Memorandum by the Maternity Alliance (MA
3)
MOTHERS IN
EXILE: MATERNITY
EXPERIENCES OF
ASYLUM SEEKERS
IN ENGLAND
In 2001, the Maternity Alliance carried out
a qualitative study of women's experiences during the asylum process.
The study found that most of the women were satisfied with their
antenatal care and half also had positive experiences during labour
and the postnatal stay in hospital. However, half of the women
experienced indifference, rudeness and racism from the health
professionals caring for them during delivery or on the postnatal
ward. These women felt powerless to challenge hostile attitudes
and fearful of the consequences if they attempted to do so. Offensive
remarks went unchallenged by other health professionals.
Interpreters were generally provided when necessary
during pregnancy and labour, except in antenatal classes, which
prevented many non-English speaking women from attending. In one
case, however, a decision was made, without an interpreter present,
to perform a Caesarean section on a woman who did not speak English.
Many women had not been given any information
about what services and support were available to them.
Key recommendations relating to healthcare and
the maternity services
— All agencies in contact with asylum-seeking
pregnant women, new mothers and babies should recognise and meet
their social, psychological and physical needs. The new support
system should provide specifically for the needs of pregnant asylum
seekers, new mothers and their babies.
— Anti-racism training for NHS staff
should be strengthened. Management should take a more proactive
role in ensuring that staff do not exploit the vulnerability of
asylum-seeking clients with racist abuse.
— Pregnant asylum seekers should be
given clear and accessible information on GP, maternity, health
visiting and child health services. There should be a clear explanation
in advance of what their choices and rights are, potential complications
and treatment options, and of what support will be available.
— There should be better communication
between maternity and child health services and accommodation
providers during dispersal, to ensure that staff are forewarned
of the arrival of asylum seekers who will need their services,
and test results and notes are forwarded.
— Funding for interpreting services,
and in particular for advocates and link workers, should be expanded.
Out-of-hours advocacy services should be developed and more female
interpreters and advocates should be recruited to them. It should
be a clear target to provide interpreting or advocacy support
for antenatal classes and for postnatal visits.
— Staff must ensure that genuine informed
consent is obtained for any interventions.
A CRYING SHAME:
PREGNANT ASYLUM
SEEKERS AND
THEIR BABIES
IN DETENTION
This briefing paper highlights the specific
problems associated with the detention of vulnerable women and
babies. Despite Immigration Service instructions that pregnant
women "normally only considered suitable for detention in
very exceptional circumstances . . .", this study found that
pregnant asylum seekers (and their babies) are amongst those currently
detained, sometimes for many months, even where there is no prospect
of early removal.
Generally the health care centres within the
detention centres did not provide the type of care or support
that women wanted. The detention centres were required to escort
the women to hospital appointments and in one instance, failed
to do so. Being moved between detention centres disrupted continuity
of care and, in one case the centre had failed to forward the
results of blood tests to a pregnant woman who had been released.
One of the detainees did not speak English and had no access to
an interpreter while in detention, including during her appointment
with the midwife. In one case medical treatment had been withheld
from a premature baby and immunisations had not been provided.
Key Recommendations
— The user of prolonged detention for
pregnant women and mothers with young children inflicts physical
and psychological harm disproportionate to the policy aim of immigration
control, and should be stopped immediately. Alternatives to detention,
such as regular reporting, should be used where there are evidence-based
concerns about an individual absconding.
— Pregnant women and young children
should not be placed in accommodation centres, if the institutional
regime and segregation from normal sources of social support found
in detention centres are replicated.
— Where brief detention (for a few
days) of pregnant women and mothers of young children is genuinely
unavoidable, no woman or baby should be detained in a place where
physical conditions (including food) or medical care are inadequate.
Detailed Operational Standards covering the needs of pregnant
women, new mothers and babies should be established.
LIVES ON
HOLD: HOMELESS
FAMILIES IN
TEMPORARY ACCOMMODATION
Low income is known to be a risk factor for
poor health status, as well as for homelessness, and living in
poor quality accommodation also has an adverse effect on health.
Evidence suggests that becoming homeless and living in temporary
accommodation may put families at further risk of ill health.
