Dana was eight months pregnant when she arrived in the UK from Afghanistan. She was desperately weak after days without food and water, and was afraid her unborn baby had died during the treacherous journey in a shipping container.
After a short stay in hospital, she was discharged to initial accommodation for asylum seekers, where she attempted suicide. She was then moved to a psychiatric unit where she felt the other patients were a danger to her, so she escaped. After that, she was moved to UK Border Agency accommodation on her own in the south of England.
When the baby arrived, she left the hospital two hours after giving birth to go to the post office to claim her asylum seekers’ allowance, because she needed to buy baby clothes.
“It was freezing, but if I didn’t go I would lose my money. For £35, I left my baby, two hours after I gave birth,” she said.
Her story is one of several harrowing accounts recorded in a report on the dispersal of pregnant asylum seekers by the UK Border Agency for the charity Maternity Action. Dana’s case is extreme but it’s not uncommon.
Rosalind Bragg, director of Maternity Action, says dispersal is just one of several government policies on asylum seekers that increase women’s vulnerability to maternal mental health issues.
“These women are at high risk of poor physical and mental health during pregnancy and continuity is extremely important in ensuring their cases are managed as best as possible,” she says.
Other damaging policies include charging migrant women for NHS maternity care and detaining pregnant asylum seekers.
Maternity Action is lobbying the U.K. Home Office to change their approach to improve the situation for asylum seekers who are pregnant or have recently given birth, but Bragg says progress is slow and the subject is under researched.
Over half of migrants currently arriving in Europe are women and children according to new research by the UN High Commissioner for Refugees. The data reveals a significant gender shift from previous years, when up to 73 percent were men.
Many of these women require access to maternity services on arrival or shortly after settling in host countries. Most come having experienced some kind of trauma as victims of conflict and crisis. Some are survivors of sexual violence. This, coupled with the fact they have been separated from usual family networks and are often living in isolating circumstances, without knowing the local language, means they are highly susceptible to experiencing mental health issues in connection with the birth of their child.
While there’s little or no data on the numbers of migrant women experiencing pre- or post-natal depression in the UK or elsewhere, there’s increasing recognition among health professionals that more needs to be done to ensure these women get access to the services they require.
In a recent speech in London, the U.K.’s most senior midwife, Cathy Warwick, appealed to European governments to make sure “fellow human beings are treated with the humanity they should expect from civilized countries.”
She called for an end to the detention of pregnant asylum seekers and said midwives and other healthcare workers need to take direct action to ensure women are not failed by the system, whatever their circumstances.
The Royal College of Midwives is now working with the Royal College of Nursing and the British Institute of Human Rights to produce guidelines for clinicians to operate their practice in a human rights context, improving treatment for women and their babies.
While guidelines are useful, some argue current maternity services could still fall short unless programs are specifically adapted to meet the needs of migrants.
A recent briefing paper for the Race Equality Foundation said the low take-up of maternal mental health support services among migrant women was in part because of “Western-centric” diagnostic tools. According Zahira Latif, the paper’s author, clinicians may miss problems because migrant women don’t recognize their symptoms or report them in a culturally recognizable manner.
“In cultures where there is little understanding and awareness of maternal mental health-related illnesses, women may not be able to easily identify symptoms or, in other cases, women may understand symptoms, but be unable to recognize them or express them,” she says, adding that some women present physical symptoms that are in fact a result of underlying mental health problems.
In Dana’s case, she became angry and anxious in hospital after her daughter’s birth because she couldn’t communicate properly with staff. “I thought if I asked a question like how to change the nappy or anything they would be angry with me,” she says.
Once social services, with the aid of an interpreter, were finally involved, Dana’s situation improved, but many of the challenges she faced could probably have been avoided.
Latif says more research is needed to understand the extent of the problem, with targeted training offered to front-line medical staff to make sure barriers preventing women accessing the care they need are removed.
Failing to do so, could, argues Usha George, professor of Community Services at Ryerson University in Toronto, have long-term and wide-ranging financial implications for countries that host a high number of migrants. She’s been researching the mental health issues of South and East Asian immigrants in Canada since the 1990s. She says incidents of depression, “baby blues” and severe post natal psychosis within these groups are very common, but it’s not often reported or talked about.
“You don’t see many of these women resorting to alcohol because of their cultural background, so from that point of view the cost to society may not be obvious,” George says. “But the hidden costs could be really significant … We have to consider the loss to the work force and the well being of their families and their children.”
She says immigrant children who grow up with a depressed or withdrawn mother may experience delayed development or difficulties fitting in at school. They may also develop challenging behavioral tendencies, which can lead to more serious social problems in the future.
She says more work needs to be done in places like Canada and the U.K. to bolster social networks in immigrant communities. Women who feel less isolated and have people they can relate to are much more likely to find people to confide in, she says. “They will also feel empowered to use clinical services available to them.”