Pregnancy and birth are complex experiences that can evoke hopes and anxieties about the past and future, and illuminate the need for care and community. For migrants, it can also mean a confronting engagement with borders and immigration controls, and regimes of surveillance and management that are defining characteristics of both pregnancy care and immigration in the UK.
In Scotland, people in the asylum system are subject to contradictory policies and political ideologies on immigration, from ‘New Scots Integration Strategies’ that claim to welcome migrants, to the UK-wide ‘hostile environment’ immigration policies that seek to make life as unbearable as possible.
The treatment of pregnant asylum seekers in the UK reveals how the control and enforcement of borders are themselves tools of violence that are frequently used but rarely recognised by the state. Increasingly restrictive access to visas or official pathways to asylum force people to pursue irregular and more dangerous journeys. Such routes put women in particular at heightened risk of violence, including sexual violence.
Taking high doses of contraceptives before their journey is one strategy that women adopt in order to prevent pregnancies occurring as a result of rape. Even if they successfully reach a country where they might seek asylum, persecution that is deemed domestic or even feminised, often fails to meet narrow legal definitions of a refugee. The ‘hostile environment’, which restricts access to basic needs and services including accommodation, healthcare, employment, and financial assistance, keeps people in a state of destitution. This state of precarity puts people at further risk of exploitation.
Pregnancy is usually presented as an additional challenge and source of vulnerability for people in the asylum system. Their experiences of pregnancy are often complicated by health problems, including poor nutrition and mental health problems. The dispersal policy, introduced under the Immigration and Asylum Act 1999, was intended to reduce the ‘burden’ of asylum seekers in the south of England by relocating people to key sites across the UK. This forced relocation has resulted in many people experiencing repeated relocations, reducing the possibility of any meaningful sense of community or support.
Such policies can have damaging effects on the health of individuals and their children. These problems are exacerbated when people are housed in poor-quality accommodation, as they were in Glasgow in the Mother and Baby Unit, and still are, in deficient hotel accommodation, where people lack access to cooking facilities and are provided with insufficient nutrition.
This accommodation, run by the private company Mears, has been widely critiqued as unsafe and unsuitable, particularly for pregnant people and new babies. It is therefore unsurprising that asylum seekers often experience a deterioration in health during their first two to three years in the UK. The hostile environment ensures that people seeking asylum frequently encounter poverty, destitution, and insecure housing. These are key barriers to health for everyone.
The National Institute for Health and Care Excellence (NICE) has emphasised the impact of social disadvantage on maternal health and pregnancy outcomes. It classifies refugee and asylum-seeking people’s pregnancies as ‘high risk’ due to the ‘complex social factors’ they face, and recommends increased efforts to improve access and engagement with maternity services.
This ‘high risk’ categorisation involves a pathway of care led by obstetrics, rather than midwifery, and a more rigorous regime of surveillance and interventions. They frequently experience high intervention births, with notably high rates of inductions and caesarean sections.
Despite this high-intervention care, refugee and asylum-seeking women in the UK continue to be at increased risk of poor pregnancy and birth outcomes. This is part of a wider context of reproductive inequalities, where Black women are four times more likely and Asian women two times more likely to die from pregnancy related causes.
These fatal inequalities exemplify the need for a reproductive justice approach. Reproductive justice was developed as a framework for activism and analysis to conceptualize the relationship between reproductive rights, racism, classism, and other forms of oppression. While reproductive rights movements have often focused on struggles for access to contraceptives and abortion, underscored by the concept of ‘choice’, reproductive justice acknowledges both the right to have or not to have children, and the right to safely and adequately parent children.
Pregnant asylum seekers in the UK are highly restricted in their choices, from what they eat, to where they live, to where and how they give birth. The hostile environment produces and compounds these multiple oppressions among some of the most vulnerable people in our society. The political salience of borders and immigration in the UK is resulting in increasingly violent policies to prevent migrants, including people seeking asylum, entering or remaining in the country.
Borders reproduce and reinforce racialized and gendered violence by categorising people as ‘criminals’, or as unworthy of human rights, which exposes people to further violence and restricts their capacity to receive care and support.
Research on forced migrants frequently emphasises the violent state exclusion of refugees, yet reproduction presents a potential zone of inclusion, where women and their infants are rendered deserving of protection on the basis of motherhood, rather than persecution. Pregnancy and motherhood can allow refugee women to form networks of social and familial support, but the financial, physical, and emotional demands of raising children can risk further isolating marginalized women and exacerbating mental health conditions that are already more prevalent among refugees and asylum seekers.
Although healthcare is provided by the NHS and (minimal) financial support is provided by the Home Office (in the case of asylum seekers and some refused asylum seekers), a plethora of organisations exist to advise, support, and advocate for refugees and asylum seekers. In Glasgow, Amma Birth Companions provide antenatal, birth, and postnatal support for refugees and asylum seekers. Frequently referred to as the ‘Amma Family’, staff and clients frequently use kinship terminology to convey the support they provide and receive. This intimate labour, grounded in opposition to the hostile environment, provides immediate support and advocacy, but also highlights the ways in which new communities of care and solidarity can be produced through universally shared challenges of pregnancy, birth, and parenting.
Lucy Lowe is a senior lecturer in Social Anthropology at the University of Edinburgh. This post draws on her ESRC New Investigator Grant funded project Maternity, Migration, and Asylum in Scotland (MAMAS).