Women survivors of domestic and sexual violence, trafficking, and FGM are being doubly punished by NHS charges
In its latest report looking at the impact of NHS charging on migrant women, the charity Maternity Action finds that exemptions which apply for the treatment of conditions caused by certain types of violence are not working in practice.
The 11-page report, A Vicious Circle: The relationship between NHS Charges for Maternity Care, Destitution, and Violence Against Women and Girls, is available to read here.
Maternity Action says the report shows that women survivors of domestic and sexual violence, female genital mutilation (FGM), and trafficking are facing charges for their NHS maternity care when they become pregnant as a result of coercion or violence.
The report notes: "Certain groups of patients are exempt from the NHS charging regime including detainees, refugees or victims of human trafficking. There are also exemptions which only apply to those services provided for treatment of conditions caused by certain types of violence: torture, female genital mutilation (FGM), domestic violence or sexual violence (Regulation 9 (f) exemptions), provided they have not travelled to the UK for the purpose of seeking treatment. Patients who have been trafficked are also exempt (Regulation 16 exemptions).
"However, calls to Maternity Action indicate that these exemptions simply do not work in practice. The narrow ambit of the Regulation 9 (f) exemptions as only 'for treatment of conditions caused by' FGM, domestic violence or sexual violence shows little understanding of the complexity of women's experiences of FGM, domestic violence and sexual violence, of the barriers to disclosure, and how problematic it is for those responsible for determining whether a woman should be charged and chasing NHS debts to require women to provide evidence of VAWG [violence against women and girls]. This requirement to show causation between the treatment sought and the violence experienced is a high bar which contrasts with the exemption for victims of trafficking who do not need to prove that the NHS treatment directly related to the fact that they had been trafficked. However, even the exemption from all charging for victims of trafficking is still hard to use for many women simply because they are too afraid to disclose that they have been trafficked or they may be deterred by charging so that they do not engage with healthcare professionals at all."
Maternity Action says that there can be multiple barriers to women and girls reporting VAWG to the police, and migrant women face the additional hurdles of navigating an unfamiliar criminal justice system, language barriers, racism, and possibly fear of engaging with the authorities due to immigration status.
The report notes that women who are in the UK on spousal visas will lose their status if they leave the relationship and although they are eligible to apply for leave to remain due to having experienced domestic violence, many women are not aware that this option is open to them.
As a result, women fleeing abusive relationships that are the basis of their regular immigration status risk becoming undocumented and losing their entitlement to free NHS care.
The report states: "For the migrant women who contact Maternity Action for help in relation to NHS charges, often the only support available when leaving violent partners, other than that of members of their community, is support under Section 17 of the Children Act 1989. Section 17 support is not usually available to pregnant women unless they already have dependent children."
Migrant Action says not only do women become destitute as a result of a combination of trafficking, sexual and/or domestic violence, and the government's 'hostile environment' policies, but they are then exposed to further sexual violence and exploitation as these policies may push them into exploitative relationships.
Scarlet Harris, Head of Policy and Campaigns at Maternity Action, said: "What we are seeing at Maternity Action is women survivors of domestic and sexual violence, trafficking, and FGM being doubly punished by the NHS charging system which is driving women into debt and trapping them in abusive relationships. We recently heard from one woman who was living in such desperate poverty that she agreed to have sex with a man in exchange for a takeaway meal. She had become pregnant as a result and was billed over £10,000 for her NHS care. This is one of the reasons why Maternity Action has launched a legal challenge of the government's charging policy which we believe has a disproportionate, negative impact on women."
Maternity Action is crowdfunding for its legal challenge through CrowdJustice.