Reproductive Borders and Bordering Reproduction: Access to Care for Women from Ethnic Minority and Migrant Groups

Recent research has reported a startling five-fold difference in maternal mortality rates among women from Black African/Caribbean ethnic backgrounds and almost two-fold difference among women from South Asian (particularly Pakistanis and Bangladeshis) ethnic backgrounds compared to White women. The COVID-19 pandemic has exacerbated these pre-existing inequalities with studies finding that over half of pregnant women with COVID-19 were hospitalised and seven of the eight pregnant women who died were from ethnic minority groups. These figures demonstrate that the current levels of reproductive and maternal health care inequalities constitute a serious public health crisis which requires a radical rethink of research and policy.

Structural frameworks around migration status further impact the accessibility and eligibility of free NHS care, intensifying the barriers to equitable healthcare for ethnic minority women. Those with ambiguous, uncertain, or insecure legal status are subject to immigration controls and are only able to access NHS services through health charging arrangements; accessing care with precarious status can even lead to detention and/or deportation. Not only does uncertainty about legal status deter migrant women from accessing care to which they are entitled, but ambiguous legal migration is often racialised, such that those from an ethnic minority background may be presumed to be ineligible for care without verification.

Evidence of these serious inequalities has already spurred on controversial policy initiatives pre-dating COVID-19, and issues related to such health disparities are increasingly at the forefront in policy agendas (e.g. the Royal College of Obstetricians and Gynaecologists - who is a key collaborator of this research proposal). Whilst policy attention is welcome, there has been an absence of sufficiently rich approaches that centralise women's experiences whilst contextualising these within the barriers associated with migration status. There is also lack of evidence on the role of health care professionals in engaging with legal and ethical implications of migration status dependent care.

The project will help fill in these notable gaps, with an overarching aim of utilising research into the reproductive, antenatal, and postnatal care provided to ethnic minority and migrant women to help overcome barriers to equitable reproductive and maternal healthcare. Our research will interrogate the complex intersections between legal and racial prejudice, which are documented to produce barriers to healthcare across the whole of a reproductive life course. Drawing on the expertise of an interdisciplinary team of philosophy, bioethics, law, and sociology scholars and practitioners, with international and comparative experience, we will interrogate the theoretical and legal frameworks that contextualise women's experiences, by bringing them into dialogue with ethnographic case studies that will be produced with the active participation of women. This multifaceted approach will give insights and understanding of different reproductive stages, sites of lived experience and action. We will advance a methodologically innovative framework, developing the 'Call and Response' method, co-producing a sensory archive, engaging in arts-based participatory workshops, to encourage dialogue across different actors (minority and migrant women, NHS professionals, policy and advocacy stakeholders, interested publics), to heighten awareness, deepen understanding, and ground future policy strategies. The project will also provide methodological training to early career and postgraduate researchers working on interdisciplinary, qualitative projects, thereby furthering both AHRC research and research training objectives.