Insecure Immigration Status Research Articles

Barriers to Reproductive Justice for Women Seeking Sanctuary in the UK: Narratives from Birth Companions and the Maternity Stream of Sanctuary

Women living in the UK with insecure immigration status are often from ethnic minority groups, have limited understanding of English, and have significant experience of trauma. Recent confidential inquiries into maternal deaths have repeatedly shown how intersecting and multiple disadvantage puts these women at higher risk of maternal mortality and morbidity. Multiple voluntary sector organisations are relied upon to support these women as they navigate the journey to parenthood. A reproductive justice framework is here employed to examine the multitude of factors intersecting to influence the access women with insecure migrant status have to maternity services. Narrative construction of three composite case studies took place to highlight the various ways reproductive justice is both violated and protected by the immigration and maternity systems in the UK. The discussion section comments on prevalent themes throughout each case study: gendered dynamics of insecure immigration status, structural barriers and complex systems, and reliance on the fragile voluntary sector. This article concludes that, alongside the work of the voluntary sector, women’s reproductive justice rights must also be emphasised and protected throughout statutory systems and services.

Interventions to improve access to primary care for inclusion health groups in England: a scoping review

BackgroundEveryone in England has the right to primary care without financial charges. Nevertheless, evidence shows that barriers remain for inclusion health populations such as vulnerable migrants, people experiencing homelessness, Gypsy, Roma, and Traveller (GRT) communities, and people who sell sex. There is little evidence for what works to improve access. This study was a scoping review of interventions to improve access to mainstream primary care for inclusion health groups in England. MethodsIn this scoping review, we searched databases (Embase, Medline, APA PsychInfo, the Cochrane Collaboration Library, Web of Science and CINAHL) and grey literature sources, including the National Health Service and National Institute for Clinical Excellence, for articles published in English between Jan 1, 2010, and Dec 31, 2020, with no limit on study design. Data were extracted according to inclusion criteria, including interventions taking place in England and targeting people with insecure immigration status, people who sell sex, people experiencing homelessness, and GRT communities. Results were presented in a narrative synthesis. Findings39 studies describing one or more interventions were included: four peer-reviewed articles (one randomised trial, two quality improvement projects, and one mixed-methods study protocol) and 25 grey literature items (38 interventions in total). Interventions mostly targeted people with insecure immigration status (17/38, 45%), and a majority (12/38, 32%) took place in London. The most common types of intervention were training, education, and resources (such as leaflets or websites) for patients or staff (25/38, 66%), and most interventions targeted GP registration processes (28/38, 74%). Interventions commonly involved voluntary and community sector organisations (16/38, 42%). Most interventions were not evaluated to understand their effectiveness (23/38, 61%). Sources with evaluations identified staff training, direct patient advocacy, and involvement of people with lived experience as effective elements. InterpretationInterventions to improve access to primary care for inclusion health groups in England were heterogeneous, commonly undertaken at community level, and developed to serve local inclusion health groups. Considerations for policymakers and practitioners include groups and geographical areas less commonly included in interventions, the elements of positive practice identified in evaluations, and the need for evaluation of future interventions. FundingNational Institute for Health and Care Research (NIHR 202050).

Technology-Facilitated Domestic Abuse: An under-Recognised Safeguarding Issue?

Abstract Responding to domestic abuse is a key element of social work practice, in both child protection and adult safeguarding. This article sets out the ways in which rapid technological advances are being co-opted by perpetrators of domestic abuse to create new ways of exerting control. After starting with a brief reminder of recent UK legislative changes around domestic abuse, the article outlines the main ways in which technologies, including mobile phones and other Internet-enabled devices, are used by abusers for surveillance, monitoring, tracking and otherwise controlling all aspects of the lives of those they target. The article then moves on to consider how some groups may be at greater risk than others of technology-facilitated domestic abuse (TFDA), including women with insecure immigration status, women with learning disabilities and younger women and girls. Finally, the key social work tool for assessing risk in relation to domestic abuse is critiqued as lacking sufficient focus on TFDA. The article concludes by suggesting what individual social workers and local authorities need to do in order to better respond as TFDA continues to evolve.

