Over the last two years I have been part of a small team of maternity professionals contacting and visiting pregnant women who were being held in Yarl’s Wood Immigration Detention Centre in Bedford. We volunteer for a charity called Medical Justice, which aims to defend and promote the health rights, and associated legal rights, of immigration detainees in the UK. Medical Justice advocates for many vulnerable patients but, as midwives, we were assessing and providing medical reports just for pregnant women.
Being a midwife is a huge part of my identity, my purpose and passion in life. I have worked for the NHS, volunteered for midwifery and mother’s groups and worked as a midwife in Malawi for a while. The stories of the women I met in Yarl’s Wood had the most profound effect on me. To offer what expertise and support 1 could was immensely rewarding, but the circumstances in which they were put were without a doubt the most shocking thing I have seen in my career,. All the more shocking is that this is happening in the UK, here, within our own health service.
The Centre is very like a prison, with tough security, locked door after locked door, isolation rooms and control over access to food and other basics of life. Because of their histories, most of the mothers we met were very vulnerable even before their detention. Sometimes the reasons they came to the UK (fleeing gender based violence for instance) made their pregnancies more fragile and worsened their mental health. Others had pre-existing health problems and complicated obstetric histories. 1 performed a review of cases for a nine-month period in 2013/2014, which comprised of all 21 pregnant women seen by Medical Justice during that period. There is no official record of how many pregnant women are detained, so we do not know what proportion of the total number of detained pregnant women that this review contained.
I estimated that, compared to the urban multi-ethnic trust population in which I worked, the women seen by Medical Justice in immigration detention in the above review were around seven times more likely to have ‘high risk’ pregnancies – that is pregnancies that we would typically refer for obstetric led care and multi-professional support (such as psychiatric assessment). Additionally, of course, disruption in antenatal care and being an asylum seeker in the first place would promote most of us to seek further specialist support for these women. The NICE (2010) guidelines clearly state that ‘Recent arrival in the UK’ ,’asylum seeker or refugee status’ and ‘difficulty speaking or understanding English’ are examples of ‘complex social factors’ which require more intensive support and care. Furthermore, the CMACE Report of 201 I finds that continuity of care is particularly important in asylum seeking women, due to their increased vulnerability.
In short, these women were extremely vulnerable and often unwell. They showed remarkable courage and strength in the face of extreme adversity, but there is no doubt in my mind that the health, both mental and physical, of the women I met was worsened by detention.
Immigration detention was created to be a short term ‘holding’ place for people who were to be immediately deported. In the review of cases above, I found that the mean length of detention of the pregnant women seen by Medical Justice was 50 days. The range was 10-122 days. All of the women in the review were eventually released by about 30 week; of pregnancy and none were deported until after the birth of their babies, or were not subsequently deported at all as their asylum claims were eventually accepted. Many of them were ‘not fit to fly’ which means that they did not meet the standard international aviation criteria for health and would not be allowed to board a plane during their pregnancies. Furthermore, it is not now legal for immigration personnel to use physical force to make a woman leave the Centre and board the plane, so if a woman refuses to go, there is no way of making her do so.
Yarl’s Wood has a small health care unit, staffed 24 hours by nurses (not midwives) and managers, with a GP in attendance on most working days. The unit is run by a private healthcare company, but of course all of the clinical staff are registered with the relevant professional bodies. Sometimes the pregnant women I met with would be given kind and compassionate care. However, all too often a culture of disbelief seemed to prevail which, coupled with a lack of midwifery/ obstetric specialism, led to many worrying symptoms and alarming risk factors being dismissed by the staff. For example, I saw a case in which it seemed not to be recognised that the limits of normal blood pressure are different in pregnancy than in the non-pregnant woman.
My major concern for these women was the denial of emergency assessment and treatment and delays in allowing women access to acute obstetric care. Cases that you or I would have immediately referred into hospital were left for days, sometimes weeks, with worrying symptoms ignored, or attributed to ‘attention seeking’. Once, a woman I was very concerned about, called herself an ambulance, as she was afraid for her health and for her baby, after several weeks of increasingly severe symptoms. The ambulance was cancelled by the health care staff, without her consent.
