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What’s the problem?

One in three births in England and Wales is to a migrant woman, i.e. a woman who was born outside the UK. In the UK, ‘underserved’ migrant women are more likely to die in pregnancy, and they are less likely to get good pregnancy care. In this project, underserved migrant women are refugees, asylum-seekers, migrant women with little money, and migrant women without an official visa. There are many reasons for poor pregnancy health amongst underserved migrant women, including not having support to access the NHS, not having family nearby, not speaking English well, and experiencing discrimination.

In the UK, refugees and asylum-seekers get free NHS care. A refugee or asylum seeker is someone who the government agrees has come to the UK because it is not safe to go back to their country. However, migrant women without an official visa (e.g., those who are refused the ‘asylum-seeker’ visa) can be charged 150% of NHS pregnancy costs. A normal birth costs around £8,000 and a complicated birth with a long hospital stay could cost £200,000. These women sometimes delay coming to the hospital to get pregnancy check-ups as they are scared the costs may be too high. This puts them and their baby at risk.

What research is needed?

In the UK, we do not fully understand how to help underserved pregnant migrant women because we have not listened to them and theirs needs, and we do not have good evidence for what works. We need new research to improve our understanding.

What will this project do?

This project will bring together underserved migrant women, midwives, doctors, researchers, charities, and the government to create a plan for action to improve underserved migrant pregnancy care in the UK.

The project will have four parts:

1. Evidence search: to see what has worked to improve pregnancy care for underserved migrants in the UK and in similar countries.

2. NHS patient data: analyse the records of 40,000 migrant women who have given birth in the UK over the past fifteen years, and look in detail at NHS notes from 60 pregnant migrant women who have died during this time. We will try to understand what makes underserved migrant women at higher risk of death or illness in pregnancy by comparing them with UK-born women giving birth at the same time.

3. Listen: to understand what underserved migrant women, midwives, doctors, researchers, government, and charities think can improve care.

4. Plan and resources: create a plan and tools for improving care for underserved pregnant migrant women, especially those women who pay for NHS care. This may include new guidance, toolkits, factsheets, a video, and social media resources.

How will patients and the public be involved?

The project has been designed with a migrant woman who is an expert by experience (someone with lived experience of being charged for pregnancy care), and forty other experts including other underserved migrant women, midwives, doctors, charities, researchers, and government workers. Two stakeholder workshops, and two patient groups helped create a plan for the project. A Patient and Public Involvement Panel and a Steering Group have been created; they will provide advice throughout the project and will help in creating an action plan. Factsheets, videos, social media, articles, and presentations will be created with these groups and will help to share the findings with the public and patients.

Award

NIHR 3-year Doctoral Fellowship Funding. Total award: £452,333

Biography

Kerrie is an NHS Public Health Physician and National Institute for Health and Care Research (NIHR) Doctoral Fellow based at the UCL Institute of Health Informatics; she is supervised by Prof Rob Aldridge. Originally from Northern Ireland, she graduated from The University of Edinburgh in 2017, and worked as a junior doctor in London before specialising in Public Health as an NIHR Academic Clinical Fellow based at the London School of Hygiene and Tropical Medicine (LSHTM). Kerrie graduated with distinction from the MSc in Public Health at LSHTM in 2021. She is the Migrant Health Advocacy Lead at the Faculty of Public Health and is a member of the Lancet Migration Global Collaboration on Migration Health and sits on the NHS Maternity Service Users' Equality Steering Group. In 2021 she was awarded the UK Faculty of Public Health President Medal for outstanding service to Public Health.