1 October 2018
1 October 2018
This factsheet provides information about applying for Section 4 support on the grounds of pregnancy or having recently given birth. It also provides general information about access to maternity services for refused asylum seekers and the particular risks such women face when pregnant. Updated 1 October 2018.
In this factsheet:
If you still have questions or need further information and advice after reading this factsheet, please contact our advice line on 020 3716 0283. It is open Mondays, Wednesdays and Fridays from 2pm to 4pm. Please note, this is a ‘second-tier’ advice line. This means that we can give advice to other advice workers but not to individual clients.
Refused asylum-seekers who are destitute and pregnant, and who do not meet any of the other criteria for Section 4 (s4) can qualify for support if they are unable to travel back to their country of origin. Support consists of accommodation and basic subsistence provided by the Home Office. If the Home Office refuses support, then there is a right of appeal to the Asylum Support Tribunal (AST).
For more information on s4 support, see factsheet 2.
The Home Office considers that women in the ‘late stages of pregnancy’ are unable to leave the UK as there is a physical impediment to travel.
According to page 11 of the Asylum support under section 4(2) policy: caseworker guidance:
‘Unless there are complications with the pregnancy supported by medical evidence that the applicant’s health and/or that of the unborn child may be at risk, support must not normally be granted until around 6 weeks before the expected delivery date (EDD).’
The NHS assesses the average length of pregnancy in the UK to be around 40 weeks, so 6 weeks before the EDD usually equates to the 34th week of pregnancy. If your client is 34 weeks pregnant or over, simply include a copy of the MAT B1 form with the section 4 application. A MAT B1 is completed by a registered midwife or doctor and states the week in which they expect the woman to give birth – the EDD. If the woman does not have a MAT B1, written evidence confirming the pregnancy and the EDD should be accepted.
Home Office policy is not to grant support earlier than 34 weeks ‘unless there are complications with the pregnancy supported by medical evidence that the applicant’s health and/or that of the unborn child may be at risk’.
NOTE: The Home Office’s guidance is not binding and women can be eligible for support at any stage in the pregnancy, provided they can show that they are unable to leave the UK.
When applying for support for a woman who is less than 34 weeks pregnant, it is a good idea to ask the midwife or doctor for a letter explaining:
When advising refused asylum-seekers who are pregnant, it is very important to ask if the woman is experiencing any difficulties with her current pregnancy or any previous pregnancies. Information concerning any complications would normally be written on the maternity notes. The midwife or doctor should refer to this in their letter and also explain why the complication places the health of the mother or child at greater risk if they were to travel.
Even if there are no known complications to do with the pregnancy, the midwife or doctor may still have concerns about advising the woman to travel. There are number of physical and social factors which create additional challenges for asylum seekers and other recently arrived migrants during pregnancy. These include: poor overall health, possible underlying and unrecognised medical conditions (including congenital cardiac disease, HIV/AIDS and TB), genital mutilation, the psychological and medical effects of fleeing war-torn countries, sexual violence, trafficking, language difficulties, homelessness and difficulties accessing maternity services. According to a confidential report into maternal health conducted in 2007: ‘Women who are socially excluded, such as asylum seekers or homeless people, have a disturbingly high risk of death’, pages vii & 32.
The midwife or doctor may decide that, because of these or other factors, there is a greater risk of harm to the mother or baby and therefore the woman should not travel. If so they should explain this in their letter to be submitted with the s4 application.
The Home Office also considers that women with babies under 6 weeks old are unable to leave the UK as there is a physical impediment to travel. If a woman has a new-born baby under 6 weeks old, she should apply to the Home Office as soon as possible with a copy of the child’s birth certificate or a document from a medical professional confirming the birth of the baby. It is important to remember that s4 applications can take some time to process. If, by the time, the Home Office makes a decision on the application, the baby is more than 6 weeks old, the application will be refused.
The Home Office disclosed its internal policy on s 4 in 2012, as a result of a High Court case (MK and AH v SSHD 2012). This document showed that the Home Office had taken an ‘interim decision’ not to discontinue support to destitute families with children. As of Oct 2018, this still appears to be the Home Office position. This means that, although the s4 policy says that support given to pregnant women will be reviewed when the baby is 6 weeks old, this does not happen in practice.
However, the Home Office will try and remove support from refused asylum seeking families if it believes that they are no longer destitute or they have breached other conditions of their support package.
In order to remove s 4 support from a woman with a child, the Home Office should demonstrate, under Section 55 of the Borders Citizenship and Immigration Act 2009, how they have discharged their duties in relation to the safety and welfare of the child. Please contact the ASAP advice line if you are working with families where the Home Office is trying to take away their support.
Refused asylum-seeking women who are pregnant and not in receipt of s4 support or s95 support may be charged for maternity services they receive. They are one of the groups not exempted from NHS charges to overseas visitors. However, it is very important to note that maternity care is classed as urgent and necessary treatment, which means that it must not be withheld from the woman if she is unable to pay. The woman, however, may be given a bill for the maternity care she receives and the hospital may pursue her for the costs.
It is not uncommon for a refused asylum-seeking woman to approach maternity services late in their pregnancy. If the woman has not yet presented to the maternity service it is very important that they are encouraged to make an appointment as soon as possible. Lack of maternity care puts pregnant women at serious risk.
If the woman is not registered with a GP it is possible for them to access maternity services directly. Many regions have drop-in maternity clinics and details about these, and accessing maternity services generally, can be obtained from local clinical commissioning groups (CCGs).
This is a complex area and eligibility for support may not be clear cut. It can take time to apply for and arrange support from the Home Office. If you are advising a pregnant refused asylum seeker who becomes destitute, we recommend that you contact ASAP’s advice line at the earliest possible stage.