Research has consistently shown that exposure to poor material
conditions in early life, including in utero, is detrimental
to health in the short term but the effects also extend into adult
life, independent of adult socio-economic status.
All of the pregnant women interviewed felt that
their pregnancy had been negatively affected by their experience
of being in temporary accommodation. Health service provision
was patchy and fragmented. There was no consistency as to the
type and level of service provision the families in different
parts of different boroughs had access to. The services a family
received were generally determined less by need and more by luck
with respect to the level and quality of what was available in
the locality in which they were living. Over half of the women
did not have a GP in the area where they were temporarily housed.
In every case this was because the women had chosen to remain
registered with their GP in the area where they had last been
securely housed. They were, therefore, often travelling considerable
distances, paying the costs of public transport, to see their
doctor. One woman, who was hoping to be rehoused in her original
neighbourhood, had been told she would not be accepted back onto
her GP's list if she left the practice and registered elsewhere,
even on a temporary basis. Women experienced considerable difficulties
in finding out about local services.
The pregnant women in the study were generally
satisfied with the monitoring aspect of antenatal care, however,
their expectations were low. They did not expect any social support
or continuity of care, yet their concerns for their pregnancy
all related to their social circumstances.
The hospital midwife interviewed described discharging
homeless women who had just given birth, with their new baby,
to the local Homeless Persons Unit (HPU). She spoke of the frustrations
and anxieties for ward staff of trying, often over several days,
to get information on a woman's new address from the HPU. Beds
were regularly being blocked by delaying the discharge from hospital
of new families, either because the women gave birth at the weekend
when the HPU is closed, or because a few extra days care might
help protect them a little from the inevitable stress associated
with leaving the hospital without a home to go to.
Key Recommendations Relating to Healthcare and
the Maternity Services
— Consistent, reliable and sufficient
access to a network of primary health care services should be
available in all boroughs.
— Health visitors and midwives should
keep in contact with families in their care that become homeless.
When the family's next temporary or permanent address is known,
their care must be transferred immediately to local teams.
— Training should be provided to raise
awareness of health related causes and effects of homelessness
on family members.
— Staff have a responsibility to be
well informed about all local services that may be of use and
interest to homeless families, and to offer this information to
families as appropriate.
— The most intensive home visiting
service possible should be offered, with the emphasis being on
building positive relationships with clients, using a family centred,
social model of care.
— Practitioners should prioritise involvement
in existing professional networks such as the CPHVA's Special
Interest Group on Homelessness (SIGH) as a means of giving and
receiving professional support, sharing good practice and acting
as a pressure group.
AS GOOD
AS YOUR
WORD: A GUIDE
TO COMMUNITY
INTERPRETING AND
TRANSLATION IN
PUBLIC SERVICES
Statutory agencies are still reluctant to recognise
both that there is a valid and ongoing need for interpreting and
that its provision is their responsibility.
In-house lists of bilingual staff are still
being used as a substitute for properly resourced and co-ordinated
interpreting services with trained, paid staff.
Attitudes to bilingualism are as misguided as
ever. People who speak two languages do not necessarily know how
to interpret. Service providers and clients alike do not always
appreciate the importance of using properly trained interpreters,
and the dangers of using unskilled ones.
Clients whose first language is not English
are still being encouraged to bring their own unpaid and often
unskilled interpreters, including children, other relatives and
friends.
Although there is more talk of consultation
and user involvement, linguistic minority communities still face
difficulties in raising these issues and lobbying for resources
owing to their lack of representation on policy-making bodies
inside the services and the absence of real commitment—financial
and political—to equal access.
There is still no recognised pay structure for
interpreting work within the health service, nor a national umbrella
organisation to represent and co-ordinate the activities of language
support service providers. This means the work suffers from low
pay, where it is paid at all, and abuse of the goodwill of volunteers
from local communities.
Where paid interpreting facilities exist, they
are usually poorly resourced and the function and role of the
interpreter is unclear and unsupported.
Despite the obvious advantages of a seamless
service and economies of scale, there is still reluctance to work
in partnership with pooled funds to provide joined-up language
services across agencies, e.g., health and local government.
