Bouncing a chattering toddler on her knee, a patterned headscarf framing her broad smile, Safa shows few signs of how difficult her life has been. But as she describes the past five years, her hand moves instinctively to her pregnant stomach.
In 2012, Safa and her husband, both in their late 20s, were living in Aleppo when a blast destroyed their home, injuring him and leaving them with nothing. The young couple travelled by bus to Lebanon where, for six months, they shared a room and one toilet with 10 other people. Surviving on a tiny stipend from the UN, they were eventually given their own room – “about the size of this”, she says, gesturing to a small table – in return for collecting all the rubbish in the block. It was there that she gave birth to her first child, a daughter, now 18 months old. “We were treated like animals,” she says.
It was in Lebanon that the new family learned they would become three of the 20,000 Syrian refugees the British government has agreed to take through the vulnerable persons relocation scheme. Of the news that they would be flown to Leeds, Safa recalls simply, “It was wonderful, like a dream.”
She became pregnant again soon after arriving in the UK, something that meant her life might still be at risk. Asylum-seeking and refugee women currently account for 14% of all maternal deaths in the UK (despite comprising only 0.5% of the population) according to the Centre for Maternal and Child Enquiries. Navigating the British health service without the language or confidence to ask the right questions, their interaction with maternity services can be too little or come too late, with complications going undetected. Asylum-seeking and refugee women are statistically more likely to experience late miscarriage, stillbirth or neonatal death.
In the UK, Safa faced the prospect of giving birth without anyone she knew in the room. “My husband will be looking after her,” she explains, whispering Arabic into her daughter’s ear. “And we are alone here – we had to leave all our friends and family in Aleppo.”
Thanks to a newly revived befriender scheme run by the Refugee Council, Safa will not be alone. Last week, she was introduced to Fatoma, a bustling, maternal woman in a denim maxi dress and peach headscarf who scoops Safa’s daughter up and tickles her. Fatoma fled the civil war in Sudan 10 years ago, arriving in Leeds; she has volunteered to support Safa through her pregnancy and the early stages of motherhood. She grins at her new friend: “I met her for the first time on Tuesday, and she has already asked me to be at the hospital during her labour.” Fatoma understands what it is like to be alone in a country you do not understand, and which often does not understand you. When she gave birth to her daughter six years ago, it was “terrifying, confusing and lonely”, she says, wiping away a tear.
I meet Safa and Fatoma in a municipal office space in Leeds. They are among a small group of mothers (Sudanese, Syrian, Russian, Bolivian) who sit and trade stories, passing their babies between them. Each experienced a terrifying flight from her home country. Now, through the Refugee Council, each of them has volunteered to support another pregnant woman. “These are some of the most marginalised women in our country,” says Rose McCarthy, volunteer coordinator for the scheme, which started in 2011 and is currently relaunching with a focus on Syrian women. “But they believe no one should have to give birth in this country afraid and alone.”
With Fatoma translating her Arabic, Safa explains: “I don’t yet speak English, so when I have the baby I want someone with me I can trust and speak to in my own language.” She looks shyly at Fatoma. “I feel so much better already, knowing that she will be there.”
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When Luisa arrived in this country from Bolivia in 2009, she spoke barely a word of English. Knowing no one, she spent two years determinedly learning the language by watching TV. When she became pregnant a few months later, it was a shock. “She was my first baby, so I didn’t know very much about being pregnant, or about labour,” she says. “I didn’t even have a GP. And I didn’t know about midwives – they don’t exist where I come from.” When she gave birth, “It was horrible – I felt like I was being torn apart.”
At home in Chuquisaca, she was a law student. She was organising demonstrations against the government when, in 2008, there were violent clashes between supporters and opponents of President Evo Morales. Her friends began to disappear and her mother, fearing her daughter would be next, sent her to the UK. After her baby, also called Luisa, was born, the two were briefly sent to a detention centre, before being moved from London to Leeds.
“I became paranoid,” Luisa says. “I had an appointment at the Home Office, but no money to get there. I went to the Refugee Council offices to ask for emergency funds, but I’d already received some and they said no. I was desperate. I had no money to feed my daughter, so I left her there in the offices, making sure she was safe. Then I walked out and tried to kill myself.”
She took an overdose of sleeping pills. Meanwhile, staff at the Refugee Council had found her telephone number, called her and kept her talking until an ambulance arrived. When she was discharged from hospital, Luisa was referred to the befriender scheme as a new mother in need. At the charity’s offices, Luisa had her first meeting with her volunteer befriender, Dasha.
“I didn’t want to know at first,” Luisa admits. “For a long time, I’d only really interacted with people who sat behind desks, asking lots of questions I didn’t feel comfortable answering. I felt everyone was pitying me, and I can’t stand pity. But Dasha was really funny, and really persistent. If I cancelled a plan to meet up, she might turn up on my doorstep. She worked in a cafe and would bring cake. For the first time since I arrived in this country, she talked to me as an equal, not an inferior.”
