Asylum seekers and the maternity services
Report of a meeting of the Forum on Maternity and the Newborn of the Royal Society of Medicine, 21 June 2007

The politics of asylum seeking and deportation
Cristel (CR), Black Women's Rape Action Project (BWRAP)

When we formed the project in 1991 there were few resources and little help for black and immigrant women in this country; it is a network of women from many parts of the world, some of whom have been in need of the project's services, having survived rape and other sexual violence and racist attacks. They include lesbian women, women who have been trafficked and are working under duress in the sex industry; many come from African countries where war is endemic and where rape is used as a political weapon. Seeking safety and protection themselves, they bring a wealth of knowledge and skills which they put at the disposal of this community of women.

80% of the world's displaced are women and children; half of the women are rape victims, and it is worse than sad that they are also the victims in this country of draconian legislation which denies them benefits and financial support. There has been the system of vouchers for food, and the regulation which denies asylum seekers housing unless they apply for asylum on arrival in the country. Such denial of human rights leaves people destitute, not an oversight but a policy, as is the denial of health care; basing the claim for asylum on rape is disbelieved and is a one-way ticket to a detention centre. This can only be described as a form of apartheid.

The decision to grant or deny asylum is based on a minimal five hours of legal representation. A woman may be lucky enough to convince a solicitor that her claim has some merit. Women and their children are held at Yarl's Wood Removal Centre, one of the main detention centres; it has been privatised, becoming a profit-making business. "I saw my solicitor three minutes before my interview with a Home Office representative, who remained silent. My application for asylum was refused 24 hours later". Within a week there is a deportation order.

About 400 women have contacted us from Yarl's Wood in the last three years. Threatened with a 12-hour night-time lockdown and the confiscation of their mobile phones - their lifeline to the outside world - and access to Sky television stopped, they decided to take action, starting with a hunger strike and protesting against the fingerprinting of their visitors. They naturally resent being treated as imprisoned criminals. We have responded with a series of press releases resulting in substantial public support, which we see as a major role for us.

There is provision for appeal against the denial of asylum, but if this fails the case is closed, and the outlook for a woman becomes virtually hopeless unless she can show that there is he a genuine risk to her life if she is returned to her home country; this requires new evidence. Overworked solicitors are very reluctant to become involved at this stage. Now the sharks begin circling, with fraudulent offers to stop the deportation order at a price of £3000, leaving a generous community with the bill.

One woman was deported on a plane to Uganda with her five children; all were handcuffed, and her treatment by the ten guards was little short of torture. A friend took in the children, but she was imprisoned by the authorities, and suffered further rape and torture. She succeeded in returning here, and a solicitor arranged photography of her injuries; in an outright lie the Home Office denied deporting her and her children. Only one of her children is with her, and her eldest daughter supports herself in Uganda by prostitution. There are similar cases, and clearly the authorities make no inquiry into the fate of deported women.

We lobby Members of Parliament, work with networks such as The Breastfeeding Network and with midwives, and hope that you my audience will play a similar campaigning part as numbers of prominent people have. We have petitioned the government to legislate so that rape is recognised as a form of persecution and torture. Our document "Misjudging rape", is based on the observations we have made in the asylum courts, where we see international gender guidelines blatantly flouted.

Newspaper articles have been helpful in raising public awareness, and the pressure we have applied has been successful in some if not all cases. Please write to the press wherever you see injustice to asylum seekers, criticise any colleagues who treat them inappropriately as we are criticising inadequate NGOs and the government. Our heads are above the parapet; we receive no funding to support our centre where two or three women volunteers work daily. We see no distinction between the suffering women and ourselves, all of us potentially seekers of asylum from an unfeeling authority.

Who are asylum seekers and what issues do they face?
Jacqueline Dunkley-Bent, Head of Midwifery, Guys and St Thomas' Hospital

Who are asylum seekers and what issues do they face?

