MIDIRS Essence > September 2009 > Midwifery News

Asylum seekers and pregnancy

Originally posted on Sept 2009

Midwifery is an ever changing profession with constant challenges and rewards.

Women are diverse and pregnancy often comes alongside other pressures; midwives may be required to support and advise on social, and other, issues that affect a woman during her pregnancy and which may be one of her main priorities in her hierarchy of needs.

These needs may relate to financial poverty, housing, teenage pregnancy, substance misuse or domestic abuse and midwives adapt to individualise care and support the woman.

One social pressure which midwives are now more aware of is that of being an asylum seeker, perhaps a new concept, but an age-old issue. The media would have you believe that asylum seekers are here for benefits and housing and are taking over Britain, whereas the facts are that the UK is ranked 10th amongst the European nations for the number of asylum seekers and 78th in the world.

Background

An asylum seeker is defined as a person who has submitted an application for protection under the Geneva Convention and is waiting for the claim to be decided by the Home Office. The Geneva Convention (1951) states that the person:

‘owing to a well founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion, is outside the country of his nationality and is unable, or owing to such fear is unwilling to avail himself of the protection of that country.’

Asylum seekers are often from war-torn countries such as the Congo, Somalia, the Ivory Coast and Afghanistan, or from countries where there is political unrest, such as China or Zimbabwe. Their stories are often harrowing and involve rape, torture, being present during the murder of a husband or parent, imprisonment or the destruction of whole villages. Often family will have paid for someone to arrange false papers and get them out of the country to safety, but unfortunately once in the UK they are left by the traffickers without papers, unaware of where they are and without support and funds. This is usually the point that they are picked up by immigration in a port, airport or local police station.

Initial accommodation

Women are often alone, but in some cases may have other children with them, or rarely a husband. Initially women are interviewed by immigration and then, if they appear to have a claim, taken to a detention centre where they may stay for one to two nights. They are then moved to one of six initial accommodation areas across the UK. These centres provide all meals and accommodation, but no funds, in hostel style premises with other men, women and children in the same situation. The stay here is for approximately three weeks during which time the woman will meet her case owner from the Home Office who will be responsible for assessing the case through interviews and for making the final decision as to whether their case is approved. Often there are many appointments with the case owner and solicitors, ensuring that they have the right documentation and information.


Medical/pregnancy care

During this time in initial accommodation all asylum seekers will have a medical assessment with a local nominated practice with screening and vaccinations as required; this will be documented in a hand-held record which they will then carry themselves. It will be at this time that any pregnant women should be referred to the local maternity services. Often women may be late in pregnancy and will have had no previous antenatal care. The CEMACH reports have highlighted that these women are at increased risk, with the latest report Saving mothers’ lives (Lewis 2007) estimating that black African women, including newly arrived asylum seekers, have a mortality rate nearly six times higher than white women. They recommended that these women receive a full medical examination including a cardiovascular assessment at booking, due to the risks of poor underlying general health and undetected cardiac problems. Due to the circumstances that have brought about the need to seek asylum, there may be other issues such as mental health needs, risks such as HIV, hepatitis and factors such as female genital mutilation to consider.

In gaining a full clinical picture, it may be difficult to obtain a history as often there is a fear of authorities and of who they may tell; also, emotionally the woman may find it difficult to tell you about her partner and family. Often she may not know when her last period was and estimating gestation during the later stages of pregnancy may be difficult. Issues such as gestational diabetes, congenital abnormalities and hypertension may have been untreated until now and in an acute phase when detected. It is therefore imperative that these women are signposted to appropriate maternity care as quickly as possible on entry to the UK and that there is effective local communication between agencies.

Dispersal

Following the period in initial accommodation the woman could have her asylum claim refused and be removed to a detention centre awaiting appeal, but more usually she will be dispersed to accommodation in the same region of the UK. For instance in Cardiff that could be to Newport, Swansea, Wrexham, Bristol or Plymouth. Dispersal accommodation is usually a room or a flat within shared accommodation; the woman will then receive weekly funds of £35 and be required to sign at a local police station, or other centre, at regular points to ensure she is still resident. Following dispersal it is essential again that women have access to local maternity services and that there is a seamless transfer of care from initial accommodation to dispersal. If there are complications which require increased care in pregnancy, a request can often be made to the Home Office to keep the woman in the same area. Once dispersed, a woman will usually remain in that area until a final decision on her asylum claim or appeal has been made.

Asylum outcome

The outcomes of an asylum decision will be:

• Indefinite leave to remain (with the option to bring spouse and children from that marriage to UK)


• Temporary leave (to be reviewed after a period of time – up to 4 years)


• Refusal (with a right to one appeal)

If a woman is pregnant and refused asylum, she could still be deported in early pregnancy, but is often deemed unfit to travel or not able to be repatriated to her country of origin. In these circumstances there can be two different outcomes. If she is able to produce evidence that she is unfit to travel and agrees to sign that she will be voluntarily repatriated when deemed necessary, she is able to apply for section 4 support. This will enable her to be provided with basic accommodation and vouchers for food and toiletries. If she is not deemed able to have section 4 support, but is not ready to be deported yet, she will be removed from her accommodation and either taken to a detention centre or start ‘sofa surfing’. Sofa surfing is a term used where failed asylum seekers move from one friend to another to sleep on their sofas; they have no access to public funds and rely on food handouts etc.

Issues for maternity services

We know that women from this group are at risk during pregnancy, but with increased mobility and communication difficulties it can sometimes feel like a mountain too high to climb. The key is often as simple as a mobile phone contact number and pre-warning the women that they may move, but that you need to know. Access is a key element to ensure that local asylum support services know how to contact maternity services as well as having perhaps one link midwife who is aware of services.

Women often find it difficult to get to appointments, often due to conflicting arrangements or lack of funds. If appointments conflict it may be necessary to negotiate alternatives and link with other agencies. If a woman is in initial accommodation or has failed her asylum claim, she will have no access to funds for bus fares etc and again the midwife may need to advocate to agencies for support.

Funding may also be an issue for baby clothing and equipment as, although a maternity payment of £300 is available for this purpose, it can only be applied for at 36 weeks and may often arrive after the baby. If a woman is receiving vouchers she will not be able to buy these items and so may need help in finding charitable agencies to help, or a midwife who has an office full of charitable donations. Linking with the local NCT after their nearly new sales may be a joint solution.

Conclusion

Women seeking asylum are often frightened, confused and emotionally traumatised; together with pregnancy this can be a very rocky road. The midwife is able to provide support and a friendly face, but if we are also knowledgeable about our local agencies we can also remove some of the barriers. We need to build up our relationship with local agencies, charities and churches to be able to signpost services and act as advocates to help these women when they need it most. It may feel as though this is above our call of duty, but if we take away the hurdles we can enable easy access to our services and a final positive outcome for mum and baby.

References

• Lewis G ed (2007). Saving mother’s lives: reviewing maternal deaths to make motherhood safer – 2003-2005. The seventh report of the Confidential Enquiries into Maternal Deaths in the UK. London: CEMACH.

Useful websites

www.ukba.homeoffice.gov.uk/asylum
www.asylumstories.co.uk

Karen Jewell | Cardiff & Vale NHS Trust | Photo: © Rainette - Fotolia.com

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