Despite an increased focus in maternity services on ethnic and racial inequalities resulting in poorer outcomes, the experience of migrant women is often hidden from these data, research and improvement programmes. To understand these inequalities and their impact further, Doctors of the World UK (DOTW UK) analysed data collected through provision of health support to 257 pregnant women accessing their service between 2017 and 2021
The key findings of the report included that:
- A very small proportion of women had been taking folic acid before conception compared to the national average.
- The vast majority women in the cohort (81%) had their first antenatal care appointment beyond the recommended 10 weeks of pregnancy. More than four in ten (45%) of the women did not have any antenatal care until after 16 weeks of pregnancy, compared to just one in ten women nationally.
- Within this group more than four in ten women with undocumented, uncertain, refugee or asylum seeker status (45%) and six in ten women from Sub-Saharan Africa (62%) accessed care after 16 weeks.
- Mental health issues occurred in over a third of women, potentially exacerbated by the fact that over a third also received a bill for their maternity care of up to £14,000.
- The COVID-19 pandemic had a clear impact on this cohort of women. When stratifying antenatal and postnatal outcomes by a timestamp denoting contact with DOTW UK before or during the pandemic, differences were noted in most variables.
- More women reported feeling stressed during most of their pregnancy, and the proportion of women who felt supported reduced since the pandemic.
- The proportion of babies born with a low birthweight in the pandemic period was 11% compared to 6.5% in England and Wales in 2020. Women were almost twice as likely to report mood disturbance after birth in the pandemic period compared to pre-pandemic.
This evidence highlights the need for urgent action to address the inequalities experienced by migrant pregnant women and their babies. There is a pressing need for immigration status to be considered as part of the ethnic and racial health inequalities agenda and for independent action to be taken to review the impact of NHS charging policy.