Suman Noori, a 26-year-old Afghan asylum seeker, gave birth to a girl at 30,000 feet during an evacuation flight from Kabul to Birmingham last month. There was no doctor on board, so the crew delivered the baby in a flight seat.
She was lucky, her care was free.
New research by Maternity Action has found that many pregnant asylum seekers and vulnerable migrant women are charged thousands of pounds for NHS maternity care, even though the law says they must be exempted.
Under rules first introduced in 2004 and revised in 2017, the NHS Trusts have a legal obligation to issue finance charges, including vital maternity care, to those “not ordinarily resident in the UK”.
There are several exceptions designed to protect the most vulnerable pregnant women and new mothers, including asylum seekers and the destitute.
But our new research report, Breach of Trust, finds that NHS Trusts routinely fail to adequately enforce these legal safeguards. As a result, vulnerable women are wrongly billed for thousands of pounds.
The impact of maternity fees on the health of mothers and their children is difficult to overstate. Our guidelines are full of scared women, afraid to go to prenatal appointments in case they are charged, even if they should be excused.
This makes it difficult for midwives to provide basic care, which is particularly concerning because this group is at higher risk for health complications.
These are women like Anne, who was unregistered at the time of her daughter’s birth, but now has permission to stay in the UK. She is currently contesting her charges on grounds of extreme poverty. She said:
“I did not attend any prenatal appointments because I did not know if I would have to pay.
When I was in the 28th week of pregnancy, I had severe pain and went to the hospital. My daughter was born but she only lived a few hours.
While the baby was blue in my hand, the lady from the outer office came over and said, “If you sleep in our bed, we’ll charge you.”
Our report presents case studies of errors in the assessment of immigration status that resulted in incorrect billing of women entitled to free NHS care; on accused women when they are covered by an exemption; And the NHS relies on aggressively seeking down payments from women who clearly need it and have no way to pay.
Guidelines from the Department of Health and Welfare support debt cancellation for women in need. However, our report reveals that some trusts take a very strict payment approach, including using debt collection agencies to keep track of unpaid fees.
Maternity Action urgently seeks changes in trust practices to reduce the negative impact of charging immigrant women’s access to maternity care.
We have worked with the Royal College of Midwives to develop guidelines to help NHS Trusts comply with the law and we are urging Members of Parliament to work with their local trusts to ensure that all NHS Trusts in England adopt this guide. .
We also call on the Trusts to immediately audit the files of the External Visitor Manager for Women in Charge of Maternity Care to determine compliance with regulations and directives, the Trust Policy and the Trust’s legal commitment to reduce health disparities; and take immediate corrective action when deficiencies are identified.
Finally, we invite the trust funds to issue public reports on the progress towards the implementation of the guide.
We must protect those who are exempt from NHS maternity fees; the lives of our mothers and our most vulnerable children depend on it.