Mothers in exile: Maternity experiences of asylum seekers in England

Mothers in exile: Maternity experiences of asylum seekers in England

Mothers in exile: Maternity expereinces of asylum seekers in England

Briefing paper

Jenny McLeish, Maternity Alliance

March 2002

Women seeking asylum may arrive in England having lost everything they value: children, partner, parents, extended family, community, home, job, health, money, possessions, culture. For those asylum seekers who are pregnant and give birth in England, the experience of exile casts a long shadow over their experiences of motherhood. Yet the special needs of pregnant asylum seekers and their babies have been largely ignored in the context of a support system designed to have a deterrent effect on people seeking to come to the UK.

During 2001, the Maternity Alliance carried out a qualitative study of women’s maternity experiences during the asylum process. The study involved semi-structured interviews with 33 women who were either pregnant or had recently given birth.

Key findings

Asylum seekers and their babies survived in a support system that fell far short of meeting their most basic needs for adequate food and safe shelter. Already lonely, disorientated and grieving, half of the women also experienced neglect, disrespect and racism from the maternity services.

· Full board emergency accommodation hotels have put the health of pregnant women and babies at serious risk.

·Pregnant and breastfeeding women went hungry because the meals provided were not suitable. They had to miss meals to attend hospital appointments or if their baby was asleep or crying during a mealtime.

· There was no formula milk provided at the hotels, even for the baby of an HIV positive mother who could not breastfeed. There was also no baby food available for the older babies who needed solid food.

· Women in hotels dominated by single men felt intimidated and experienced sexual harassment.

· The dispersal policy has been applied inconsistently, to the detriment of pregnant women and newborn babies.
o Women in late pregnancy may be refused dispersal when they are desperate to leave the emergency accommodation, or dispersed away from their only friends just before giving birth.
o Women with young babies have been repeatedly moved around by accommodation providers.

· Pregnant women and new mothers have been placed in temporary accommodation that was generally very poor quality and often seriously overcrowded. Lack of space put their babies at risk of accidents and impaired normal child development. Women (including young women under 18) were sometimes placed in all male hostels where they were sexually harassed while using shared kitchen and bathroom facilities.

· Restrictions on access to the £300 maternity grant have left vulnerable mothers and newborn babies destitute at a critical period. Mothers have been forced to beg from strangers in hospital to get nappies for their newborn babies.

· The level of voucher support was inadequate to support maternal and infant health. Pregnant women could not afford adequate food and could not find culturally suitable food in the supermarkets that accept vouchers. They also could not afford to buy looser clothes as their body shape changed. New mothers went without food and warm clothes to buy necessities for their babies. Pregnant women and new mothers have gone hungry when poor administration has left them and their babies without any financial support at all for weeks at a time.

· 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 for 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 experienced sadness and anxiety in early pregnancy. Postnatally many described sitting alone crying endlessly, but none had been diagnosed with postnatal depression or offered any assistance. Many expressed strong feelings of powerlessness, vulnerability and insecurity about the outcome of their asylum cases. Women missed their mothers and other female relatives and friends particularly acutely during childbirth and in the postnatal period.

· Women described extreme loneliness and craved female companionship, but found it difficult to build lasting new friendships in precarious circumstances. They greatly valued the social and practical support provided by refugee support groups.

· Many women had not been given any information about what services and support were available to them. Several who had left behind children in their country of origin had not been told about the legal right to family reunification if they gained refugee status.

Case study 1: "Don’t touch me"

She is 20 years old and came to England with her husband two years ago. She is still waiting for the result of her asylum application. She has a baby now 10 months old. She cried all the time when she was pregnant, and cried every day for two weeks after her baby was born, missing her parents. She didn’t leave the flat for two months. People shout abuse at her in the street.

The midwives were kind when she was pregnant, but when she was in labour the midwife was very unfriendly. "I was delivering the baby, without my mum, and it was painful, so I took the midwife’s hand. She said ‘Don’t touch me!’ And I had to say to her ‘Sorry, sorry!’ when I was in that difficulty, because I thought she might hate me and might not help me."

Case study 2: "They don’t give me milk"

She has been living in a squalid emergency accommodation hotel for five months. She is HIV positive and has therefore been told not to breastfeed her baby to reduce the risk of transmission. As an asylum seeker she is not entitled to milk tokens to buy formula milk, but the hotel did not regularly provide any. "Sometimes there is a problem when they don’t give me milk for two or three days and she is vomiting because I have to give her the milk we buy for adults. I had to fight to get the formula milk." One day her baby had nothing to drink for six hours because the hotel kept her waiting. "I only want my baby to be OK, I don’t want her to suffer because she doesn’t have milk."

