Rarely have I felt more ashamed of Britain than when having to provide passport details before my first ever midwife appointment.
There, alongside my name and address, close to the section about smoking and family history, I was asked to prove – what, exactly? That I was British enough to deserve a healthy pregnancy?
That this baby had been sweated into existence on British soil? That the sperm and egg within my body had been sufficiently British to deserve care? The notion that my passport number could dictate my access to free midwife appointments, scans, folic acid and vitamin D implied two things: that not all foetuses are created equal and that nationalism can seep into corners even a speculum can’t reach.
At the time, I felt sick, scared, tired. I mean, of course I did; I was pregnant. But those feelings were as nothing compared to the experiences of the refugees and migrants who are, according to a recent survey by Maternity Action and backed by the Royal College of Midwives (RCM), being charged sometimes tens of thousands of pounds for the sort of antenatal care that can, quite literally, mean the difference between life and death.
In phone conversations with a small group of midwives, including birth centre, community and specialist midwives, the study found that charging patients – particularly marginalised, vulnerable and undocumented migrant women – is not just damaging to the midwife-patient relationship, but will also make those women less likely to assess maternity care. Well, of course it will.
Migrant women already have a higher risk of maternal death and adverse pregnancy outcomes than native-born women. Not to mention the health of a child that had, quite literally, no say in where it would eventually be born. If I had fled war, famine, bombs or disease, possibly been raped during a journey that left me exhausted and impoverished; if I had been trafficked into Britain against my will; if I were still suffering the trauma and anxiety of an undocumented existence in which I couldn’t seek housing or employment; and then found out that I might be charged £7,000 I didn’t have, just to discover if this unseen, unheard life within my body was still growing, what choice would I have?
As the report explains, even those women who may be eligible for free treatment are too scared, too disenfranchised, or have an insufficient command of English to ask for it, for fear of being charged. Which prompts the question: what precisely are these charges seeking to achieve, other than adding another string to the whip we call “the hostile environment”? As the report puts it: “There is scant evidence that cost recovery actually helps the NHS. We need to recognise that vulnerable migrant women are not responsible for pressures in maternity services or the NHS generally; the government has a duty to give the NHS the resources it needs and should not be using NHS clinicians, including midwives, to patrol our borders and demonise some service users.”
Of course, it is not just the pregnant patients who suffer as a result of charging. According to the report: “Midwives resent being made part of cost recovery architecture, finding it an anathema to the professional ethics of midwifery.” When, as a government, you are asking the very people who pull our future nation from people’s bodies to do something they feel untrained for, unwilling to take part in and professionally opposed to, it is probably fair to say you have gone terribly, horribly wrong. The big question is if our politicians will ever have the nerve, the strength or the humanity to repair their mistakes.