Asylum seekers I know say that they are women who want to be believed; here are two official definitions:

An asylum seeker is a person who has submitted an application for protection under the Geneva Convention (1951) and is waiting for the claim to be decided by the Home Office.
A person is a refugee when their asylum claim has been accepted by the Home Office. Refugee status means that a person has been accepted under the Geneva Convention and granted indefinite leave to remain, which means permanent residence in the UK.


It is the waiting for asylum to be granted, for the women to be defined as refugees, which is causing them so much grief.

An asylum seeker's story.

Elizabeth came to me for counselling when she was pregnant as a result of rape. She had not revealed that she was 18 weeks pregnant on arriving in England for fear of deportation; she was sure that her story would not be believed. She had been tortured and abused in Rwanda, where she was made to witness the murder of her family; rescued and then hidden, she could finally escape Africa. Aged only 17, she was placed with a foster family who abused her mentally while her application for asylum was being processed. I was able to get her moved to the care of a supportive family.

Rejected by a number of general practices, she was referred to us by the Refugee Council, and she booked for her maternity care two weeks before attending my clinic, when 26 weeks pregnant. Her ability to cope with her experiences had collapsed, and she was in severe physical and psychological pain, made worse when she learned that she was HIV-positive.

Flashbacks to the Rwandan horror interfered with her developing a relationship with her baby girl. Social services, midwives, her health visitor and the new foster family all helped her to overcome this problem.

A reported 50% of asylum seeking women have been raped, and I am often asked why these women do not resort to termination of the ensuing pregnancies; they always say that they will not dispose in that way of the only family they now have.

You will readily see how many of the items in the long list of problems highlighted by the British Medical Association relate to Elizabeth's story:

Depression
Stress and related physical ill-health
Anxiety
Fear of people in authority
Oppression
Persecution
Rape
Pregnant as a result of rape
Rape during pregnancy
Homesickness
Separation from family
Deprivation of human rights
Political repression
Loss of status
Harassment, racial and other
Coping with new culture
Limited or no access to community networks
Uncertainty around claiming asylum in the UK
Anxiety about the outcome of seeking asylum
Fear of deportation
Fear of detention
Poverty
Anxiety and guilt about the fate of those left behind
Feelings of insecurity
Powerlessness
Inability to settle
Communicable diseases (hepatitis A, B, C, HIV/AIDS)
Parasitic infections
Fear of death
Flashbacks to witnessing death and torture
Malnutrition
Imprisonment
Injuries arising from beatings and torture
Held under siege
Forcible destruction of home property and body
Other

My preferred approach for the relief and improvement of Elizabeth's situation is multidisciplinary and multi-agency . This implies sharing information, so that women do not have to repeat their stories again and again and they can realise that they are believed despite the extreme nature of their descriptions.

A responsive service carries out a needs assessment, provides comprehensive information about available helping agencies in the local community. These include community groups and church leaders, access to services, engaging key stakeholders, and direct referral to a midwife. A skilled workforce exercises sincerity, empathy and positive regard, rethinking care pathways reflective of the needs of the community and engaging community groups in ways which may be outside our normal sphere of practice.

Providing care for asylum seekers reminds us of the need constantly to be revising practice.

The experience of providing care
Felicity Ukoko, Midwife, Guys and St Thomas' Hospital

The previous speakers have given a full account of the problems facing women seeking asylum in the UK. Among them is the difficulty of getting access to maternity care; my role has been to facilitate this, being a gatekeeper to services as all midwives are.
I have set up a weekly drop-in antenatal clinic in the Stockwell Euro Tower, but due to the frequent displacements which these women face their attendances are often brief. The numerous issues which they presented to me resulted in booking visits lasting up to two hours; they are wary of authority figures, and I had to listen to them and create a situation which they could trust. I encouraged them to use my contact telephone number at any time, initiated a file which they could take with them when they moved, and had interpreters present whenever required.

The women usually book late (average 24 weeks), are not taking folic acid and have not had the benefit of preconception advice; many have health problems related to the countries of their origin, are severely anaemic due to poor diet, and have mental health issues. Female genital mutilation and HIV/AIDS are common complicating factors. Some women, unaware that they carry the gene, have sickle-cell disease. Appropriate specialist referrals are made. The multitude of other problems have already been noted, and these are distractions from health education. Factors increasing the risk of maternal death are often present.

