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Why it is unethical to charge migrant women for pregnancy care in the National Health Service
  1. Arianne Shahvisi1,
  2. Fionnuala Finnerty2
  1. 1 Ethics, Brighton and Sussex Medical School, Brighton, UK
  2. 2 Sexual Health and HIV, Royal Sussex County Hospital, Brighton, UK
  1. Correspondence to Dr Arianne Shahvisi, Ethics, Brighton and Sussex Medical School, Brighton, East Sussex, BN1 9PX, UK; A.Shahvisi{at}


Pregnancy care is chargeable for migrants who do not have indefinite leave to remain in the UK. Women who are not ‘ordinarily resident’, including prospective asylum applicants, some refused asylum-seekers, unidentified victims of trafficking and undocumented people are required to pay substantial charges in order to access antenatal, intrapartum and postnatal services as well as abortion care within the National Health Service. In this paper, we consider the ethical issues generated by the exclusion of pregnancy care from the raft of services which are free to all. We argue that charging for pregnancy care amounts to sex discrimination, since without pregnancy care, sex may pose a barrier to good health. We also argue that charging for pregnancy care violates bodily autonomy, entrenches the sex asymmetry of sexual responsibility, centres the male body and produces health risks for women and neonates. We explore some of the ideological motivations for making maternity care chargeable, and suggest that its exclusion responds to xenophobic populism. We recommend that pregnancy care always be free regardless of citizenship or residence status, and briefly explore how these arguments bear on the broader moral case against chargeable healthcare for migrants.

  • Women
  • reproductive medicine
  • obstetrics and gynaecology
  • allocation of health care resources
  • sexuality/gender

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  • Contributors Both authors jointly conceived, wrote, edited and finalised this work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.

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