0902 GMT October 15, 2019
Rules specify overseas women who are expecting a baby must be charged for National Health Service (NHS) care – with charges starting at around £7,000 but potentially doubling if there are complications with the pregnancy, The Independent reported.
Frontline service providers say pregnant migrant women are being subjected to a range of “troubling problems” linked to the NHS charging system – with women also being incorrectly billed twice for one pregnancy when they change hospitals.
They warned women are scared to access antenatal care for fear of being detained or deported and some women are giving birth at home unattended – arguing the policy of charging for NHS care is ultimately placing women and their babies’ lives at risk.
Women who are chargeable for their maternity care include destitute women in the asylum system and women who have fled domestic abuse and sexual exploitation.
Rosalind Bragg, director of Maternity Action, said, “The NHS still sometimes charges for miscarriages and stillbirths. It is an appalling practice. We are very concerned about women receiving bills for miscarriages shortly afterwards. This affects their engagement with bereavement services.
“It is also not uncommon for women to be fined twice due to changing hospitals. Many of the women who are charged are very vulnerable and don’t have secure housing – as a result, they receive care from more than one hospital and receive more than one bill. The problematic practice of charging means women receive bills months and years after they have given birth. We regularly find women getting bills several years after they received the care.”
Maternity Action, which provides legal support to women, says women who encounter these issues can contact hospital staff to explain they have been wrongly charged but are often too vulnerable to navigate a complex bureaucratic system. The organization notes women often receive bills which are unclear and do not specify the treatment for which they have been charged.
Bragg said they routinely come across women who have been wrongly charged when they are in fact entitled to free antenatal care — adding these women are often family members of EU nationals.
“You have hospital staff whose experience is in low-level admin roles being expected to do immigration law,” the campaigner said.
She said the charity has come across women with high-risk pregnancies who were scheduled for caesareans who went on to birth at home unattended due to concerns about charging.
Bragg added, “Women are avoiding antenatal care and postnatal care which is putting their lives at risk and babies at risk. Women are isolating themselves from services. It is not uncommon for women to arrive at hospitals after they have attempted to give birth at home and had problems. It is very dangerous. We don’t have the numbers of women who are pregnant and destitute however there are significant numbers of women in this situation.”
The campaigner said she suspected there may be people working as informal midwives helping pregnant migrants but noted it was difficult to track them down due to it being a criminal offence to provide clandestine unofficial birth care.
Maternity Action is calling for the immediate suspension of the NHS charging policy pending a full and independent review of its impact — as well as arguing debt from maternity care should not affect future immigration applications.
Claire van Nispen tot Pannerden, women’s and children’s health lead at Doctors of the World UK, said it was “very unfair” and “traumatizing” for women who have endured miscarriages to be incorrectly charged for giving birth.
“The system doesn’t always check the quality of pregnancy, it just sends out bills,” she said. “If you have had a miscarriage, it is very distressing to receive a bill.”
The doctor, who works at a weekly clinic for migrant women in east London, added, “Some of the women know about the hostile environment and are afraid of accessing healthcare services out of fear of being reported to the Home Office or deported. A lot of these women have no support from others. Many women are sent a bill during their pregnancy. It tends to be more than £7,000 and it tends to be a big shock. They feel afraid and they worry. They have a huge dilemma. They often have no income at all.”
She said she advises women to focus on their pregnancy and not think about the bill until after they have given birth but many struggled to take this advice and anxiety about payment hung over their pregnancy.
“The charging makes the experience of pregnancy more stressful,” the doctor said. “A significant number of the pregnant women we see disappear and go uncontactable. We also come across women who have had bad experiences in frontline antenatal care. Everyone is entitled to have an interpreter and sometimes it is not organized.”
Jennie Corbett, UK policy & advocacy officer for Doctors of the World UK, noted many women who are affected by the charging system do not have a legal right to work in the UK.
She said: “A lot of our patients are fearful of their rights of approaching the NHS as an arm of the state. After having an appointment they will have a letter about charges they can’t pay. If you do not pay these debts within two months, this will be passed on to Home Office and it will affect your immigration status.
“The rule is if a patient is in debt of over £500 after two months to the NHS they are reported to the Home Office as this debt could influence immigration application – and in the reporting of that debt there is also an exchange of the patients’ information which identifies name and address — which can be used for immigration enforcement.”
A Department of Health and Social Care spokesperson said, “The NHS will never refuse maternity care, regardless of whether someone can pay.
“We recently invested £1m to expand a team of NHS experts to help hospitals understand cost-recovery rules and exemptions consistently, making clear that urgent treatment – including all maternity services — should never be withheld.
“Every taxpayer supports the health service and so it is only right that overseas visitors contribute towards their treatment costs but exemptions are in place to protect vulnerable people who receive care free of charge.”