Asylum seekers may be discouraged from applying for the Maternity Grant to which they are entitled by the conditions of application: this must be in writing, and submitted four weeks before or six weeks after the birth. The Refugee Council helps them to complete the application, and as their advocate I do everything possible to make sure that they get the grant, despite their high mobility. Housed in deplorable accommodation, they are provided with bland repetitive meals, and I have had to press the accommodation providers to make sure that they get some fruit and vegetables. Relocation arrangements are often thoughtless, for example within days of the expected date of a birth, or to a remote city far from friends; if my assessment was requested it was sometimes successful in preventing these mistakes.

The value of my contact telephone number was confirmed when a woman displaced to a different area of London rang and described symptoms which told me that she had premature rupture of the membranes at 24 weeks. She had no idea of her location, but when I told her to dial 999 I later learned that she had been transferred by ambulance to a hospital with a special care baby unit with a successful outcome.

Not only do newly-arrived asylum seekers lack information about health services, but even if they are booked by a midwife and referred for specialist advice it is likely that we will not be informed of a relocation address to which recent data, not included in the file she carries, can be sent. If, as is often the case, asylum is denied, benefits are withdrawn unless an application is made for state aid under the European Commission General Block Exemption Regulation Section 4, Article 24; then these women are required to return to their countries of origin, an option often unthinkable for political reasons, or because of the stigma that they are pregnant and unmarried.

A homeless Congolese woman came to me when 28 weeks pregnant; she missed an antenatal appointment and returned at 34 weeks with hypertension requiring emergency caesarean section. When she and the baby eventually left hospital a church parishioner provided her with a tiny windowless room. Such is often the fate of women with no recourse to public funds; in abject poverty their health inevitably suffers, and they and their children add to the number of disadvantaged members of the UK community. As midwives we must be socially and politically aware if we are to make any difference and influence policy change.

The experience of not receiving care.
Janipher Maseko, All African Women's Group, Crossroads Women's Centre

An orphan in Uganda, I went to work for a couple; he raped me when his wife was out of the house, but when I reported this to her she didn't believe me and they beat me severely. Later criminals broke into the house, tied me up and threatened my life. With the help of a friend I sold my mother's property and used the money to come to England. I claimed asylum and got a college degree in social care.

I met my boyfriend in 2005 and bore him a daughter the following year. Despite the passport evidence of my age - I was 17 then - the authorities disbelieved this and refused my asylum claim. My benefits and housing benefit ceased, and pregnant with my second child I became homeless; I was only housed again when hospital staff appealed to social services, but after the birth I was homeless again with my children, and my property was thrown into a skip. We were sleeping rough, and the police locked me in a cell for four days without a shower or change of clothing. Although I was breastfeeding my baby Colin and told social services that I wanted to continue as their mother the children were placed in foster care,and I lost contact with them. I was still bleeding after the birth, and my breasts were painfully engorged. I felt that I was being treated worse than any animal.

Transferred to Yarl's Wood I was still in pain and sleepless, without a change of clothing or means of keeping myself clean. There was no medical care for me there, I was suffering the separation from my children, feared that I would be deported without them and was helpless. I was told that my daughter Chantal was not eating and was losing weight. No attempt was made to take my breast milk to feed the baby.

Then I was told about Crossroads Women's Centre , and I was helped to send a fax to the BWRAP, who were very supportive. On my behalf they contacted the Breastfeeding Network, midwives, a doctor and a Member of Parliament, with the result that immigration were forced to reunite me with my children in Yarl's Wood, which is no place for children. We were escorted everywhere and treated like criminals although we had done nothing wrong. Mothers were placed in a family wing where no health care was available. I was determined to resume breastfeeding, and finally succeeded. Chantal's eczema went untreated. If the children were sleeping or were not hungry at meal times they might have to go without food, which was in any case insufficient, of poor quality and poorly prepared.