Associations with sub-optimal clinic attendance and reasons for missed appointments among heterosexual women and men living with HIV in London

Poor engagement in HIV care is associated with poorer health outcomes and increased mortality. Our survey examined experiential and circumstantial factors associated with clinic attendance among women (n = 250) and men (n = 106) in London with heterosexually-acquired HIV. While no associations were found for women, among men, sub-optimal attendance was associated with insecure immigration status (25.6% vs. 1.8%), unstable housing (32.6% vs. 10.2%) and reported effect of HIV on daily activities (58.7% vs. 40.0%). Among women and men on ART, it was associated with missing doses of ART (OR = 2.96, 95% CI:1.74–5.02), less belief in the necessity of ART (OR = 0.56, 95% CI:0.35–0.90) and more concern about ART (OR = 3.63, 95% CI:1.45–9.09). Not wanting to think about being HIV positive was the top reason for ever missing clinic appointments. It is important to tackle stigma and the underlying social determinants of health to improve HIV prevention, and the health and well-being of people living with HIV.

The violence of uncertainty: Empirical evidence on how asylum waiting time undermines refugee health

The idea of violent uncertainty was first introduced in the New England Journal of Medicine (Grace et al., 2018) making claims about the deleterious impacts of insecure immigration status on the health of migrants. Policies of uncertainty are said to directly and indirectly create harm by impacting on individual's health via detention and public degradation and undermining healthcare services. We offer original empirical evidence indicating an association with uncertainty, in the form of asylum waiting times, on refugees' self-reported health. We devise four hypotheses that: long waiting time for asylum decisions increases likelihood of self-reported health problems and the effect persists overtime, that female refugees report higher levels of health problems resulting from uncertainty and religion moderates the association between health and uncertainty. We use data from the UK longitudinal Survey of New Refugees wherein all new refugees were sent a baseline survey immediately after receiving refugee status and then follow-up surveys 21 months later. The findings show longer asylum waiting time is associated with poor health. Female refugees were more likely to report poor emotional and physical health. The negative effect of asylum waiting time on emotional health persists 21 months post settlement and is worse for women. The hypothesisabout the ameliorating effect of religion is only partially supported. Our findings supports existing theory and qualitative studies about the deleterious effects of using policies of waiting-related uncertainty for managing migration. Given the wide use of such policies in the Global North, our work is suggestive of likely generalisability. Thus, countries with large refugee populations might want to consider our findings when developing asylum policy which minimises impact on refugee health.

'She come like a sister to me': a qualitative study of volunteer social support for disadvantaged women in the transition to motherhood in England.

This qualitative study explores the ways in which disadvantaged women benefit from social support from a trained volunteer during pregnancy and the postnatal period, using the theoretical frameworks of stress and coping and a multi-dimensional model of social support. Forty-seven mothers took part in semi-structured interviews. The mothers, who had received social support through nine volunteer projects in England, faced many potentially stressful challenges besides having a baby (such as poverty, poor housing, histories of abuse, motherhood at a young age, living with physical or mental health difficulties, migration and insecure immigration status). Analysis was in two distinct stages: first, an inductive thematic analysis of mothers' experiences, and second, mapping of the results onto the theoretical frameworks chosen. Volunteers built relationships of trust with mothers and gave skilled emotional support, positive appraisal support, informational support and practical support according to mothers’ individual needs, thereby assisting mothers exposed to multiple stressors with problem-focused, emotion-focused and perception-focused coping. This helped to reduce social isolation, increase effective access to services and community resources, and build mothers' confidence, self-esteem and self-efficacy. Volunteer social support may have particular salience for mothers who lack structural support and need skilled functional support.This article is part of the theme issue ‘Multidisciplinary perspectives on social support and maternal–child health’.

‘Those tablets, they are finding an empty stomach’: a qualitative investigation of HIV risk among sexual and gender minority migrants in Cape Town, South Africa

ABSTRACT Objectives: HIV prevalence among sexual and gender minority (SGM) individuals in South Africa is among the highest in the world; however, SGM migrants, an especially vulnerable subgroup of both the SGM and migrant populations, have frequently been overlooked in the country's robust public health response. This qualitative study, guided by syndemics theory, explored the processes by which SGM migrants in South Africa are exposed to HIV risk and those that may reduce this risk. Design: We conducted 6 focus groups with a total of 30 SGM migrants living in Cape Town. Participants were men who have sex with men, women who have sex with women, and transgender women. Transcripts were analyzed using grounded theory. Results: Participants identified a number of interrelated factors (insecure immigration status, financial and housing instability, food insecurity, stigma and discrimination, and lack of social support) contributing to HIV risk. While some took PrEP or HIV medication, adherence could be affected by structural and psychosocial barriers. Conclusion: Interventions that respond to the syndemic impacts on HIV outcomes are needed to reduce disease burden among SGM migrants in South Africa.