Dasha, whose family claimed asylum in the UK from Russia 15 years ago, took Luisa to playgroups. Together, the women joined self-esteem classes provided by students from Leeds University in collaboration with the Refugee Council. “She even bought me a Christmas present,” Luisa says with a smile.
One day, Dasha dropped by Luisa’s flat and found her young daughter falling in and out of consciousness. “Luisa didn’t know what to do,” Dasha remembers. “There was deep snow outside but I told her we had to get to the hospital.” She bundled the three of them into a taxi and they rushed to A&E.
“The doctors were talking about terrifying possibilities, and making Luisa sign all sorts of forms,” Dasha tells me. “Everything turned out fine, but sometimes you just need a friend, someone who knows how the system works, someone who can explain and hold your hand, who can pack an overnight bag and bring snacks for you.”
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There are many reasons why migrant women might fail to engage with health services. Like Luisa, their isolation might mean they simply do not know about them. Others fear being charged for services they cannot afford: undocumented women can be charged up to £9,000 for giving birth in this country; last month’s government proposal that patients could be required to bring two forms of identification to hospital to alleviate so-called “health tourism”, has fuelled further fears.
Pregnant refugees often need urgent care. They are likely to have arrived in this country malnourished, with conditions ranging from tuberculosis and malaria to HIV. Plus, as Dasha says, “They come here to escape from danger – how could they not be psychologically damaged, too?” Yet those who do access help often report poor experiences: no interpreters, or midwives and other maternity workers who do not understand their cultural and health needs.
In Leeds, any English-speaking, asylum-seeking and refugee mothers can apply to be befrienders. Successful applicants undergo four training sessions, which cover listening and empowerment skills, as well as understanding how health and maternity care differs across cultures. In 2011, 74 women speaking 30 different languages were recruited as volunteers and matched with 180 women in Leeds, referred by midwives, children’s centres and community refugee organisations. Research carried out after the first year showed that every woman involved reported a higher sense of wellbeing.
Funding for the scheme ended in 2014 – but three months ago, McCarthy managed to revive the programme, specifically to support the 419 Syrians who have been resettled in the Yorkshire and Humberside region since October 2015. Her old volunteers have flooded back, along with new ones. Since September, McCarthy has recruited and trained 40 volunteers. The first three befriending pairs have already been matched. With 1,340 Syrians expected to settle in the region over the next two to three years, “there is a big appetite for it”, she says.
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When Alia arrived in the UK this year, she had to hide the fact that she was more than eight months pregnant: she feared being banned from the flight. She was fleeing the genocide in Darfur, Sudan (where an estimated 480,000 people have now been killed), to meet her husband, who had already made the arduous journey and settled in Leeds.
“I took her to the local children’s centres, and to antenatal classes,” says Muna, a volunteer befriender, and another Darfur refugee, who met Alia within days of her arrival. Then one evening her phone rang. “Her husband was crying,” Muna remembers. “He said: ‘We’re at the hospital and they say there is an infection. The baby is in danger. We need an emergency caesarean but Alia won’t consent.’”
While Muna tells their story, Alia quietly nurses her five-month-old son, Sammy. “I was scared,” she says softly, with Muna as her translator. “Where we come from, when you do this sort of operation, either the baby or the mother dies.”
“So I ran,” says Muna. “I dropped everything and ran all the way to the hospital. I didn’t see the cars. Everything was a blur.”
This wasn’t just any running: Muna had competed in the 800m for Sudan in the 2008 Olympic Games. Minutes later, she was at Alia’s bedside. “I knew nothing about caesareans. I was terrified,” she says. “But I held her hand and I said: ‘You must do this and I will go in with you. I will talk to you while they do it, and you can talk to me, and the baby will be fine.’”
The two women went into theatre together. Moments later, Sammy was born, a greenish blue, but alive. “When it was over, I cried,” says Muna, “I could stop being brave for her. Afterwards, I was with her every day, I helped her with breastfeeding, how to bathe the baby – I am like her second mum.”
Officially, volunteer befrienders are only expected to give up three hours of their time a week, and are under no obligation to attend the birth itself. Often, however, three hours turn into much more, and partnerships turn into lifelong friendships. Many befriended women end up as volunteers themselves. Luisa, for example, has become a vocal campaigner for the scheme. “Last week I chaired a debate,” she says, smiling. “I’ve spoken in parliament, in conferences and schools. I even went to Glastonbury festival to talk.”
Other women have gone on to find paid jobs after volunteering. “There’s nothing like this work,” Dasha says. “It gives you such self-confidence, a feeling of doing good.” She now works for the council, providing information about housing support.
As midwives become increasingly overstretched, McCarthy hopes that similar schemes could be introduced across the UK. “Befrienders make the most enormous difference,” she says. “They are figures of trust for women who may be scared to trust others.”
I leave the group of women chatting and giggling, and cooing over Sammy, who is now sleeping soundly. One more healthy baby, and a life saved by a group of ordinary, extraordinary women.
