London: Pregnant women living in the UK without documents are having to make difficult decisions about accessing maternity services, potentially risking their own lives and those of their unborn children, because of crippling fees imposed by the NHS, say charities.

Campaigners say vulnerable women already struggling to support themselves are being charged up to £6,000 (Dh31,834) for a normal birth, with emergency procedures such as Caesareans adding around £3,000, because of the 150 per cent surcharge introduced to prevent “health tourism” from outside the EU.

Family health doctor Clare Shorthall, who runs a weekly clinic for women and young children excluded from health care across London, said the charges are putting women in impossible situations.

“Most of the people coming to our clinic are living below the poverty line,” she said. “The [pregnant] women make their own calculations. They say, ‘maybe I’ll just see the midwife once’ or ‘maybe I’ll have a home birth’.”

Shorthall, from Doctors of the World, said clinicians are required to report unpaid bills to the Home Office. “I don’t think we should be acting as border guards,” she said. “That’s not the way that medicine works.”

The stories of two single women struggling to survive in London highlight how devastating these charges can be.

Ngozi, originally from Nigeria, had been in the UK for three years when she gave birth to her second child. Four months after the birth, which she described as traumatic, she received a bill for £4,134.50.

The 33-year-old has the right to stay in the UK for two and a half years in the first stage of a 10-year family settlement plan, but has no right to benefits.

She is now paying £20.50 a month out of the £120 she receives from her children’s fathers. “I didn’t know what to do,” she said. “They kept sending me red letters. I was threatened with court and bailiffs if I didn’t pay the money.”

Rose, a 36-year-old who fled an abusive relationship in Uganda, is another who was billed for antenatal care. She said she had arrived in the UK “stressed, worried and sick” when she was 27 weeks pregnant. “I didn’t go to a GP at first because I was told if I didn’t have enough money on me I wasn’t going to get any help,” she said. But when she started suffering abdominal pains she was persuaded to go and see Doctors of the World, who provide support for migrants afraid to use the NHS.

The group encouraged her to go for an antenatal check-up at the nearby Newham hospital, where she was asked for £329.

“They told me I had to pay for the services, they told me they couldn’t do anything for me if I didn’t have the money,” she said.

Confused and frightened, Rose gave birth to her daughter two weeks later with the bill hanging over her head.

She was finally able to get the charge waived on the grounds that she was claiming asylum, but that claim has since been rejected and she and her daughter are awaiting a second hearing — while sharing a one bedroom flat with another family in Plaistow, East London, and surviving on handouts from friends and food banks.

Maternity Action, a charity campaigning for pregnant women’s rights across the UK, said the costs are likely to be wholly out of the reach of almost all undocumented women, who are routinely charged “despite evidence that recent migrants face higher risks of adverse pregnancy outcomes than the general population”.

Many billed

Those billed for health care include refused asylum seekers, undocumented migrants who may have lost their status as a result of a relationship breakdown or an expired work permit, and those left in limbo as their asylum claims are processed.

If a trust is left with an unpaid bill of more than £1,000 it is required to pass the information to the Home Office, leaving women scared this will affect their prospects of being granted official status.

Migrants face higher risks of adverse pregnancy outcomes than the general population

A Department of Health spokesperson said that no woman should be denied treatment for maternity care. “Overseas visitors who are not entitled to free NHS health care will be charged for services, but this shouldn’t delay their treatment and we would never refuse services to pregnant women.

“Although she must be informed if charges apply to her treatment, those responsible for her care should be especially careful to inform pregnant patients that further maternity care will not be withheld,” the spokesperson added.

But Maternity Action say this is “likely to be of little comfort to women who are aware that a debt to the NHS can block further immigration applications”.

The charity believes that the charging policies have become more aggressive since the Immigration Act was introduced in 2014. Whilst the Immigration Act applies across the UK, the home nations have the power to decide who to charge.

Refused asylum seekers, for example, are exempt from secondary charges in Wales, Northern Ireland and Scotland.

— Guardian News & Media Ltd