The exclusion of pregnant women from NHS health care: a cross-sectional, humanitarian, health service evaluation

Abstract

BackgroundRecent UK immigration policy, including obligatory charging and data sharing between the NHS and the Home Office, has created an atmosphere of fear and increased the barriers to health-care faced by highly marginalised and vulnerable individuals. Charging for maternity care (often incorrectly) leads to avoidance or delayed presentation for antenatal care and increased maternal and neonatal morbidity, mortality, and associated costs. MethodsThis cross-sectional health service evaluation used data collected from patients during medical consultations at Doctors of the World (DOTW) clinics in the UK. DOTW is a humanitarian organisation, providing care to those excluded from NHS health care. We describe patient characteristics with a particular focus on pregnant women presenting to DOTW for antenatal care instead of NHS care. Findings980 adults had a medical consultation at DOTW between Jan 1, 2016 and Dec 31, 2016. Of these 945 (96%) of 980 people were non-EU or EEA nationals, 518 (53%) of 980 were women, and 104 (20%) of 518 were pregnant. Among pregnant women, 18 (17%) of 104 had a experienced a history of violence and 36 (34%) of 104 had an urgent medical need. 86 (83%) of 104 pregnant women were presenting for their first antenatal visit; 50 (58%) of these 86 women were attending after 10 weeks gestation. InterpretationAttendance at DOTW clinics is evidence of exclusion from mainstream health-care provision. A fifth of women attending medical consultations at DOTW in 2016 were pregnant, with a third having an urgent medical need. Most were attending for their first antenatal visit, with over half attending after 10 weeks gestation; NICE recommend first antenatal visit by 10 weeks. These results are of great concern, particularly given the refusal of the government to publish its review of the public health impact of the NHS overseas visitor charging regulations. FundingWellcome Trust, European Union; European Programme for Integration and Migration, European Commission: DG Health and Food Safety/Consumers, Health, Agriculture and Food Executive Agency.