In addition, approximately 1.4m migrants in the UK have leave to remain subject to the condition of ‘No Recourse to Public Funds’ (NRPF), meaning they have no entitlement to most state welfare support. These migrant groups are liable to pay secondary NHS charges, including hospital treatment and maternity care. These costs and lack of welfare support can result in financial hardship, unstable housing, isolation and a lack of access to services, thus posing public health risks. The associated harms fall disproportionately on women, children, low-income, minoritised and disabled groups and there is wide national variation in support offered.
Despite approximately 25 per cent of those with NRPF and/or irregular immigration status being women and children, little is known about their long-term health and social outcomes. Research into maternity services has found a lack of professional knowledge and guidance, and consistent errors in the assessment of immigration status, resulting in women wrongly being charged. Many women do not access essential antenatal care for fear of being charged for care they cannot afford. Experts recommend 'larger-scale and quantifiable research to assess maternity and wider welfare outcomes’.
This project aims to explore the long-term health and social outcomes of pregnant women and young children with NRPF, and to develop and evaluate multidisciplinary guidance to reduce inequalities. Two leading charities (Birth Companions and Maternity Action) will guide the direction and scope of the research, co-produce multidisciplinary guidance, disseminate findings through their networks and coordinate engagement with women with lived experience and grass-roots organisations. The project advisory group also includes charity groups (Birthrights, Happy Baby Community and Project 17), maternity care professionals and academic experts.
This novel research will address these significant knowledge gaps through four workstreams:
• Workstream one (November 2023-September 2024): A systematic review of the international literature to identify long-term health and social outcomes of pregnant migrant women and children up to the age of 5, the impact of High income countries integration policies, and an accurate proxy to measure women who are likely to have NRPF. A national mapping exercise will identify variation in local authority support available to pregnant women with NRPF, and how this aligns with the UK’s legal framework.
• Workstream two (October 2024-September 2025): Analysis of two well-established UK-based cohorts to explore differences in access, experiences and long-term health and social outcomes between women and children with NRPF/irregular immigration status, other migrants, and UK-born residents.
• Workstream three (October 2025-December 2026): Co-production of guidance for multi-disciplinary professionals using realist methodology. Women with NRPF who have given birth within one year, and stakeholders at six NHS trusts serving diverse populations will be interviewed to identify how access to services, experiences, and health and social care outcomes might be improved.
• Workstream four (January 2027-October 2028): Implementation and realist evaluation of the guidance at six pilot sites.
A group of approximately 6-10 women with lived experience of pregnancy whilst having NRPF will be recruited for the entirety of the project, although membership to the patient and public involvement (PPIE) and engagement group will evolve over the five years. Formal meetings will be held tri-annually throughout the research project with both the PPIE and project advisory groups. These will be used to update members on the progress of the research and ensure the focus remains embedded in the needs of those who the research aims to benefit.
Zenab Barry, an experienced peer researcher, Director of National Maternity Voices (until February 2024), and current PPI member of the South London ARC Maternity and Perinatal Mental Health Theme will have the role of PPIE advocate. Zenab will work with the project lead to ensure that the PPI group’s voice is embedded all in all aspects of the research. Zenab will also act as a PPIE mentor for the PPI members, enhancing research that involves strong, meaningful, and diverse patient and public involvement.
She will also provide reverse mentoring to the project lead. After the first-year other members of the PPI group will be given the opportunity to co-chair PPI and project advisory group meetings on a yearly membership to ensure varied and up to date involvement. The PPI advocate will continue the role of a mentor for the remainder of the research and will also be involved in the planned systemic review.
This sensitive project has brought together a team of experts by experience who are all passionate about exploring the link between the no recourse to public funds policy and migrant women’s maternal experience.
By continuing to build a trusting rapport with all participants, my role (and aim) is to support the latter through training and mentorship, to enable them to confidently lead the development and dissemination of outputs.
As a team, we have opted for a flexible and informal collaborative approach, with a special focus on trust-building and meaningful co-production
We aim to develop an enhanced evidence-base of the impact of the NRPF policy and NHS charging programme on women and children’s health and social outcomes, including guidance on what works to improve inequalities. We will share our findings with local communities, key stakeholders, policy makers and the scientific community
Maternity and perinatal mental health research at ARC South London