Abstract
BackgroundUndocumented migrant women experience complex barriers to maternity services, are less likely to receive the recommended level of maternity care, and have poorer obstetric outcomes than non-migrant women. There are concerns increasing restrictions on entitlement to health services have a detrimental impact on access to services and obstetric outcomes, particularly among undocumented migrant women. The study aimed to investigate the experiences of undocumented migrant women who have been pregnant in England, and factors affecting access to care and health outcomes.MethodsWe conducted in-depth semi-structured interviews June–December 2017 with a purposive sample of migrant women born outside the UK (aged>18) who had experiences of pregnancy and undocumented status (without permission to reside) in the UK, recruited through Doctors of the World (DOTW) UK. Interpreting services were used on request. Interviews were recorded, transcribed, and analysed using thematic analysis. Ethical approval: Imperial College London Research Ethics Committee (ICREC reference: 17IC3924).ResultsSemi-structured interviews were conducted with 20 participants, 10 of whom had their first antenatal appointment after the national target of 13 weeks, and nine of whom reported complications. Themes defining women's experiences of pregnancy included: restricted agency, intersecting stressors, and an ongoing cycle of precarity, defined by legal status, social isolation, and economic status.ConclusionsThis study provides new evidence of women's experiences of pregnancy in the UK in the context of increasingly restrictive health policies including charging and data sharing. Six recommendations are made to ensure the UK and other migrant receiving countries work towards reducing inequalities and achieving national and global targets for maternal and child health and universal health coverage.
Highlights
There are clear calls to ensure the 250 million international migrants worldwide (WHO, 2018; UNHCR, 2015) are not ‘left behind’ (Winter 2019; Abubakar and Zumla, 2018)
Half of all migrants and refugees are women and girls (Women refugees), who are at increased risk of poor obstetric outcomes compared to non-migrants (Department of Health, 2015; Royal College of Obstetricians and Gynaecologists, 2008), and have been shown to seek antenatal care later, and access fewer maternity services (Heaman et al, 2013; Bollini et al, 2009; Almeida et al, 2013)
Given high rates of maternal morbidity and mor tality among migrant women in the UK, it is imperative we better un derstand their experiences to inform health policies that are not discriminatory and do not have a detrimental impact on health outcomes. The aim of this qualitative study was to investigate the experiences of undocumented migrant women who have been pregnant whilst living in England in order to understand factors affecting access to care and maternal health outcomes
Summary
There are clear calls to ensure the 250 million international migrants worldwide (WHO, 2018; UNHCR, 2015) are not ‘left behind’ (Winter 2019; Abubakar and Zumla, 2018). In the UK, policies of deterrence, fear, lack of trust, language, cultural and system-level barriers, and inadequate information about where and how to access care have been highlighted as key challenges (Jayaweera and Quigley, 2010; Rowe et al, 2008; Henry et al, 2020; Winn et al, 2018; Floyd and Sakellariou, 2017) This has been reiterated in systematic reviews (Bollini et al, 2009; Gagnon et al, 2009; Small et al, 2014; Fair et al, 2020; Martinez et al, 2015; Woodward et al, 2014), and reflects evidence on the impact of exclusionary policies in other receiving countries (Campbell et al, 2014; Kuile et al, 2007; Martinez et al, 2015; Woodward et al, 2014). Six recommendations are made to ensure the UK and other migrant receiving countries work towards reducing inequalities and achieving national and global targets for maternal and child health and universal health coverage
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