Case study 3: "These Africans…"

When she was pregnant and going to lengthy hospital appointments, the hotel only gave her money for the bus fare, not for food so she had nothing to eat all day.

When she went into hospital to give birth, she had no clothes or nappies for her baby, and neither money nor vouchers to buy them with. After a Caesarean delivery the midwife refused to give her any nappies and told her to go and beg from other mothers on the ward. "She cried, my baby, she cried, she cried, and me I had pain, and I started to walk to find a nappy." She developed an infection, but when she reported her symptoms to a midwife, the midwife turned to a colleague and said, " These Africans! They come here, now she sleeps in a nice bed, and eats nice food, so she doesn’t want to move from here …what’s wrong with them, these Africans?" and some of the other midwives laughed.

Case study 4: "I hope I will make it"

She fled to England following the murder of her parents. She was initially refused support until she was raped while living rough, surviving by eating from bins. She now lives in a tiny bedsit so damp that the carpet is mouldy and the bed, which is the only place to sit, is wet to the touch. The toilet in the room above has leaked onto her bed. Her ten week old baby was resuscitated at birth and is not thriving. He has constant fevers and infections and a cough, and his weight has dropped from 8 kg to 6.5 kg.

She is extremely depressed. "I’ve got no family. I’ve got no history. My history is just what I talk about…I hope I will make it. I don’t know. I’m so confused. I’m lost…I pretend too much to be happy but inside me I am dead."

Key recommendations

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.

Accommodation

· Single women and families should always be accommodated separately from single men.

· Pregnant women and new mothers should be placed in self-catering accommodation. They should not be placed in the proposed accommodation centres.

· In full board accommodation there should be more flexibility in the timing and location of meals, and the meals should meet nutritional and cultural standards defined in consultation with refugee groups. Arrangements should be made to ensure that women attending antenatal appointments do not miss meals.

· In full board accommodation there should be explicit responsibility for providing necessities for mother and baby, including: a cot with clean bedding, nappies, sanitary towels for postnatal bleeding, and, where appropriate, formula milk, bottles, sterilising equipment and baby food. Where no maternity grant has been received, baby clothes should be supplied.

· Asylum seekers under the age of 18 should be placed with a foster family or in supported accommodation.

· Environmental health standards should be strictly enforced.

Dispersal

· Pregnant women and newly-delivered mothers should be consulted on the timing and destination of dispersal. Their need for practical and emotional support during labour and in the post-partum period should be considered alongside any medical grounds affecting dispersal.

· Pregnant women and newly-delivered mothers should only be dispersed to areas with adequate support services, including language support and health visiting services.

Vouchers and the new support system

· The Maternity Grant should be available to asylum seekers on the same basis as the Sure Start Maternity Grant, from the 29th week of pregnancy up until the baby is three months old. An equal grant should be available to all supported pregnant asylum seekers irrespective of the body responsible for their support.

· Pregnant and breastfeeding asylum seekers and their babies should have full access to the Welfare Foods Scheme, which currently provides milk tokens and vitamins.

· Financial support should be set at a level demonstrably adequate to support maternal and infant health.

Healthcare and the maternity services

· 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 intervention.

Social and practical support

· Refugee community groups, befriending organisations and networks providing practical help to asylum seekers should be funded in all dispersal areas. Outreach work should be funded to ensure that isolated new mothers have the opportunity to remain in touch with local sources of support.

· English language classes supported by free childcare facilities and transport should be funded in all dispersal areas.

· Specialist health visitor posts should be funded to meet the needs of asylum seekers. Health visitors should be able to identify antenatal and postnatal depression in women from different cultures, so they can offer appropriate support or make referrals where necessary.

· In recognition of the emotional burden which may be carried by professionals in supporting asylum seekers who have had traumatic experiences, they should have access to effective mechanisms of peer support, debriefing and, where appropriate, counselling.

Co-ordination

· Within every dispersal area, there should be a named co-ordinator to facilitate multi-agency co-operation on asylum issues.

· To enable any professional in contact with an asylum seeker to signpost all relevant local services, effective resource packs should be developed.

Detailed findings and recommendations are in the full report of this study: McLeish J, Mothers in exile: Maternity experiences of asylum seekers in England, Maternity Alliance, March 2002, price £8 individuals / voluntary groups, £10 organisations, plus £1.50 p&p

THE MATERNITY ALLIANCE
45 Beech Street
London EC2P 2LX
Office * 020 7588 8583

Source: http://www.maternityalliance.org.uk/