‘Fat cat’ lawyers and ‘illegal’ migrants: the impact of intersecting hostilities and toxic narratives on access to justice

ABSTRACT This article examines how three spheres of hostility intersect to prevent effective access to justice for those living with insecure immigration status. The neoliberal governance model, the barren justice landscape and the hostile environment are supported by the cynical construction of the ‘fat cat’ lawyer and the toxic ‘folk devil’ narrative of the ‘bogus’ asylum seeker. To the extent that the judiciary have frustrated the more obvious, ideologically driven, attempts to restrict access to justice for migrants, the austerity predicated measures pursuant to the Legal Aid, Sentencing and Punishment of Offenders Act 2012 (LASPO) have completely altered the legal landscape. The analysis is informed by the findings of the ‘Legal advice and support for persons with insecure status’ project (hereafter LAPIS) in Nottingham which explores the challenges faced by service providers and the lived experiences of those with insecurity of status. It is clear that access to justice is a passport to the realisation of other rights, yet participants struggled to access a remedy because legal advice is too often out of reach.

‘I'm Here as a Social Worker’: A Qualitative Study of Immigration Status Issues and Safeguarding Children in Private Fostering Arrangements in the UK

Private fostering of non‐citizen children in the UK has become a focus of child protection social work since the Laming report into the death of Victoria Climbié. This paper reports on a qualitative study that aimed to understand children's experiences of private fostering and social work practice. The study involved interviews with social workers and privately fostered children, reviews of advice line calls to Children and Families Across Borders and a review of safeguarding reports from London boroughs. It found that many children who present as ‘privately fostered’ have been in effect abandoned by their parents and are living with strangers. While the homes that they live in may be safe, insecure immigration status renders children vulnerable and, if not regularised, will lead to complicated and stalled transitions to adulthood. The key findings of this study are that children whose parents are not resident in the UK are treated as privately fostered, but the underlying premise of private fostering legislation, which is that the parent retains meaningful responsibility for the child, is often not in place.‘Reports on a qualitative study that aimed to understand children's experiences of private fostering and social work practice’Key Practitioner Messages Privately fostered children may have insecure immigration status. Social workers should consider regularising immigration status for privately fostered children as part of safeguarding. If a child's parents are not resident in the UK, social workers should consider whether the local authority has a duty to make arrangements for him/her to have a safe home.

"I Must Be Silent Because of Residency": Barriers to Escaping Domestic Violence in the Context of Insecure Immigration Status in England and Sweden.

This article draws on qualitative research examining domestic violence against women with insecure immigration status in England and Sweden. Empirical data were collected through in-depth semistructured interviews with 31 survivors from 14 non-European Union (EU) countries, and 57 professional stakeholders including 19 support service providers. This article reveals a multilayered process of actualizing women's right to live free from violence, with survivors required to be formally eligible for services according to their immigration status, having to prove their eligibility, overcome informal barriers including the fear of deportation, and gain access to accurate information about their rights and services.

Exploring the relationship between postmigratory stressors and mental health for asylum seekers and refused asylum seekers in the UK.

Numerous studies have linked the high rates of traumatic events experienced by refugees to the elevated rate of mental health problems in these populations. A growing body of evidence has also highlighted the importance of considering postmigratory stressors when making sense of displaced person distress. This study explored the relationship between mental health and postmigratory stress for asylum seekers and refused asylum seekers in Britain. The study further examined if those refused asylum experienced elevated distress and postmigratory stress compared to those awaiting the outcome of asylum applications. Results indicated that participants ( N = 97) had endured a range of pre- and postmigratory stressors and had high scores on measures of anxiety, depression, and PTSD. A postmigratory factor comprising items associated with isolation, restrictive policies, and stressors associated with having an insecure immigration status, was significantly associated with PTSD scores. This relationship remained when controlling for the variance accounted for by premigratory trauma predictors. Being refused asylum was the strongest predictor of depression and anxiety. Those refused asylum scored higher on a factor associated with barriers to accessing services. Social materialist theories of distress are drawn upon to contextualise the heightened vulnerability of those refused asylum. The paper concludes by emphasising the problems associated with taking an exclusively trauma-focussed approach when working with asylum seekers and argues for community orientated interventions to support displaced people to cope with the various stressors endured in exile.

‘No Recourse to Public Funds’, insecure immigration status and destitution: the role of social work?