Pregnancy was often used as a reason for forcible deportation, whatever a woman's state of health. I saw a woman covered in bruises after such treatment. Immigration wanted to deport me without my children - to steal my children, I thought. There is a book explaining the rights of asylum seekers, and with its help I eventually got the services of a solicitor. I am fighting a civil claim and the solicitor is making a new application on my behalf. At present I am the only African in poor hotel accommodation, where the manager discriminates against me, the only resident not permitted to use the washing machine among other deprivations. Our room is small, and there is nowhere for Chantal to play. My complaints are ignored; I am told that I complain too much. With no GP, my children and I were denied routine healthcare until the Breastfeeding Network intervened. The social worker is on the manager's side, not mine; the health visitor confirms that the children have the right to better accommodation.

Discussion

CR: We in BWRAP work closely with Women Against Rape , but partly because of the lack of funding these are the only two organisations of which I am aware that exist to help asylum seekers who are the victims of violence.

Despite the influential network attempting to support her, Janipher is still housed in completely inappropriate accommodation. She was separated from her children for two weeks; as soon as they were returned to her, she was told that they would all be deported in eight days' time. How inhumane is that? Midwives should be aware that this treatment breaks laws. We may expect this sort of abuse to be meted out in other countries, but are shocked to learn that it happens here. We are up against public and media indifference, and so the government know that they can get away with it. Your income tax is paying for this, and your silence is complicit.

It is shocking that there is no accountability within the walls of Yarl's Wood, where rationing of basic items such as breast pads and sanitary towels is at punishment levels. Doctors have set up the organisation Medical Justice to try to correct this anomaly.

There are workshops on how to get legal advice. Students from the School of Oriental and African Studies (SOAS) are going into Yarl's Wood, seeing the appalling conditions there, and advising inmates; some individuals, including very few Members of Parliament, are prepared to step in, and 11th hour interventions at airports to prevent flights taking women back to countries where they may fall immediately into the hands of the authorities can be effective. Bank holidays, when legal help is unavailable, are a favourite time for deportations.

A midwife was at a loss to discover that she was providing postnatal care to a failed asylum seeker; the only guidance she received was "Refer her to the Home Office". I am a member of Nursing Matters. We are there to help women who are nursing mothers and who are on the street. We can supply the hygiene basics, but it is now clear that our most effective resource is our loud and persistent voices.

Failed asylum seekers may receive care throughout pregnancy, birth, and postnatally, but they get a bill from the government of up to £3,000. The rules are largely unknown by midwives and hospital maternity departments.

A midwife drew attention to Birth Companions ; members of this organisation visit women in Holloway prison, some of them asylum seekers, and these women find themselves in the difficulties which have been so graphically described here on their release. About a quarter of the midwives who attend our training days have very negative attitudes to these women: "they are not entitled to care, they are wasting taxpayers' money, they are blocking beds". Once our information is given and absorbed compassion replaces these attitudes.

It was only when a woman who had been delivered by emergency caesarean section began to demonstrate severe mental disturbance that we learned of the horrific experiences to which she had been exposed before coming to the UK. She and her baby were transferred to a psychiatric mother and baby unit, the care most appropriate to her circumstances.

A midwife delivering outreach care described the Sanctuary GP Surgery in Hackney, London. Refugees and asylum seekers living locally can register there as patients and receive general health care and maternity services. Islington Council offers the same service at the expense of the borough, and it is hoped that other councils will follow this lead, especially if they know that public opinion supports them.

All present please be sure to email your Members of Parliament on this subject this evening.

It is important to know that under the law breastfeeding mothers may not be separated from their babies unless they are deemed to be a danger to them. Also in general they receive better treatment than women who are using formula. The World Health Organisation has recently published their view that it is safer for the babies of HIV positive women to be breastfed than to be given formula.

The Chair reflected on the duty of all health care workers to support women in need of their care whatever we may feel about their rights, and to lobby MPs and the media about the neglect to which so many women are being subjected.