[CG] Asylum seekers and refugees in maternity care

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Asylum seeker, refugees and mothers for whom English is not the first language are recognised as a vulnerable group with regard to pregnancy outcome. They remain three times more likely to die during or after pregnancy and four times as likely to develop postnatal depression as white British women. They also have twice the risk of stillbirth or neonatal death.

The risks centre around:

  1. Mothers arriving with additional challenges, physical and emotional (undiagnosed pre-existing disease, FGM, trauma as a result of violence, often sexual violence, or from having witnessed violence.)
  2. Inability to access care (language barrier, not understanding the healthcare system, frequent dispersal/housing changes, financial difficulty, difficulty adjusting to host country)

This is compounded by the lack of previous family, social and cultural support.

SIGN guideline 2010 recommends all women should be able to fully access all standard antenatal care. The women who died were much less likely to seek care early, and less likely to remain in contact with maternity services.

Recommended additional support in maternity care

  1. medical review, if not carried out in primary care
  2. interpreting service for all episodes of care
  3. allow time to explain the health care system here
  4. ensure any changes of address and phone number are updated, and that women know to mention this
  5. ensure women have out of hours contact numbers and feel able to use them
  6. ensure next appointment is given to the patient directly at each episode of care, not left to the patient to make herself, especially if referring on to another clinic/ service
  7. if trauma or any other pre-existing mental ill-health is present, consider referral to SNIPS

Last reviewed: 12 April 2022

Next review: 01 April 2027

Author(s): Dr E Ellis, Christine McGee

Version: 1

Document Id: 1023