UK’s hostile immigration policies harm maternal health

23 January 2023

A Reach-UCL case study in the London Borough of Camden shows poorer maternal health outcomes for recent refugees, asylum seekers and undocumented migrants (RASU).

A new report from the Reach Alliance, co-mentored by Dr Kate Roll from UCL Institute of Innovation and Public Purpose (IIPP), shows that the UK’s “punitive and ethically fraught” immigration policies disrupt the delivery of humane maternity care to recent refugees, asylum seekers and undocumented migrants (RASU).

The report, Accessing Maternal Healthcare in a Hostile Environment, states that in order to better support migrant groups, UK immigration policies must be repealed, with greater attention paid to migrant-focussed maternal care.

The UK introduced two new Immigration Acts in 2014 and 2016, designed to create a hostile environment for migrants and discourage so-called “illegal” migrants. Other organisations, such as Maternity Action and Doctors of the World, have highlighted the barriers such policies create for accessing maternity care and the negative effects on maternal health. A growing number of organisations, such as the Royal College of Obstetricians and Gynaecologists, and the British Medical Association, have released statements condemning the hostile environment policies and have called for their abolition.

Together with Dr Sara Hillman from UCL Population Health Sciences, and UCL students Tiffany Kwok, Deveney Bazinet, Poppy Pierce, Catherine Cooke and Haleema Adil, Dr Roll led a case study in the London Borough of Camden, which has historically been home to many RASU individuals, and has recently seen a rise in such migrant groups. The research was designed to bolster the growing body of evidence on the negative impact of hostile policies on migrants. The report is UCL’s first with the Reach Alliance, a student-driven, faculty-mentored research and leadership initiative aimed at addressing the UN Sustainable Development Goals (SDGs), which it joined in 2021.

Following a literature review, the researchers developed their specific research question – ‘How does the relationship between immigration status and related policies affect the access to, provision, and delivery of maternal health services for refugees, people seeking asylum, and undocumented migrants?’ The team divided efforts between healthcare professionals, such as midwives and doctors, and community organisations, including local councils and existing support networks for the RASU population. More than 30 interviews were carried out in total.

The most commonly identified challenges for RASU individuals in accessing and engaging with maternity services include greater difficulty in navigating the healthcare system, distrust, and fears of being charged or sanctioned by the Home Office. To tackle the problem, it is vital to ensure better collaboration between the stakeholders, including coordinating action and information sharing. Community organisations and healthcare professionals are currently overburdened and could be supported through coalition building and resource sharing.

“Looking at the stakeholders we were able to reach and connect with, and the complexity of the circumstances we were able to understand, we recognise that we have established just the foundation for more work to be done in shaping the systems to assist the RASU population access quality maternal healthcare at UCLH, in Camden, and more broadly in the UK. The context that these migrant groups exist in is changing all the time and rarely for the better, so the research does the essential work of shining a light on the challenges they face and provides recommendations for how to improve access to quality maternal care going forward,” says Tiffany Kwok, MPA Digital Technologies and Policy at UCL.

“I joined Reach for the opportunity to bolster my capabilities in academic research and to be part of a project that would generate meaningful and actionable insights to improve maternal health outcomes for the most vulnerable in the London Borough of Camden - to contribute to essential work in the place I was calling home for a year,” says IIPP’s Deveney Bazinet, MPA Innovation, Public Policy and Public Value.

New projects and more mentors

The next UCL-Reach Alliance projects have already begun, including researchers from IIPP. More UCL mentors have joined the initiative, resulting in additional case study research projects to be studied with the support and expert guidance of researchers from a wider range of disciplines. The new mentors are Professor Monica Lakhanpaul, Professor of Integrated Community Child Health at Great Ormond Street (GOS) Institute of Child Health, Professor Priti Parikh, Professor of Infrastructure Engineering and International Development The Bartlett School of Sustainable Construction, Dr Celine Lewis, an NIHR Advanced Fellow at GOS Institute of Child Health, and Dr Nadia Svirydzenka, Associate Professor in Culture, Identity, and Mental Health at the Faculty of Health and Life Sciences, De Montfort University.

Dr Hillman and Dr Roll are mentoring UCL students Laura Piana Lemos, Laura Herren, Francesca Lanzarotti and Savo Noori on a project in Nepal entitled ‘Women’s access to healthcare in Nepal’, focused on SDGs 3 (good health and wellbeing), 5 (gender equality) and 10 (reduced inequalities). The right of women with disabilities to make autonomous choices during pregnancy is the same as that of women without disabilities. However, in low-income countries such as Nepal, their access to healthcare and choices during their pregnancy journey are often limited, which increases their risk of neglect, non-consensual care, and obstetric violence. This research project aims to identify institutional and social barriers that affect these women’s access to care in Nepal.

IIPP MPA students James Grant, Lorenzo Dall’Omo, and Anna Pearl Johnson, with UCL student Safaa Yaseen, are working on a UK project entitled ‘The importance of play for children living in temporary accommodation with limited resources’, focused on SDGs 10 (reduced inequalities), 11 (sustainable cities and communities) and 17 (partnerships for the Goals). It will be mentored by Professor Lakhanpaul, Dr Lewis, Professor Parikh, and Dr Svirydzenka. The UK’s long-running housing crisis has recently accelerated into a new and damaging phase, compounded by rising costs of living. Social safety nets are straining to match the growing need for affordable, decent accommodation. Within England, there are now 120,000 homeless children living in temporary housing and the consequences of crisis risk hampering their development. This research will take an interdisciplinary approach to exploring the challenges that families living in temporary accommodation face.

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The Reach Alliance was founded in 2015 at the University of Toronto’s Munk School of Global Affairs & Public Policy, in partnership with the Mastercard Center for Inclusive Growth. It also includes the University of Cape Town in South Africa, Singapore Management University, the University of Melbourne in Australia, Ashesi University in Ghana, Tecnológico de Monterrey in Mexico and the University of Oxford in the UK.