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Migrant women are charged up to £14 000 for maternity care in England, report finds

BMJ 2022; 377 doi: (Published 20 June 2022) Cite this as: BMJ 2022;377:o1517
  1. Marina Politis
  1. The BMJ

Women including refugees, asylum seekers, and undocumented migrants are being charged as much as £14 000 (€16 270; $17 140) to give birth on the NHS in England, a report by Doctors of the World (DOTW) has found.

The report,1 which examined inequalities in maternity care among migrant pregnant women and babies, gathered the experiences of 257 pregnant women accessing DOTW’s services from 2017 to 2021. It found that over a third (38%; 88/233) who accessed its services had been charged for healthcare, often inappropriately. The women were charged £296 to £14 000, and half of them were billed over £7000.1

The report said that inequalities in access to antenatal care experienced by migrant women were likely to lead to poorer outcomes for their pregnancy and the health of their children.

Anna Miller, head of policy and advocacy at DOTW UK, told The BMJ, “Every pregnant woman should feel able to receive care from a midwife, and every child deserves the best start in life, yet this report shows that refugee and migrant women have very poor access to maternity services. From the Doctors of the World clinic we know that the NHS charging policy plays a big role in this: we see women who are simply too afraid to go to antenatal appointments because they fear debts they will never be able to repay.

“To address this, we urgently need to end the NHS charging policy. It’s a policy that puts women who are living in this country—and their babies—at risk and places unnecessary pressure on NHS maternity services, as they are left dealing with unplanned and complicated births.“

Although maternity care should not be withheld because of a lack of ability to pay, migrant women in England face barriers in accessing antenatal care. The charging regulations for those unable to prove eligibility for free NHS care in England, such as undocumented migrants including refused asylum seekers, mean that antenatal care is billed, with a warning that failure to pay could affect future visa applications and that a debt of £500 unpaid at three months may be reported to the Home Office.1

The report notes that this policy has consequences for the care that migrant women receive. In England, while 68% of women have their first antenatal appointment at or by 10 weeks’ gestation, the majority of women interviewed for the report (81%) had their first antenatal care appointment beyond the recommended 10 weeks, and a further 45% did not receive antenatal care until after 16 weeks of pregnancy, compared with 10% of women nationally.


A recent report from Maternity Action,2 the UK’s maternity rights charity, said that NHS trusts’ failures regarding the charging policy were personally and financially detrimental to the women affected and deterred them from accessing subsequent care. DOTW UK data from 2018 show that 19% of attempts to register patients with a GP in England were wrongly refused.1

Earlier this year a review by the NHS Race and Health Observatory of ethnic inequalities in maternal healthcare highlighted a lack of adequate interpreting services and resultant communication barriers, as well as disrespect, stereotyping, and discrimination within maternity services.3

Habib Naqvi, director of the NHS Race and Health Observatory, told The BMJ, “The observatory is aware of the role immigration status can play in exacerbating existing health inequalities among our diverse communities. This report adds to the limited available insight on inequalities in access to maternal care experienced by migrant women.”

James Skinner, former nurse and now interim codirector at Medact, told The BMJ, “As we have seen time and again, the presence of NHS charging and the threat of data sharing with the Home Office serve to deter people from accessing care that they need, forcing them to choose between their health or possible destitution and deportation.

“The government must end these cruel policies and instead focus on addressing the disparities in health outcomes that are rooted in discriminatory policies like NHS charging.”


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