migrant women for maternity care and to carry out an urgent review of how maternity care is provided to the group. It is the first time the health professionals’ body has issued a position statement on this issue.
The charity Maternity Action and the Royal College of Midwives have long expressed concern about the impact of NHS charging on this group of women. Charging forms a key plank of the Home Office’s hostile environment for migrants.
The government says the charging policy is in place to deter health tourism but medics treating migrant pregnant women say there is little evidence that previously free NHS maternity care for all attracted health tourists.
Under current NHS rules, some groups of migrant women including those who are undocumented or who have been refused asylum are expected to pay for NHS maternity care. Bills typically start at about £7,000 and can rise to tens of thousands of pounds if complex care is required.
NHS trusts can report debts of £500 or more to the Home Office, which can threaten a woman’s present or future immigration application.
According to the 2019 MBRRACE-UK confidential inquiry into maternal deaths, three women were found to have died between 2015 and 2017 who may have been reluctant to access maternity care due to fears about charging and impact on their immigration status.
Dr Brenda Kelly, an NHS consultant obstetrician working in Oxford, treats many pregnant migrant women. She is calling for the barriers to them accessing maternity care to be removed urgently.
She described the case of one migrant woman who arrived in A&E shortly before delivering a stillborn baby. The woman had been fearful of coming forward for antenatal care although she was suffering from multiple, pregnancy-related health problems.
“I hope I never have to hear cries like that woman’s cries ever again,” said Kelly. “The way to safeguard these women is to build up trust. If they are landed with a bill of several thousand pounds they will disengage. They are not health tourists, they are desperate. The commitment to maternal health equity means ending charges for maternity care. The time for action is now.”
Along with immediate and permanent suspending of charging some migrant women for NHS maternity care, the RCOG is calling for a review by NHS trusts to improve practice when dealing with this group of women.
It wants the introduction of minimum standards for interpreting services for women who do not speak English and an urgent review by government of how they care for pregnant, migrant women – including those who do not have to pay for maternity care, such as asylum seekers, but who are often moved around the country at short notice by the Home Office severing ties with the maternity team looking after them.
The Department of Health and Social Care said: “All refugees, asylum seekers and victims of modern slavery are exempt from NHS treatment costs. While some other migrants or visitors to the UK may be required to contribute – in which cases they’ll be told if costs apply to them – we’ve always been clear urgent care should never be delayed or withheld over charges, including all maternity services. Trusts can also write off owed payments if someone is genuinely unable to afford it.”
