The Maternity Stream of Sanctuary

City of Sanctuary is a movement committed to building a culture of hospitality and welcome, especially for refugees seeking sanctuary from war and persecution Started in Sheffield 2011 – 12 groups groups over 60 groups ??

City of Sanctuary Streams Health Arts Welcome Schools Faith

The maternity stream in Leeds in 2011 The Refugee ‘s Council Health Befriending Network Trusting relationship, issues uncovered 6 women suicidal, over 50% domestic abuse 12% maternal deaths to AS&R only 0.3% population (Lewis 2007) Experiences of women shared at peer support meeting “I don’t want other women to suffer as I have suffered” Women need a voice Maternity Stream – a forum for change, led by women, working in partnership with health professional, researchers and third sector

NCT groups at Choto Moni Children’s Centre

A safe environment to share hopes, fears and experiences. “What you need is a friend”

Asylum issues affecting women who attend   Accommodation  Fear of 4 D’s dispersal, destitution, detention and deportation  Living in Limbo Lack of knowledge of support Lack of knowledge of support  A ccess to interpreters Lack of suitable interpreters key finding in CEMACE report 2011 – Lack of suitable interpreters key finding in CEMACE report 2011 – 12% maternity deaths to AS&R women though 0.32% population (Lewis 2007) 12% maternity deaths to AS&R women though 0.32% population (Lewis 2007)

Health issues pregnant AS&R women might face Mental Health issues. Stress and anxiety – miscarriage and small babies. Relive the horrors from home including seeing family members killed Family left behind Unhealthy diet HIV –cost NHS up to 1 million per baby! FGM Domestic violence Inspirational Women

Hunger

Should men be at the birth? Will I give birth alone? Compare maternity care back home and in the UK. Give women a choice and belief in themselves. More normal births??

Access to Antenatal Care for Pregnant Migrant Women(DOTW 2015) 2/3, Ist antenatal appt 2 nd trimester of pregnancy 50% less then minimal recommended antenatal care Nearly 1/3 billed for maternity care, up to £6,000 even after their baby died. "I am a lesbian. I had a forced marriage which is why I am pregnant. I had to flee for my life. At the hospital here they gave me an estimate for the cost of my delivery up to £9,793." London 2014

The Refugee Crisis Pre election 2015 wave of anti immigrationBirth and death in the Mediterranean Have attitudes changed? Government policy? Proud to be tough, not proud to protect “I believe this is our generation’s Holocaust. Our great-grandchildren will judge us on the compassion we showed. If you can help, please do.” Bethany Usher, The Northern Echo

2014 Immigration Act & refused asylum seekers/ undocumented migrants Entitled to access NHS maternity care but may be asked to pay for care. Maternity care is ‘immediately necessary’ care and must not be withheld because the woman is unable to pay in advance; antenatal, intranatal and postnatal care and HIV treatment May be asked to pay for secondary care considered ‘non- urgent’. This can be refused if the woman is unable to pay in advance. Only clinicians can decide on the urgency of treatment. GPs have the discretion to register refused asylum seekers Entitled to free NHS care for: compulsory mental health treatment, testing and treatment for communicable disease, emergency care provided in Accident and Emergency.

How can the maternity stream help? Aim to work with maternity services so they develop in a way that overcomes inequalities How? Improve access, experiences and outcomes of maternity services for AS&R women through the maternity SOS award

Maternity Service of Sanctuary (SOS) award Engage Maternity care provides 1.Learn 2.Embed 3.Share Use Maternity Stream resources Celebration and opportunity for reflective learning Written evidence AS&R volunteers help with learning Evaluation by appraisal group and presentation at award ceremony

The work of the volunteers Training in public speaking Created 2 Maternity Stream of Sanctuary films Monthly peer support meetings National and International nursing and midwifery conferences Chairing conferences Service users within a university Talking in parliament Maternity Services Liaison Committee Awareness raising sessions for women, student midwives, social workers, medics & university staff Consultation group for COST European research into birth Experts guest for COST in Europe

25+ Volunteers Bradford Service User group Recruitment Teaching Assessment Research “Before going, I felt too low for this place. How could I guide students when they know more than me ? I pushed myself, I had to do it.” “Afterwards I felt more confident, more human and valued” Young refugee mum from Ethiopia

So far…….. First Sanctuary award was received by the Haamla service in Leeds. The Haamla service support women and families from minority ethnic communities, including asylum seekers and refugees Conferences held at Bradford and Leeds Nominated Charity of the year by Bradford Midwifery Society Workshops held at Bradford University Leeds NCT branch and The Together Women Project (Leeds) are in the process of applying for the Sanctuary award Films made of women’s experiences and are being viewed across the globe!

Provide evidence to MPs about reality and experience of women to bring about change in policies What next? Maternity Stream in Hull – meeting on 8 th February pm, Fenchurch Children’s Centre, HU5 1JF Workshops to be held at University of York and Leeds Resource Pack – For services going for the award, links for online resources, case studies, give information beyond NHS How and why access maternity care – raising awareness session for women

Women’s stories ‘Excellence in Maternity care’ model The women and their stories on film ‘ The Pregnant Woman Within the Global Context’ model Other resources on the website urces Online e-learning resource for the RCM Articles in the BJM Maternity stream resources

Building a community 70 people attended Summer outing to Soltaire

This summer a weekend break in the Yorkshire Dales!

In Conclusion Pregnant AS&R women are a vulnerable group Volunteers can help women access services and improve experiences and outcomes of maternity care Through the Maternity Stream AS&R women have a voice Together we can address inequalities and improve maternity care for ALL women and their families

The Maternity Stream of Sanctuary Please like us on Facebook Follow us on Any questions ??

References BRISCOE, L. & LAVENDER, T Exploring maternity care for asylum seekers and refugees. British Journal of Midwifery, 17, CMACE Saving Mothers' Lives: reviewing maternal deaths to make motherhood safer: 2006–08. The Eighth Report on Confidential Enquiries into Maternal Deaths in the United Kingdom. London: CMACE. Department of Health (2008) Real Involvement: Working with People to Improve Health Services. HMSO, London. DH (2010) Volunteering- involving people and communities in delivering and developing health and social care services. HMSO, Leeds. DH (2012) Liberating the NHS: No decision about me, without me- Government response to the consultation. HMSO, London. SHORTALL C et al (2015) Experiences of Pregnant Migrant Women receiving Ante/Peri and Postnatal care in the UK. A Doctors of the World Report on the Experiences of Attendees at their London Drop in Clinic. GAUDION, A. & ALLOTEY, P Maternity Care for Asylum Seekers and Refugees in Hillingdon. A Needs Assessment. Uxbridge: Centre for Public Health Research, Brunel University. HAITH-COOPER, M. & BRADSHAW, G. 2013a. Meeting the health and social care needs of pregnant asylum seekers; midwifery students' perspectives: Part 3; “The pregnant woman within the global context”; an inclusive model for midwifery education to address the needs of asylum seeking women in the UK Nurse Education Today, 33, NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE Antenatal care. Routine care for the healthy pregnant woman. London: National Institute for Health and Clinical Excellence. WAUGH, M The Mothers in Exile Project. Women Asylum Seekers' and Refugees' Experiences of Pregnancy and Childbirth in Leeds. Women’s Health Matters.