New report from Maternity Action looks at the impact of NHS charges on maternity care

The charity Maternity Action last week released a comprehensive new report examining the impact on midwives of NHS charges for maternity care.

The 53-page report is available here.

According to Maternity Action, the report is the first to investigate whether and how NHS charging affects the work of health care professionals.

Maternity Action notes that while migrant women are not required to pay in advance for maternity care, the NHS charging regulations nevertheless have a deterrent affect and leave migrant women anxious about costs.

The report states: "the impact of NHS charging is to exacerbate inequalities in access by deterring women from attending care. They also suffer increased mental distress at the prospect of incurring a debt to the hospital and of probably being reported to the Home Office."

The report finds that NHS charging is especially damaging for undocumented migrant women, many of whom are socially and economically marginalised and vulnerable.

According to Maternity Action, migrant women in vulnerable situations are at particular risk for developing perinatal mental health problems due to emotional stress, exacerbated by the financial burden of charging, low socio-economic status, unemployment and social marginalisation.

The report finds that undocumented migrant women "face multiple and overlapping barriers to healthcare, including language difficulties and a lack of understanding about how the NHS works, discrimination and demands for documentation when registering with GPs. Previous negative experiences with health services can also mean that migrant women can be reluctant to engage with care again."

It continues: "Women also fear being reported to immigration enforcement and being charged for NHS care. Women seeking asylum reported having been 'blocked' or refused by reception staff acting as gatekeepers, often in conjunction with expectations or experiences of prejudice and discrimination. Similar gatekeeping is also experienced by undocumented migrants. For all these reasons, vulnerable migrant women's access to maternity care is likely to be more limited and to start later than for the rest of the population."

In terms of the impact of the NHS charges on the work of midwives, the report finds there are three main consequences:

• Midwives face conflicts in their professional practice as a result of charging
• They also experience an increased workload as a result of women's responses to charging
• They find themselves having to deal with ethical dilemmas about how far they need to engage with the charging regime

Maternity Action concludes: "This study shows that the division of the NHS into free treatment for the eligible and punitive charges for the 'ineligible' not only has a detrimental effect on how patients engage with it, but also changes health professionals' relationships with their patients. This is particularly damaging in the case of maternity care, despite its 'immediately necessary' status, as creating a relationship of trust is absolutely central to midwives' roles. "

Maternity Action makes a number of recommendations and calls on the government to immediately suspend charging for maternity care, given the deterrent effect on women's access to maternity care.

Gill Walton, Chief Executive of the Royal College of Midwives, said: "This report makes for sobering reading as it demonstrates the dilemma midwives in England face when caring for women who are required to pay for their maternity care. Women affected by these charges are some of the most vulnerable people in our society. But attempts to recover money from these women seem to be driving a wedge between midwives and the women who desperately need their care."

"The recommendations from this report, if implemented, will absolutely improve the situation for vulnerable migrant women and the midwives who care for them, and begin to right the wrongs of Cost Recovery. We recommend NHS Trusts, commissioners and most of all, the government, listen to the voices of midwives in this report and do the right thing."

In response to the report, a government spokesman from the Department of Health and Social Care told the Guardian: "We take the provision of maternity services very seriously – and we will never refuse maternity care, regardless of whether someone can pay. Every taxpayer supports the health service and so it is only right that overseas visitors contribute towards their treatment costs, but exemptions are in place to protect vulnerable people who receive care free of charge."