Access to maternity care is a human right – CEDAW and NHS Charging of Pregnant Migrant Women

It’s been nearly 40 years since the UK government signed the UN Convention on the Elimination of Discrimination Against Women (CEDAW), yet it remains little known and little used in this country. CEDAW, sometimes referred to as the “women’s Bill of Rights”, really should be better known. It enshrines women’s rights in human rights law and provides a framework to hold our government to account on women’s rights.

CEDAW is relevant to much of the work of Maternity Action. The most obvious link is Article 11 which requires states to prevent pregnancy discrimination and to prohibit dismissals on the grounds of pregnancy or maternity. Given that 54,000 women lose their jobs due to pregnancy discrimination each year in the UK, there is clearly much work to do before the UK government can meet its obligations under Article 11.

It’s not just Article 11 that is relevant to our work at Maternity Action. As well as campaigning on workplace maternity rights, we also campaign on pregnant migrant women’s access to NHS maternity services. Women who are not “ordinarily resident” in the UK and who do not qualify for an exemption (eg. Those with refugee status and those in the national referral mechanism for trafficking are exempt), are now charged for hospital treatment. NHS trusts must now issue invoices issue invoices for 150% of the tariff, actively chase debts and tell the Home Office about any unpaid debts.

Article 12 of CEDAW is clear that access to maternity care is a fundamental right. The convention says:

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“States Parties shall ensure to women appropriate services in connection with pregnancy, confinement and the post-natal period, granting free services where necessary, as well as adequate nutrition during pregnancy and lactation.”

(CEDAW Article 12)

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The average charge for maternity care is over £7,000 but for complex pregnancies or difficult labours the bill could be much more. Even though women should not be charged until after they have received the care, Maternity Action has interviewed women who received bills and threatening letters while they were still pregnant. Any debts incurred as a result of maternity care can affect future immigration applications, leaving women stuck with irregular immigration status, without the right to work to pay off the debt, and without any entitlement to housing support or social security. The father is not charged and his immigration status is unaffected by the mother’s inability to pay the charge.

Unsurprisingly, the women we speak to tell us that these bills cause them huge anxiety which affects their physical and mental health. Women have also reported that the charges have deterred them from accessing vital maternity healthcare for fear of the financial cost. One woman was sent a bill for her treatment in relation to a miscarriage. She never went back to the doctor for follow up treatment and investigations for fear she would be charged more.

The main articles of the convention are accompanied by a series of recommendations. General Recommendation 24 builds on the requirements of Article 12. It requires governments to report on how they ensure free services to women – particularly vulnerable groups of women – in pregnancy:

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“Reports should also include what measures States parties have taken to ensure women appropriate services in connection with pregnancy, confinement and the post-natal period..….States parties should include in their reports how they supply free services where necessary to ensure safe pregnancies, childbirth and post-partum periods for women. Many women are at risk of death or disability from pregnancy-related causes because they lack the funds to obtain or access the necessary services, which include ante-natal, maternity and post-natal services. The Committee notes that it is the duty of States parties to ensure women's right to safe motherhood and emergency obstetric services and they should allocate to these services the maximum extent of available resources.”

(General Recommendation No.24 (20th Session, 1999) Article 12 (2))

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Our written submission, which is on the UN CEDAW website, elaborates on our concerns about the impact of NHS charging of pregnant women as well as raising concerns about the low levels of asylum support for pregnant asylum seeking women and the impact of dispersal on pregnant women and women with young children.

If you want to find out more about our campaigning on NHS charging and maternity care, read our report and our campaign toolkit.

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Author

Scarlet Harris is Head of Policy and Campaigns at Maternity Action. Maternity Action is the UK’s leading charity committed to ending inequality and improving the health and wellbeing of pregnant women, partners and young children – from conception through to the child’s early years. In December 2019, Maternity Action released a report on how the NHS charging is penalising victims of trafficking, FGM and sexual violence: A Vicious Circle: The relationship between NHS charges for maternity care, destitution, and Violence Against Women and Girls