THE EQUALITY IMPLICATIONS OF BEING A MIGRANT IN BRITAIN
There is evidence of pressures on maternity services, where women arrive late in the pregnancy, making planning service provision difficult (IoCC/LGA, 2008). In some areas the increase in birth rates among migrants is said to have contributed to the closure of some units, so that midwives could be moved to areas of more urgent need 27 . The London Strategic Health Authority argued that the increase in the number of births to migrant women, and the fact that ‘births within migrant groups can often be more difficult, more dangerous and more expensive – with much higher rates of type 2 diabetes, tuberculosis and HIV among mothers who often turn up very late in their pregnancy’, partly explained why maternity services in London performed poorly. In central London, senior consultants and health managers put the blame for unacceptably poor standards on a lack of resources to deal with the pressures of migration 28 . In their study of the impact of migration on maternal and infant health in the West Midlands, Taylor and Newall (2008) concluded that infant mortality was a significant problem among large migrant communities with high levels of deprivation. Although the data is poor, there is evidence that children of migrants have a higher stillbirth rate than those born to British mothers in Birmingham. Among the various migrant groups, women seeking asylum and the growing number of women with ‘No Recourse to Public Funds’ are particularly vulnerable. The authors recommend that ‘infant mortality strategy must take account of the needs of migrants, including developing methods to systematically monitor the impact of migration and immigration policy upon outcomes, and ensuring that services meet needs and that a multi-sector approach is required in order to address infant mortality within this group, as so many of the issues relate to the “wider determinants of health”’. 8.5 Sexual orientation No literature was found on sexual orientation, health and migrants. Even the literature on HIV/AIDS tends to focus separately on gay men, in isolation from other at-risk groups such as Africans, sex workers and injecting drug users. 8.6 Conclusions In spite of a great deal of concern about differential health needs and outcomes among migrants, there is very little data on migrants and health services as such. There is, however, substantial research evidence about the difficulties migrants may have in accessing appropriate services, which may itself then lead to strains on services because of late or inappropriate access (use of A&E instead of GPs, or late presentation of pregnant women to maternity services and hospitals). The long-term 27
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