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Guest post: ‘Women and Children First?’ The reality of maternity care for Scotland’s refused asylum seekers

By Vicky Glen

For mothers in Scotland (and the world over), experiences of maternity care are key in influencing the overall experience of motherhood. Health policy has been a devolved matter since the creation of the NHS. As such, asylum seekers (including refused asylum seekers) are entitled to free primary and secondary health care in Scotland (in contrast with England and Northern Ireland, where refused asylum seekers may be required to pay for secondary health care, which can include maternity care). But do asylum seeking women experience a level of maternity care equal to that of other women living in Scotland?

It was this question that Sylvie Da Lomba of University of Strathclyde Law School and Nina Murray, Women’s Policy Development Officer at Scottish Refugee Council, sought to answer. While work had previously been conducted into the quality of maternity care for asylum seeking women in England and Wales, there was no primary focus upon the experiences of refused asylum seeking women. Previous work had already identified the severity of the health needs of asylum seeking women, with these needs exacerbated during pregnancy.

In light of the then proposed changes to access to healthcare under the Immigration Act 2014 (now a sad reality), and the challenging of asylum support levels by various third sector organisations (now perfectly exemplified in the case of Refugee Action v Secretary of State for the Home Department), the project aimed to assess: whether female asylum seekers were accessing free maternity care in Glasgow as ordinarily resident UK citizens (in line with Scottish government guidance); the extent and nature of any barriers to this access; and whether the access and quality of this care was in line with statutory, governmental and international human rights obligations.

Their research ‘Women and Children First? Refused asylum seekers’ access to and experiences of maternity care in Glasgow’illustrates, that, overwhelmingly, women asylum seekers (including women whose claims for asylum have been refused), are indeed accessing maternity care in Glasgow as ordinarily resident UK citizens. They are considered as ‘women and children first’ by NHS health professionals, a testament to the universality of free primary and secondary health care enshrined in Scottish Government regulations. The study also shows that specialist maternity services are provided to asylum seeking women (in the form of a link midwife) in an attempt to respond to the specific needs of asylum seeking women.

It follows, however, that not all findings are quite so positive. The study identified a range of issues which have impacted negatively on the experiences of asylum seeking women’s maternity care, including: the quality, provision and professionalism of interpreters, the complexity and stress of the asylum process (particularly the dangers of destitution and living on cashless support), the relevance and quality of maternity information provided to asylum seeking women, barriers to accessing antenatal classes (including a lack of information, awareness and language barriers) and a lack of accessible English classes for pregnant women.

On Friday 27^th June, the authors, along with the Centre for Migration and Health Policy at Strathclyde University, held a dissemination seminar for ‘Women and Children First?’. This event was attended by around 30 stakeholders, including health professionals, health policy officials, representatives of the Home Office and third sector workers from the Greater Glasgow area. Presentations on the findings of this work were made by both Sylvie Da Lomba and Nina Murray, Jayne Sellers, the Asylum Bridging Team leader for NHS Greater Glasgow and Clyde and Ayanda Dube, a representative of the Refugee Women’s Strategy Group who had also participated in this research. All four speakers agreed that cost-free access to maternity care was vital to satisfy the most basic of healthcare needs for asylum seeking women and their children (with Sylvie Da Lomba highlighting the human rights based approach to healthcare as a positive of devolved health policy) but acknowledged the gaps in equality of access (Ms Dube particularly, having experienced maternity care in Scotland as an asylum seeker).

A question and answer session with the panel prompted a valuable and interesting discussion, with various suggestions made to improve access to maternity care for asylum seekers. These included increased engagement with asylum seeking communities to ensure that maternity packs include a leaflet specifically for asylum seeking women and also the need to minimise confusion and stress for asylum seeking women throughout the maternity process, perhaps by way of an individual named midwife to work with each woman throughout the process. It is important to note that changes to the provision of asylum advice services were of particular concern, with stakeholders stressing the need for independent advocacy for pregnant asylum seeking women throughout the maternity process.

Certainly, the universality of healthcare provision is something to be celebrated, especially so within the context of the Immigration Act (described by one opponent as ‘the most racist piece of legislation we’ve seen in 40 years’) and an increasing right wing presence within the UK media. But barriers still remain, particularly in relation to access to services, awareness of female asylum seeker-specific needs, information provision and the impact of the day-to-day reality of asylum support.

These barriers cannot be broken down overnight; a committed, equality-centric and informed approach is required. Above all else, women and children must be considered purely as these, across not only Scottish government health policy but Home Office asylum support policy and indeed the asylum process. Only then will women and children truly be first.

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Vicky Glen is the Policy and Communications Assistant at Scottish Refugee Council.

Scottish Refugee Council is an independent human rights organisation and Scotland’s leading refugee charity. They advocate for fair, humane, and effective legislation, policy, and practice affecting refugees and those in the asylum system.

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