It is well known that high-quality care during pregnancy is important for the health of the mother and the development of her unborn baby. Pregnancy provides an ideal opportunity for midwives and health professionals to promote public health messages, healthy behaviours and parenting skills to the woman and her family.
As health professionals, midwives should be able to provide universal access to care in the pregnancy continuum regardless of the woman's legal status or ability to show documentation. Unfortunately, this is not always the case. Based on face-to-face medical and social consultations with 22 171 individuals in 2014, in nine European countries, including Britain, a report by Doctors of the World UK found that more than half of the pregnant women surveyed did not have access to antenatal care, putting both the mother's and baby's health at risk. Furthermore, 82.7% of those surveyed in London, had no access to the NHS (Doctors of the World, 2015). This intermittent and/or lack of health care during pregnancy has a detrimental effect on the health of not only the individual women and babies, but the population as a whole.
These women were unable to access health care for many reasons—legal, bureaucratic and financial. In the UK, antenatal care for undocumented pregnant women is considered as secondary care and is therefore not free at the point of use. This means that women are often sent a huge bill for their care (around £5000 if their pregnancy is without complications) that they cannot pay, even when they lose their babies.
Lesley Page, president of the Royal College of Midwives believes that, ‘midwives and other maternity staff should not act as gatekeepers to maternity services. They owe a duty of care to all pregnant women who seek care from them and they should provide care to all pregnant women irrespective of ability to pay.’
This applies not only to maternity care, but to the public health messages the midwives relay to the women in their care. The public health white paper (HM Government, 2010: 66) says: ‘There is a wider social duty to promote equality through the services provided by the NHS and Public Health England, paying particular attention to groups or sections of society where improvement in health and life expectancy are not keeping pace with the rest of the population.’ To be effective, public health messages need to be given to the whole population, and not leave out entire sections of society, particularly these high-risk and hard to reach groups. In order to break the cycle of deprivation and health inequalities, it is imperative that these public health interventions are delivered early in life.