Skip to content

University College London researchers find hostile environment policies disrupt the delivery of maternity care for refugees, asylum seekers and undocumented migrants

30 January 2023

An academic report from October that was published last week looks at the experiences of pregnant refugees, asylum seekers and undocumented migrants in the London borough of Camden accessing maternal health care in a hostile environment.

Report coverYou can read the 21-page report here. It was authored by academics and researchers at University College London (UCL), and was published by the Reach Alliance based at the University of Toronto.

The authors explained: “Our research focuses on how the hostile environment policies affect access to and quality of maternal healthcare for refugees, people seeking asylum, and undocumented migrants (RASU). In particular, we examine care provision in Camden, a diverse borough of over 275,000 people in London that has traditionally been a place to settle for these migrant groups. While some studies have explored the provision of care at health institutions in other London boroughs, or other cities in the UK, there is limited Camden-specific research. This research also contributes to the growing need for evidence that illuminates the challenges of the hostile environment policies and offers insights for improved policy decision making and healthcare service design.”

The report identifies three main hostile environment policies which negatively affect the access of maternal health care: the NHS charging regulations, the asylum dispersal policy, and information sharing between the NHS and the Home Office. In addition, many other hostile environment policies had an indirect effect on access and quality of maternal care.

In combination, the hostile environment policies were found to create a climate of uncertainty and distrust that permeates into the UK@s healthcare system. The policies also increased the complexity and uncertainty of an already complicated and fragmented healthcare system.

Community organisations interviewed for the report highlighted a lack of understanding among refugees, asylum seekers and undocumented migrants about their rights to health care, as well as a lack of resources or knowledge to advocate on their own behalf.

Healthcare professionals interviewed for the report highlighted a lack of understanding of hostile environment policies and related processes among their colleagues. They cited poor communication and limited and difficult-to-understand guidance from the Home Office and the NHS trusts.

The frequency of immigration policy changes also contributed to confusion in the provision of maternal health care.

The report notes: “For example, GPs — one of the most utilized referral pathways to maternity care — regularly encounter confusion about policy requirements. Several interviewees commented on the lack of clarity within the 150-page policy document that was handed to trusts on the NHS registration policy, which outlines how patients access primary care. Often GPs believed that proof of address was necessary to be registered, as did some individuals working at the surgeries’ front desks, despite this being unnecessary given that people can access primary care without proof of address. This demonstrates the lack of clarity regarding [healthcare professionals’] knowledge which acts as a major barrier for RASU individuals. Other barriers include the lack of resourcing available to help people understand and comprehend these new practices, and the lack of a standardized communication pathway for policy changes regarding updated practices.”

A number of community organisations interviewed for the report highlighted problems encountered when using NGOs outsourced by the Government to provide help on immigration-related issues. There were multiple cases where these services had provided individuals with incorrect or misleading information.

Both healthcare professionals and community organisations told UCL researchers that austerity measures — including outsourcing and widespread budget and staffing cuts — negatively affected health outcomes among pregnant refugees, asylum seekers and undocumented migrants.

The overall the consensus among healthcare professionals and community organisations was that “punitive and ethically fraught” hostile environment policies disrupt the delivery of humane maternity care.

The report makes a number of recommendations for improving access to quality maternal care, including a separation of access to health care from immigration policy.

In significant related news last week, the Home Office announced the ramping up of immigration enforcement activities and the establishment of the UK’s first cross-government ministerial taskforce on immigration enforcement. The taskforce aims to “ensure every available power across government is utilised to support law enforcement activity to identify and reduce illegal migrants in the UK, and ensure only those eligible can work, receive benefits or access public services.”

The Times headlined it as part of the Prime Minister’s plan to see a return of the hostile environment. It follows on from the Prime Minister’s December statement in which he said data sharing had been restarted to prevent migrants in the UK illegally from opening bank accounts.

Jacqueline McKenzie of Leigh Day Solicitors told the Guardian: “The hostile environment never really went away but, for outward appearances, the language was changed. But it is distressing nevertheless to hear of a formal resumption of the ideas.”