Those with insecure immigration status in the UK maybe subject to a condition known as ‘No Recourse to Public Funds’ and risk the prospect of facing destitution within the complex landscape of a discriminatory immigration system. This article examines ‘No Recourse to Public Funds’ and reports findings from ethnographic research. It documents tensions between immigration legislation and social services’ statutory duty to safeguard and promote the welfare of destitute ‘No Recourse to Public Funds’ families with children.

Group work: a powerful site of resistance for migrant women experiencing gender-based violence

During 2016, Safety4Sisters North West, a small women’s organisation based in Manchester, UK, worked with 61 women who had insecure immigration status and had experienced gender-based violence. This article examines the themes that arose from the project’s group work highlighting the realities of vulnerable migrant women living at society’s margins, resisting and navigating both patriarchal and immigration control within the context of austerity.

"I didn't think we'd be dealing with stuff like this": A qualitative study of volunteer support for very disadvantaged pregnant women and new mothers

Objectiveto identify the particular issues associated with volunteer support for very disadvantaged mothers (who were young, had insecure immigration status, were recent migrants whose English was poor,misused drugs or alcohol, or were involved in crime), from the perspective of the volunteers. Designa qualitative descriptive study, informed by phenomenological social psychology. Semi-structured qualitative interviews were carried out between July 2013 and March 2015. Interview transcripts were analysed using inductive thematic analysis. Settingnine volunteer support projects for pregnant women and new mothers, run by third sector organisations in England. Participants38 volunteer supporters. Measurements and findingsthree key themes were identified: 'Meeting challenges', 'Needing support' and 'Identifying successes'. 'Meeting challenges' contained the subthemes 'making the relationship of trust','remaining non-judgemental', 'maintaining boundaries' and 'dealing with child protection'. 'Needing support' contained the subthemes 'feeling prepared', 'feeling supported' and 'staying safe'. 'Identifying successes' contained the subthemes 'celebrating the small wins', 'validation as a mother', and 'supporting access to services'. Key conclusionsvolunteers were able to build strong, empowering relationships with some very disadvantaged women during pregnancy and afterwards, including where the mothers did not readily engage with professionals. However, supporting women with complex needs is emotionally challenging and volunteers need to be carefully selected, realistically trained and robustly supervised and supported during their volunteering. Implications for practicethird sector organisations offering volunteer support for pregnant women and new mothers can be valuable partners in reaching very disadvantaged women who may find it difficult to engage with services. Volunteers can build up a relationship of trust with vulnerable mothers over time, but need to be well supported to do this safely and effectively.

How does gender influence immigrant and refugee women's postpartum depression help‐seeking experiences?

The number of migrants arriving in Canada from non-European countries has grown significantly over the past three decades. How best to assist these escalating numbers of immigrant and refugee women to adapt to their new environment and to cope with postpartum depression (PPD) is a pressing issue for healthcare providers. Evidence has shown that immigrant and refugee women experience difficulties in accessing care and treatment for PPD. This qualitative study was conducted with 30 immigrant and refugee women using in-depth interviews to obtain information about the women's PPD experiences. The primary aim was to explore how cultural, social, political, historical and economic factors intersect with race, gender and class to influence the ways in which immigrant and refugee women seek help to manage PPD. Results reveal that immigrant and refugee women experience many complex gender-related challenges and facilitators in seeking equitable help for PPD treatment and prevention. We will demonstrate that (a) structural barriers and gender roles hinder women's ability to access necessary mental healthcare services and (b) insecure immigration status coupled with emotional and economic dependence may leave women vulnerable and disadvantaged in protecting themselves against PPD.

Legislating Gender Inequalities

Research on domestic violence documents the particular vulnerability of immigrant women due to reasons including social isolation, language barriers, lack of awareness about services, and racism on the part of services. Based on qualitative interviews with 30 South Asian women with insecure immigration status residing in Yorkshire and Northwest England, this article explores how inequalities created by culture, gender, class, and race intersect with state immigration and welfare policies in the United Kingdom, thereby exacerbating structures of patriarchy within minority communities. It is within these contexts that South Asian women with insecure immigration status experience intensified forms and specific patterns of abuse.

