Pierce Poppy, Adil Haleema, Kwok Tiffany, Cooke Catherine, Bazinet Deveney, Roll Kate, Hillman Sara L
Medical School, Faculty of Medical Sciences, University College London, London, United Kingdom.
Department of Science, Technology, Engineering and Public Policy, University College London, London, United Kingdom.
J Migr Health. 2024 Dec 28;11:100291. doi: 10.1016/j.jmh.2024.100291. eCollection 2025.
The London borough of Camden has long been home for many refugees, asylum seekers, and undocumented migrants (RASUs). Over time, it has witnessed an increase in the population of these migrant groups, accompanied by notable changes in the obstacles they encounter when seeking health services, particularly maternity care. We explore how the 'hostile environment' policies affect access to and delivery of quality maternity services for RASUs.
This study was conducted over eight months (November 2021-July 2022) both remotely and face-to-face, in various locations in Camden and in the Maternity Department at University College London Hospital, UK. Healthcare professionals (HCPs) and community organisations (COs) were identified as two major stakeholders involved in the care provision for RASUs. 33 semi-structured interviews were conducted (with 22 HCPs and 11 COs) to understand their experiences of delivering care to this population.
There was consensus among HCPs and COs that the current immigration policies undermined their duty of care, personal morals, and the principles of the NHS. These policies have created a restrictive environment, making it increasingly difficult for migrants to navigate the healthcare system and creating an atmosphere of distrust, propagating fears of being charged. This has led to HCPs and COs going beyond their remits to ensure that RASUs are accessing and engaging with maternity care, regardless of an individual's status and despite any potential repercussions for themselves.
In the face of an intensifying hostile environment under the UK government, supporting RASUs cannot be solely reliant on political measures. We need to advocate for healthcare navigator roles, health justice partnerships, specialist teams, and comprehensive training for service providers. HCPs and COs should be adequately supported in their endeavours to ensure RASUs have access to standardised, high-quality maternity care.
长期以来，伦敦卡姆登区一直是许多难民、寻求庇护者和无证移民（RASUs）的家园。随着时间的推移，这些移民群体的人口有所增加，他们在寻求医疗服务，尤其是孕产妇护理时遇到的障碍也发生了显著变化。我们探讨了“敌对环境”政策如何影响RASUs获得和接受优质孕产妇服务的情况。
本研究在八个月内（2021年11月至2022年7月）通过远程和面对面的方式进行，地点包括卡姆登的各个地方以及英国伦敦大学学院医院的产科。医疗保健专业人员（HCPs）和社区组织（COs）被确定为参与为RASUs提供护理的两个主要利益相关者。进行了33次半结构化访谈（与22名HCPs和11名COs），以了解他们为这一人群提供护理的经历。
HCPs和COs一致认为，当前的移民政策损害了他们的护理职责、个人道德以及英国国家医疗服务体系（NHS）的原则。这些政策营造了一种限制性环境，使得移民越来越难以在医疗系统中顺畅就医，并营造了一种不信任的氛围，加剧了对被收费的恐惧。这导致HCPs和COs超越了他们的职责范围，以确保RASUs能够获得并参与孕产妇护理，无论个人身份如何，也不顾及自身可能面临的任何后果。
面对英国政府日益强化的敌对环境，支持RASUs不能仅仅依赖政治措施。我们需要倡导设立医疗保健导航员角色、建立健康正义伙伴关系、组建专业团队，并为服务提供者提供全面培训。应充分支持HCPs和COs的努力，以确保RASUs能够获得标准化、高质量的孕产妇护理。
