Pregnant Migrants Unfairly Denied NHS Treatment

Pregnant women are being denied antenatal care by the NHS because of their immigration status, endangering mother and baby, a medical charity has found.

Médecins du Monde, which normally works in deprived and developing parts of the world, set up a clinic in London a year ago because of concerns that some people were struggling to get healthcare in one of the world’s richest cities.

One year on, its experience shows that the NHS, intended to be free to all, is not available to some of those who need it and who, under the letter of the law, are entitled to medical help.

Of greatest concern are pregnant women from migrant communities. Late access to maternity care – after 20 weeks of pregnancy – is a recognised risk factor for maternal death, yet 44% of the women who went to Médecins du Monde’s centre in Bethnal Green, east London, were more than 23 weeks pregnant, says the organisation’s report on its first year.

In a foreword to the report, Paul Hunt, UN special rapporteur on the right to the highest attainable standard of health, says: “One of the key reasons for monitoring the right to health in high-income countries with a high standard of health and a good healthcare system is to assess how we look after the most vulnerable people in our societies. Any policy measures which hinder access to maternity care and could lead to a worsening of maternal health for some vulnerable women give genuine cause for concern.”

Project London saw 349 clients for 435 consultations in its first year. On average they had lived in the UK for three years, which, says its director, Susan Wright, “goes a long way towards rebutting the myth of the health tourist”.

In response to the notion that sick people from abroad were arriving specifically to get free NHS treatment, the government tightened access to hospital care in 2004. But migrants, whatever their status, are still entitled to emergency treatment in hospital and treatment for infectious diseases except HIV/Aids.

The rules say that any treatment a doctor believes is “immediately necessary” must be provided. The government has been consulting on whether access to GPs should be restricted, but at the moment a GP can choose to accept a migrant or asylum seeker as a patient or not.

Of the 39 pregnant women who went to Project London, 28 had tried to get care but had experienced difficulties. Of these, 18 had been unable to register with a GP, seven had encountered difficulties accessing antenatal care at a hospital and four had experienced problems trying to get the pregnancy terminated. One migrant worker from the Philippines on a valid visa could not register with a GP because her employer was keeping her passport.

In another case, a woman went to the Project London clinic who was 38 weeks pregnant. “She had been told that, as a refused asylum seeker, she was not entitled to either primary or secondary care. As a result she had not received any care throughout her pregnancy,” it says. Some were told they must pay for their antenatal care. One arrived at Project London when she was eight months pregnant and was “extremely frightened by the prospect of the bill of £3,300 for the antenatal care she had received and for the delivery. She was about to be made homeless and had no means whatsoever to pay the bill.”

The rules on maternity care say that women who are overseas visitors should be charged, but they should not be refused care if they are unable to pay.

In most cases, Project London was able to help people receive mainstream NHS care. More than 75% needed help to register with a GP. Ms Wright said it was cost-effective to give such people GP care so that they were less likely to need expensive hospital care later.