Ending the Hostile Environment for Pregnant Women

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2020 National Women's Conference
23 October 2019

In the UK, everybody has a right to free medical treatment in instances of accident and emergency, however, the legislation around who can receive non-emergency medical treatment and whether, and when, payment is required depends on two things:;The patient�s immigration status,;The urgency of the treatment requiredFor UK citizens ordinarily resident in the UK and for those people who have been formally granted leave to remain, NHS treatment is provided free and there is no requirement to repay the cost. For undocumented migrants and failed asylum seekers, the situation is more complex. For these patients the law requires that NHS Trusts charge patients for non-emergency medical care at the rate of 150% of the tariff for private treatment. Where the treatment is considered non-urgent, patients are required to pay for it in advance, however, where a patient requires urgent care or the treatment is immediately necessary then the law states that their treatment must not be delayed or refused and that they should be allowed to pay later. For maternity care, these charges are not itemised and typically start at around �7,000 for a pregnancy and birth without complications and can rise to tens of thousands of pounds where complications arise. Furthermore, many of the women affected do not have access to an income because their immigration status prohibits them from working, making it impossible for them to pay. But the result of non-payment can be very serious indeed.Under current rules, patients with debts of �500 or more which has been outstanding for over two months must be reported the Home Office. This could result in future immigration applications being refused and even deportation to their country of origin – the very environment from which they have fled. As one example, a woman who came to the UK for an arranged marriage but who subsequently fled her violent husband, was afraid to return to her country of origin because her family would force her daughter to undergo Female Genital Mutilation (FGM). Her application for asylum was refused and, finding herself unable to pay the NHS charge, she and her daughter now risk deportation.To make matters worse, some NHS Trusts are not applying the rules correctly and, while Conference recognises that all maternity care is immediately necessary and cannot be delayed, there is evidence that not all NHS Trusts agree. Despite the legal position outlined above, research carried out by Maternity Action has found that some Trusts are refusing treatment or seeking payment in advance for maternity care charges. Where women do not have access to these funds there is a very real risk that they will resort to desperate means of raising the money or to dangerous alternatives to hospital treatment.Conference is concerned that the practice of threatening to withhold NHS maternity care increases the risk of women being exploited as they attempt to raise funds by other means and also increases the likelihood of them seeking �back street� abortions or having their babies delivered by unqualified or unregulated midwives, placing their own lives and that of their unborn children at risk. Furthermore, some of the affected women have been subjected to FGM, making birth more difficult, increasing the likelihood of complications and making high quality medical care even more important.Conference believes that the application of a 50% surcharge and the failure to provide a breakdown or costs or itemised invoice suggests that these are penalty charges designed to create a hostile environment for migrant women. When combined with the fact that it is highly unlikely that the women affected would be able to make the payments then it becomes clear that this is not about recouping the cost of treatment but a deliberate choice to deny essential medical treatment to vulnerable women.There is no doubt that the women subjected to this treatment experience fear and distress and this is often exacerbated by language barriers and previous experiences of trauma and abuse. In many cases the women are already fleeing physical abuse, forced marriage, sexual violence, human trafficking and conflict or human rights abuses in their country of origin.Conference believes that all women living in the UK should be able to access free maternity care regardless of their immigration status and we call upon National Women�s Committee to:1)Disseminate information around the issue of NHS maternity charges for non-documented migrant women and failed asylum seekers, including Maternity Action�s online Toolkit and their research document, �What Price Safe Motherhood?�2. Raise awareness of the issue among UNISON members who are likely to encounter pregnant or migrant women in the course of their work, to include:;outlining the current legal position to enable members to identify instances where charges are being made incorrectly, and;providing information to enable members to signpost affected women to available support as necessary.3. Publicise the Maternity Action�s All Mothers campaign as well as their petition calling for the immediate suspension of NHS Maternity Charges and to encourage members to sign it.4. Work with Labour Link and other groups as necessary to lobby for political parties to adopt the recommendations outlined in Maternity Action�s research document, �What Price Safe Motherhood?� including the immediate suspension of all NHS maternity care charges.5. To produce a template for Regional Women�s Committees and Branch Women�s Groups to make Freedom of Information requests to their local NHS Trusts to ask:a)How many women have been charged for maternity care for the twelve month period for which most recent figures are available?b)The total amount charged to undocumented migrants and failed asylum seekers during the same period?c)How much of the charges made during that period have been recovered?d)How much has been spent by the Trust in attempting to obtain payment for those charges?This information to be fed back to and collated by National Women�s Committee to be disseminated to members and passed on to Maternity Action in order to support the campaigning work that they are undertaking.