Maternity care for migrant women must not be refused or delayed by issues such as immigration status, charging or ability to pay, says the Royal College of Midwives (RCM) in new guidance published today. The guide has been published with support from Public Health England.
Aimed at midwives, maternity support workers (MSWs) and other maternity staff, the guide outlines the duty of care health staff have towards vulnerable migrant women. It also details how maternity services should support migrant women in areas such as mental health, interpreting and financial support.
“The role of midwives and their colleagues is to give these women the care and support they need and are entitled to. Any issues around immigration status and whether or not they should pay for their care are not the responsibility of midwives or MSW,” said the guide’s author, Clare Livingstone, Professional Policy Advisor at the RCM.
The guide sets out how to assess women initially, along with advice on communication, how to ensure women’s safety and making sure there are no barriers to any ongoing care needs.
Some of the traumatic experiences migrant women may have faced are also addressed, including the possibility that they have been sexually exploited, and may not be aware of options to seek protection from further abuses. Figures from the Office for National Statistics show that one in four women is a survivor of sexual violence, and forced migration increases the likelihood of this happening. Some may be survivors of female genital mutilation (FGM), and the guide outlines key points for midwives and health staff to consider in the care of these women.
In a related move last week Maternity Action published a report around charging of migrant women for NHS maternity services. Ros Bragg, Director of Maternity Action said: “Charging migrant women for maternity care increases stress and anxiety for a group who are already at increased risk of destitution and homelessness. Many women avoid maternity as they are fearful of incurring debts they cannot pay. Our research has shown that exemptions from charging are not working. Vulnerable women are being wrongly invoiced for care and Trusts are aggressively pursuing debts from women who are manifestly unable to pay.”
Many of the myths around migrants’ rights are also busted in the guide, such as those saying all migrants must pay for NHS care, or that midwives have a duty to report immigration status. Both are wrong said the RCM. Health staff are also taken through a range of scenarios of vulnerable migrant women coming into maternity services, with tips and suggestion as to how staff can handle these cases and support the woman and her family.
“There must be no barriers that prevent or make these women fearful of coming to our maternity services for the care they need. This can have very serious consequences for their pregnancy, their baby and their own health. Migrant women have a right to NHS maternity services, just like any other woman in this country. Midwives also should not be pressured into reporting women’s immigration status,” said Clare Livingstone. “Many have come from areas of conflict and may have had little or no antenatal care. They may be traumatised and have little or no support in this country. Our duty is to care for them as well as we possibly can.”
The guidance can be read and downloaded at https://www.rcm.org.uk/media/5280/caring-for-vulnerable-migrant-women-2020-125x85mm_14.pdf.
The Maternity Action report on migrant charging can be read at Breach-of-Trust-report-Sept2021.pdf (maternityaction.org.uk).
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