Gender, Asylum Seekers and Mental Distress: Challenges for Mental Health Social Work

This paper engages with the critique that mental health social work with asylum seekers requires urgent attention, as current practice is inadequate. Four key issues are discussed in the paper. First, I briefly interrogate key aspects of the UK's current asylum policy: poverty, dispersal and detention. I elaborate on the mental health implications of each of these and argue that these policies replicate known risk factors in mental ill health. Second, much of the psychiatric literature relating to asylum seekers and refugees draws on post-traumatic stress disorder (PTSD) as the key diagnostic category. The paper argues that PTSD has to be problematised and highlights the importance of maintaining a social model of understanding mental distress and developing it further to include insecure immigration status in our models of understanding mental distress. Third, I consider the specific issues facing women asylum seekers and illustrate how an analysis at the intersection of gender, mental distress and asylum is essential. Lastly, I argue that, to respond more effectively in this complex area of work, interventions at a practitioner, organisational and societal level are required if the espoused values of social work are to be more than mere rhetoric.

Young caregiving and HIV in the UK: caring relationships and mobilities in African migrant families

AbstractRecent research in Sub‐Saharan Africa has revealed the importance of children's caring roles in families affected by HIV and AIDS. However, few studies have explored young caregiving in the context of HIV in the UK, where recently arrived African migrant and refugee families are adversely affected by the global epidemic. This paper explores young people's socio‐spatial experiences of caring for a parent with HIV, based on qualitative research with 37 respondents in London and other urban areas in England. In‐depth semi‐structured interviews were conducted with young people with caring responsibilities and mothers with HIV, who were predominantly African migrants, as well as with service providers. Drawing on their perspectives, the paper discusses the ways that young people and mothers negotiate the boundaries of young people's care work within and beyond homespace, according to norms of age, gender, generational relations, and cultural constructions of childhood. Despite close attachments within the family, the emotional effects of living with a highly stigmatised life‐limiting illness, pressures associated with insecure immigration status, transnational migration, and low income undermined African mothers' and young people's sense of security and belonging to homespace. These factors also restricted their mobility and social participation in school/college and neighbourhood spaces. While young people and mothers valued supportive safe spaces within the community, the stigma surrounding HIV significantly affected their ability to seek support. The paper identifies security, privacy, independence, and social mobility as key dimensions of African young people's and mothers' imagined futures of ‘home’ and ‘family’. Copyright © 2009 John Wiley & Sons, Ltd.

No Recourse, No Support: State Policy and Practice towards South Asian Women Facing Domestic Violence in the UK

This paper examines the extent to which government policy and practice meet the needs of women with insecure immigration status who are experiencing domestic violence. The research on which this paper is based was conducted between January and June 2007 and included qualitative interviews with thirty South Asian women who were barred from receiving public funds (known as ‘no recourse to public funds’ (NRPF)) due to their status as recent marriage migrants, who were living in the North West and Yorkshire regions of England. This paper examines the complex legislation that governs the entitlement of women with NRPF who are facing domestic violence, women's experiences of social service practice, its impact on the safety and welfare of the women and their children, and suggests a way forward.

Seeking Sanctuary: Exploring the Changing Postcolonial and Racialised Politics of Belonging in East London

This paper explores the changing postcolonial and racialised politics of belonging in East London. In particular it draws on research with multi-sector professionals and 15 to 18 year old young separated migrants. Separated from parents, these teenagers include those who had applied for asylum and were living under social services care as ‘unaccompanied’ and those living with their extended family. It also includes separated migrants wanting sanctuary, but who had insecure immigration status because their asylum claim had failed, or because they had not yet applied for asylum and had no other visa status. The research focuses on healthcare issues and the broader life-situations of young separated migrants as a way to examine the changing politics of belonging in East London. Features of this politics include a rise in popularity of the Far Right, the impact of immigration and healthcare legislation and practice, and racial hostility. As well as looking at this, there is an exploration of resistance to this racialised political context by teenagers and certain professionals, and the struggle for a convivial multiculture that is a feature of their resistance. The argument here is that the changing racialised politics of belonging in East London: (1) show how underdevelopment, geo-political and postcolonial forces contribute to shaping local experiences of racism (2) sometimes involves, rather than aggressively targets, British citizens from NCWP (New Commonwealth and Pakistani) backgrounds and their descendants, as skin colour becomes less of an articulated symbol of ‘otherness’ than immigration status (3) therefore excludes ‘new migrants’ and especially those seeking sanctuary, such as the young people in this paper, from belonging (4) faces local resistance. However resistance to this politics might be better informed by a greater understanding of how postcolonialism shapes local racism and militates against a convivial multiculture, with sociology playing a role in accomplishing this