The mothers I met told me of the extreme discomfort of being in the Detention Centre whilst pregnant. Most did not find the food palatable and the restrictions on when and what they were able to eat worsened pregnancy related sickness for many of them. Several also told me how frightened they were by the guards, and by a lack of privacy in the Detention Centre leading to sometimes feeling exposed and ashamed.
As above, we do not know how many pregnant women are in Yarl’s Wood Immigration Detention Centre, though we suspect, from very rough estimates based on what women inside are able to tell us, that it is not a very large number. The pregnant women that we saw were not deported during their pregnancies due to health concerns, and were released without deportation making their detention pointless. In addition, the immense physical and mental stress of being in a detention centre had a negative impact on many of their pregnancies, not least because of the disruption to their pregnancy care and lack of access to emergency assessment and treatment. Detention is damaging for these mothers. It doesn’t really matter what you think about immigration. Perhaps you are in favour of tougher screening for asylum seekers and further limits in the number of migrants given permission to stay in the UK, or perhaps you have more lenient views. Either way you would realise that there will always be a process to follow to assess claims for asylum and immigration. Most people would be of the opinion that such a process should be fair (everyone gets treated the same), reliable (we are able to usually tell who is genuinely in need of asylum) and humane.
Most people would also add that it should be efficient – at the lowest possible cost to the taxpayer.
The detention of pregnant women is none of these things. The cost to their wellbeing is disproportionate because of their greater health needs .Their ability to cope is reduced by the normal but difficult symptoms of pregnancy and further by their higher risk of serious pregnancy complications; they are vulnerable. Furthermore, as deportation is more difficult when a woman is pregnant, because of airlines’ health related restrictions and because the immigration personnel are not allowed to use physical force on a pregnant mother, it becomes pointless. The high cost of keeping a woman in detention, potentially causing her and her baby to suffer, only to release her without deportation, is to needlessly spend money.
I am first and foremost a midwife. My commitment to the NMC Code of Conduct (2015), as the bedrock of my professional integrity, is true no matter where a woman comes from, no matter where she is living or who is master of her. Whilst these vulnerable women are in the UK, their care must be held to the same standard that we pride ourselves on in our daily practices. I have reported my concerns through our supervisory system but since the women are almost ‘outside’ of midwifery, and can’t access midwifery care by themselves, it is hard to see what can change whilst they are still detained. The NMC Code states that we must:
- Make the care of people your first concern, treating them as individuals and respecting their dignity
- Work with others to protect and promote the health and wellbeing of those in your care, their families and carers, and the wider community
- Provide a high standard of practice and care at all times
(NMC Code 2015)
This is demonstrably not always the case for the women we have met in Yarl’s Wood, and this has to change.
How you can help
- Become a midwife-volunteer for Medical Justice (see below or contact me)
Donate to Medical Justice
- Write to or email your MP with your concerns
References and Links
Centre for Maternal and Child Enquiries (CMACE) Saving Mother’s Lives: 2006-08. The Eighth Report on Confidential Enquiries into Maternal Deaths in the United Kingdom.BJOG, I 18 (suppl. I) 1-203.
National Institute of Clinical Excellence (2010) Pregnancy and Complex Social Factors. London, NICE Guidelines.
Nursing and Midwifery Council (2015) The Code. HMSO, London.
Public Health England (2013) Guidelines for Malaria Prevention in Travellers from the UK. PHE publications gateway number: 2013054. London, HMSO.
Medical Justice www.medicaljustice.org.The APPG 2015 report on detention and Expecting Change can also be found on their website.
Tsangarides, N.,Jane Grant, J. (2013) Expecting Change, the case for ending the detention of pregnant women. Medical Justice, London.
First published in Midwifery Matters ISSUE 145 Summer 2015