This blog is part of SLSA blog series ‘Exploring people’s experiences of ‘law’ through the lens of migration’ (Edited by Dr Simran Kalra and Dr Fanni Gyurko), which takes a socio-legal approach to migration related issues in a variety of contexts and jurisdictions. In this blog-series we shift the focus from the nation-state understanding of migration to the ‘migrant’s perspective’. This blog-series is an opportunity to exploring new, migration-related research agendas and perspectives. 

Migrants and birth justice in the UK: why should we focus on the migration experience itself? 

 Dr Fanni Gyurko, Postdoctoral Researcher, University of Oxford, Faculty of Law (Centre for Socio-Legal Studies)

Anyone who has experience with the National Health Services (NHS) will agree that the NHS is riddled with informal rules, norms and practices. Neither getting access to health care services, nor the interactions with the health care providers are straightforward. Anyone who has tried to book an appointment with a General Practitioner knows that explaining our embodied experience is not enough, we must ‘play the game’ and say the right key words in the right order to gain swift access. We can easily imagine the difficulties that people experience who do not have the language skills, communication competencies and / or do not understand these norms or the ‘rules of the game’. 

In line with this we know that for example Central and Eastern European (CEE) migrants are often struggling to make sense of the UK healthcare system, and often sought (predominantly before Brexit) transnational care, both by stocking up on medicine, and seeking treatment and continuing to access health services in their home countries . More specifically to maternity care, CEE migrants have a particular struggle with transitioning to a less medicalised maternity system. 

UK Maternity care involves a complex web of legal rights (e.g. the right to safe and appropriate care, informed consent, freedom from discrimination), entitlements derived from policy and practice (birth plan, continuity of care), and organisational and social norms. Navigating these rights is challenging not only for migrants, as the UK Birth Trauma Inquiry (2024) found that pregnant people endured very poor experiences, suggesting that in general people in the UK have a lack of understanding of rights and / or a reluctance use them. ‘Birth justice’  encompasses access to maternity care, but also the right to culturally respectful labour, and that no aspect of pregnant people’s decision making is minimised or belittled.

In this blog, I argue that a focus on the migration experience itself should be considered as a valuable way of researching migrants’ access to birth justice, which involves antenatal care, birth giving and post-natal care. 

A gap in the research focus and knowledge: 

While specialised NGOs are paying increasing attention to Black and Asian minorities (who might be migrants) experiencing disproportionately poor maternity care and outcomes (including birth trauma), less focus is on how the aspects of migration itself affect access to birth justice. Similarly, UK policies increasingly address ethnic inequalities in maternity care, but without specific provisions for migrants. Existing qualitative research specifically addressing CEE migrants’ experiences is mainly focused on language barriers and communication issues. These are important factors as both academic and practitioner-led (policy, NGO) research found that according to mothers’ perceptions, more than half of the birth trauma issues were caused by interpersonal factors with medical professionals, such as poor communication (not being kept informed), and lack of compassionate care. . The MBRRACE-UK’s (2024) study of 25 migrant women (including 5 EU migrants, of which 4 spoke Romanian) showed that language barriers might also explain the low uptake and low quality of antenatal care for migrants. Attending antenatal care appointments and accessing services is an important factor in reducing negative outcomes for both birthing people and the baby. However, a study of Polish mothers in Scotland revealed that participants did not regard UK psychosocial antenatal care as valuable, preferring medical monitoring, which raises questions about the antenatal care provided in the UK, and whether it is in line with the requirements of birth justice, especially being culturally sensitive and respectful. 

Birth experience in the UK through an empirical lens: 

I first came across the intersection of migration and birth justice when conducting my PhD research with Hungarian migrants in Scotland. I was interested in migrants’ lived experience with informal practices and norms in their everyday life, and whether those practices migrate with them. Birth giving was one of topics discussed by my participants, because in Hungarian state-funded health care, it is often accompanied by informal practices. . These informal practices involve paying a significant amount of money (up to a Hungarian’s average monthly salary) to a ‘chosen doctor’ in the state-funded maternity care system, to avoid – what is coined in the UK – ‘postcode lottery’ (i.e. the quality of care being decided by which part of the country you live in). Access to adequate maternity care should be free within the health care system, therefore some of my research participants referred to this informal payment as ‘fear money’. The fear comes from the perceived threat that if something ‘goes wrong’ there is not a trusted person (in Hungary specifically a doctor, not a midwife) there to help. Access to (post-socialist) state-funded health care in many CEE countries often needs to be mitigated by informal practices, such as utilising social relations or providing informal payment. . 

Some of my research participants described that they either went back or were considering going back to Hungary to give birth. While it was an interesting finding in terms of exploring the pervasiveness of informal norms brought from their home country in the migrants’ life, it was also puzzling. Why would someone choose an arguably dysfunctional heath care system in Hungary over NHS Scotland? 

Then I had my own birth journey and experience in Scotland, which made it clear that such a decision is likely to be motivated by a desire of being in control of what happens during the birth, and it is about feeling safe and empowered. Navigating a new and unfamiliar system of health care is difficult enough for migrants, and there is the added pressure of the significant, life-changing event of giving birth. 

Migration as a significant factor:

My research participants described giving birth in Scotland as an ‘alien experience’, pointing out the lack of personal care and compassion. Yet others, who have not yet had a child, were worried about what a birth experience would entail, in reference to their experience with their General Practitioner – who they described as uncaring and unprofessional (‘Googling’ their symptoms on the computer). Others, who had been through the birth described how they were anxious and worried about the follow up visits from the health visitor, because they heard that if the health visitor perceives that the conditions are not suitable for a baby, then it can be taken away. On of my research participants described how she cleaned the house a couple of days after the baby was born, and locked the dog out in the garden, because she wanted to satisfy the health visitors. Finally, difficulties with family planning were discussed in terms of accessing childcare and economic circumstances. Many of the CEE migrants were working flexibly, experiencing precarious working conditions or taking night shifts. They were worried that they would not be able to take maternity leave – this was often related to the fact that if they became unemployed, they would not have access to some welfare benefits. One of the often-employed solutions for migrant families was to bring their (grand)parents to Scotland, who would provide free childcare. (This was in 2019, when these migrants were not worried about Brexit and the new point-based immigration system). 

These accounts point to many issues that are experienced by migrants when accessing birth justice, which go beyond knowing their rights. Moreover, all these accounts address issues related to migration or being a migrant in some ways. This raises questions about how migrants manage their ‘new life’ while also experiencing the transformative event of pregnancy, especially given that CEE migrants are likely to encounter precarities due to their status (insecure migration status, loss of perceived social status, problems with housing, precarious working conditions and trauma associated with migration).. 

The current (scarce) research on migrants’ access to birth justice in the UK is focused on the fact that migrants are also often minorities, with language barriers and low uptake of antenatal care. There are many contributing and interconnected factors that enable or deprive people of access to birth justice in the UK, however there should be a new research direction, which helps to disentangle issues of ethnicity, language, culture and migration experience.