Pregnant migrants in the UK have up to 74% higher risk of emergency caesarean, 49% severe life-threatening complications needing intensive care or blood transfusion, and 53% babies born in poor health.
Pregnant migrants in the UK have up to 74% higher risk of emergency caesarean, 49% severe life-threatening complications needing intensive care or blood transfusion, and 53% babies born in poor health.
The King's College London research on over 44,000 pregnant women is the first to measure the effect of UK's immigration policies on the health outcomes of women and their babies.
The study found that pregnant women with access to free healthcare have 29% higher risk of emergency caesarean, 28% higher risk of life-threatening complications, and 23% more likely to have their babies born in poor health. The risks for women with no access to free healthcare are higher, at 74%, 49%, and 53% respectively.
Published in the journal Midwifery, the study found that visa policies are so difficult to navigate that women do not receive maternity care on time and are often asked about their immigration statuses before accessing care.
In the NHS, maternity care is treated as "immediately necessary", meaning all women cannot be refused care. However, many migrant women are asked about their immigration statuses before receiving care.
Women and healthcare professionals find the policies difficult to interpret, and a specialised team need to be brought in to confirm their eligibility to free care. This can cause delay in getting maternity care, increasing risk of complications and causing anxiety.
As researchers used anonymous data for this study, they consulted a lived experience group in the design of the study. Members of this group did not receive care through the NHS trusts involved in the study.
Sonia, a member of the group, shared, "When I was seven months pregnant and seriously anaemic, I was referred to the hospital by a GP. I didn't have ID and didn't know what asylum meant. Many aspects of the system were strange to me. When I arrived at the hospital, I was visibly pregnant and very sick, and I was asked for ID. They needed me to prove my immigration status and whether I was a resident. They said I might need to pay for a scan but didn't make any appointment. Only after applying for asylum and providing paperwork was I finally able to be scanned. I never had a midwife or a scan until I could prove my immigration status. "
This research is supported by National Institute for Health and Care Research (NIHR) Applied Research Collaboration South London (NIHR ARC South London) at King's College Hospital NHS Foundation Trust.
"We identified another alarming layer of structural barriers that prevent women from accessing timely maternity care, and we now have evidence showing how these barriers are linked to poorer outcomes for mothers and babies. Immigration policy and NHS charging rules are complex, and both migrant women and health and social care professionals can struggle to navigate them. When entitlements to care are unclear, vulnerable women may not be signposted to support or may delay seeking care, increasing the risk of adverse outcomes."
Dr Rayment-Jones, the lead author of the study and NIHR Advanced Research Fellow at King's College London
The researcher's earlier studies found that migrant women in the UK and other high-income countries face significant health inequities during pregnancy. Women with NRPF is 64% less likely to access early antenatal care and 11% less likely to attend maternity triage.
In this study, researchers measured the consequences of these delays in terms of mothers and babies' health. Migrant women, born outside the UK, were found to have poorer outcomes compared to UK-born women.
Additionally, this study identified that ethnicities, age, country of origin, and fluency in English are mitigating factors for migrant women's experience of maternal care.
Another member of the lived experience group, Queenie, share her experience about maternity charging, "I had my baby last year and never received any information about being charged for maternity care, I didn't know anything about it. A year later, after my baby got a British passport, the Home Office contacted me saying my immigration application was delayed because of unpaid NHS debt. I received a letter saying I owed £11,850. This was for a vaginal delivery, no c-section. I was so shocked. Only after contacting a charity and arranging legal support did I learn how to handle the debt and set up a repayment plan."
This study used anonymised healthcare record from 2018-2023 from the eLIXIR-BiSL cohort. Data came from women with single births receiving care through two NHS Trusts (Guy's and St Thomas' NHS Foundation Trust and King's College Hospital NHS Foundation Trust) and one mental health Trust (South London and Maudsley NHS Foundation Trust).
Recommendations from the research include clearer, more accessible guidance so migrant women understand their rights to maternity care, expanded interpreting services, and improved training for health and social care professionals on charging regulations and entitlements. The findings also urge policymakers to consider how immigration and charging policies may affect timely access to maternity care and maternal and infant health.
Dr Rayment-Jones added, "The recent interim Baroness Amos report highlighted systemic problems that disproportionately affect ethnic minority and socially disadvantaged women. Our study aligns with these findings and shows that immigration status can create additional barriers to accessing care, which may further worsen outcomes for some migrant women and their babies."