Services for ethnic minority groups rely on
tokenistic funding, usually from government. Eventually the funding
runs out and services evaporate. Tokenistic funding leads to a
lack of interest and a growth of unprofessional attitudes. The
powerlessness that surrounds ethnic minority groups seems to permeate
through the NHS. For services to be equitable, someone has to
make a commitment that lasts a lifetime and not just until "the
money runs out".
Key Recommendations
— Health services (and other agencies)
should establish a policy on language and communication for all
services.
— Health services should allocate permanent
mainstream resources to all services to set up properly structured
and supported interpreting services.
— Health services should ensure real
consultation with linguistic and ethnic minority communities.
MATERNITY SERVICES
FOR WOMEN
WITH LEARNING
DIFFICULTIES: A REPORT
OF A
PARTNERSHIP OF
MIDWIVES, COMMUNITY
NURSES AND
PARENTS
The "Right from the Start" project
looked at ways to improve maternity services for people with learning
difficulties. For women with a learning difficulty, the possibility
of motherhood is often discouraged, active decisions to become
a parent are unsupported and resources to prepare and support
the future parent are unavailable. The project aimed to find ways
of involving women with learning difficulties which gave them
a real say and did not treat them as token participants.
MOTHERS' PRIDE:
A SURVEY OF
DISABLED MOTHERS'
EXPERIENCES OF
MATERNITY
Recommendations
— More care and understanding from
medical and allied staff.
— A change in attitude towards disabled
people from staff.
— An end to discrimination at an institutional
level, not just on an individual basis.
— Assessment of womens' needs as an
individual, and an acknowledgement of their particular needs arising
from their condition.
— Staff should have the time and patience
to listen and be more understanding of disability.
— Staff should be ready to admit a
lack of knowledge and take advice from the disabled woman herself.
CONSUMER EMPOWERMENT:
A QUALITATIVE STUDY
OF LINKWORKER
AND ADVOCACY
SERVICES FOR
NON-ENGLISH
SPEAKING USERS
OF MATERNITY
SERVICES
The contribution of linkworkers and advocates
to the empowerment of non-English speaking users of maternity
services is considerable. Women were able to make fuller use of
the maternity services. They felt more confident and reassured,
able to ask questions and make maternity services. They felt more
confident and reassured, able to ask questions and make choices
and generally expressed satisfaction with their experience of
maternity care when supported by a linkworker or advocate. However
there are a number of constraints and weaknesses that limit the
effectiveness of linkworker and advocacy services. A number of
recommendations detail how linkworker and advocacy services can
be best developed and utilised in order to improve the maternity
experiences of non-English speaking users.
TRAVELLER MOTHERS
AND BABIES:
WHO CARES
FOR THEIR
HEALTH?
This report looks at some of the ways in which
health authorities and local authorities can take action to promote
the health of Traveller mother and babies. Travellers often face
acute problems with access to health care. A woman who is moved
on from one official stopping place to another has little chance
of consistent or even continuous antenatal or postnatal care.
After every move, she must seek out local health services and
begin again, with health professionals who don't know her and
who may have no access to her medical records. The hostility which
Travellers often face from the settled population raises yet another
barrier in the route to health care.
Recommendations
Local health services should include in their
strategic plans a statement on their proposed action on the health
care of Travellers and should be encouraged to give evidence that
they are attempting to work with Travellers.
— Local health services should liaise
with local authorities and other agencies to update information
about sites within their districts. There should also be opportunity
to all agencies to meet for discussion with user representatives.
— Local health services should identify
a named person to co-ordinate information relating to Travellers,
including transfer of health records when Travellers move across
health authority boundaries and notifying relevant health professionals
when the local authority is planning an eviction from an unauthorised
site.
— Before embarking on initiatives in
service provision, there should be careful collaboration and consultation
with representative of the main Traveller organisations and of
local Traveller communities who may not be represented by official
organisations.
— A national system of personal health
records should be developed which Travellers keep and take with
them on visits to different health professionals in different
health authorities, so helping to maintain continuity of record
keeping. An evaluation exercise should be set up to establish
the most useful format and content of such personal records.
— Health services should review their
policies with regard to Travellers in order to identify and eliminate
discriminatory practices. They should provide specialist induction
and in-service training for all staff working with Travellers.
May 2003
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