Eritrean refugee Helen* was two months pregnant when she left Calais refugee camp in France, hidden in the back of a lorry. But when she arrived in London, she immediately knew something was wrong. "I was in pain, and when I got up I saw that I was covered in blood."
Having boarded the lorry with 29 other desperate migrants, Helen was the only stowaway not to be found when police searched the vehicle at the border. "I was hiding under the flooring so they couldn't find me. It was a dangerous hiding place; unknowingly, the police were walking on top of me. I didn't think about the pain I felt. All I thought about was getting to England," she says.
On arrival though, the pain and panic kicked in. "The lorry driver shouted at me when he saw me, but I begged him to show me to the nearest police station," she says. Later, in hospital, a doctor confirmed that Helen had miscarried her baby.
As difficult pregnancies go, the circumstances don't get much more grim than preparing for a baby while fleeing your home in search of safety—and, for Helen, this pregnancy really was traumatic from beginning to end.
Like so many women in her position, Helen was regularly and repeatedly raped by traffickers while she made the perilous journey towards Europe. Amnesty International has testimony from several women of widespread rape and sexual assault occurring on the smuggling route.
"No women pass through the Sahara to Libya without being raped," Helen says. "We were all raped, all of us. They didn't use any protection. What they forced me to do will be an everlasting fire inside me, burning for the rest of my life."
Even for those whose pregnancies are not the result of violence and exploitation, being pregnant while on the move is incredibly challenging. A recent report by Doctors of the World (DOTW) found that nearly half (43.6 per cent) of vulnerable pregnant migrants across Europe don't have access to any antenatal healthcare—often because they can't afford the charges or because they fear arrest.
Of the pregnant women DOTW saw, nearly 20 per cent were in the process of claiming asylum, while a further 50 per cent had a more precarious immigration status—many as failed asylum seekers or undocumented migrants.
As well as struggling to access health care, half of pregnant migrants surveyed (48.8 percent) described their current housing situations as unstable, "meaning they could not be sure of having a roof over their head when they delivered."
Before making her journey to England, Helen was in a makeshift refugee camp called Isbergues, near Calais, where she met Marchu Girma of charity Women for Refugee Women, who has continued to support Helen since her arrival in the UK. (Full disclosure: I currently work as a communications executive for Women for Refugee Women, but was not involved in the trip to Calais and Isbergues.) There were no toilets or showers in the camp, much less any kind of healthcare. "We washed our bodies once a week when some volunteers came to take us to the showers," she says.
There was only one thing on my mind: to get to the UK, to reach a safe place where my baby and I could have a good chance at life.
"There were a lot of us and space was tight; five of us were sleeping on one mattress, and there was no sleep. During the day people would come in and out, and at night I would always be out trying to get on the lorries. One night I slept on my feet. There was only one thing on my mind: to get to the UK, to reach a safe place where my baby and I could have a good chance at life and feel safe."
Elsewhere in France, DOTW's patient Nehla—a Tunisian migrant—also struggled to access antenatal healthcare, despite the high risks associated with her diabetes. Like nearly 70 per cent of the pregnant women DOTW surveyed for the report, Nehla had no access to health coverage, and the charity had to intervene to request emergency state medical aid.
For Dr Sarah Boutros, who works in DOTW's London family clinic, this situation is all too familiar. Although asylum seekers and recognized refugees have access to free NHS healthcare in the UK, the vast majority of pregnant patients who Boutros sees in clinic are not eligible because of their immigration status.
Most have been in the UK an average of five years, many having previously been refused asylum, and nearly half have experienced violence—which often only comes to light during pregnancy. "Last year 46 per cent of the pregnant women we saw had experienced violence at some point—either domestic violence, violence during their route coming in, or violence back home—and about 15 per cent were identified as potential victims of trafficking. A lot of pregnancies are a result of violence and exploitation, and women just feel stuck," she explains.
"Access to healthcare is a major issue. We've seen 151 pregnant women over the last year, and nearly 90 per cent hadn't accessed antenatal care by the time they came to us. About 60 per cent of the women we saw had missed their 12 week scan, and about 25 per cent had missed their 20 week scan," Boutros says. "Not accessing antenatal care also puts women in labour at a much higher risk; last year we saw two women whose babies unfortunately died at birth," she adds.
Her mental wellbeing just deteriorated, there was a lot of anxiety, a lot of phone calls in desperate situations.
The main reasons why women don't access NHS care, she explains, are that: "they don't know what they're entitled to, they're very fearful of being reported, and they're very fearful of charging." The average antenatal care and delivery package, for an uncomplicated pregnancy, is about £6,000 to £7,000 for migrants—a huge bill for anyone, but particularly for the vast majority of DOTW's UK patients who live below the poverty line.
"The rules for accessing antenatal care are very clear that women should not be denied access based on their ability to pay, and this amount shouldn't be paid upfront—but there's also a lot of miscommunication," Boutros says. "In our clinic we spend a huge amount of time explaining what women are entitled to. We also do a full holistic assessment of all the woman's needs, we give them the vitamins they need, and then we would refer them either to the hospital or a GP practice, depending on how urgent it is for them to be seen."
As across the rest of Europe, unstable housing is a key issue facing vulnerable migrants in the UK. "A lot of people are moving from one place to another, couch surfing with friends and relatives, which is a major source of stress for pregnant women," Boutros says.
"We recently had a case of a lady who became homeless at 35 weeks of pregnancy. For about four to five weeks her housing was extremely unstable, so she wouldn't go to antenatal appointments because clearly that was not her priority. Her mental wellbeing just deteriorated, there was a lot of anxiety, a lot of phone calls in desperate situations."
Another of Boutros's patients, Anna*, received regular phone calls from the hospital, chasing her for payment. It lasted for three stressful months after her baby was born, despite having been recognized as a victim of trafficking. "The bill should just be canceled once you've been recognised as a victim of trafficking and started the asylum process," Boutros explains.
"It shouldn't really be part of our job, but advocating for women who are in the asylum process is an enormous part of what we do—fighting for housing, support, getting their healthcare bills scrapped. It's a huge struggle for vulnerable women and families even to get the support they're entitled to."
* Name has been changed