Charging for NHS care and its impact on maternal health

NHS care remains chargeable for people with undocumented immigration status, despite repeated calls by health professionals for social justice and health inequalities now highlighted by unequal COVID-19 outcomes.1,2 We describe the devastating consequences of charging for undocumented pregnant women, compounded by misinformation, xenophobia, and institutional racism. These are well-documented,3 but lack recognition in everyday practice.Feldman4 reports that government policy, purposefully creating a ‘hostile environment’ for immigration, means maternity care is often de facto unavailable for undocumented women. The policy5 claims to ‘reduce inequalities relating to the health service’ and ‘ensure the needs and interests of vulnerable or disadvantaged patients are protected’. We contend that it does the opposite: widening existing inequalities in maternal health and contributing to maternal deaths. While government legitimises this policy as necessary for a sustainable NHS, the evidence contradicts any fiscal gain as costs are not wholly recoverable and care becomes delayed.6MBBRACE-UK report that women born outside the UK represent nearly a quarter of maternal deaths.7 Refugee and asylum-seeking women, despite contributing 0.29% of the population,8 make up 6% of this …