The British Medical Association argues that charges for temporary migrants are unfair.

Proposed charges for immigrants to use NHS services aimed at stamping out so-called ‘health tourism’ will endanger pregnant women, advocacy groups have claimed.

The Immigration Bill, first proposed in October 2013 and passed by the House of Commons on 30 January 2014, is now subject to parliamentary scrutiny in the House of Lords and changes will be introduced over the coming year.

It aims to introduce a new requirement for temporary migrants who have only a time-limited immigration status to ‘make a contribution to the National Health Service’ when they access services including A&E (accident and emergency) services.

However, as the British Medical Association (BMA) points out, there are ‘significant variations in the length of time it can take different individuals to gain indefinite leave, which may result in inequity over who is liable to pay and who is not’.

The BMA also argues that the charges are unfair, given that many without indefinite leave status still work, pay their taxes and make national insurance contributions.

A government consultation asked people whether certain services, including maternity care, should be exempt.

That reported that NHS frontline staff believed ‘we must remain firm’ and not provide maternity care free for everyone because ‘some people’ are abusing the system by coming into the country early enough to have one or more antenatal appointments before giving birth on the NHS – without intending to pay.

Many groups, such as the Refugee Council, the Royal College of Midwives and Maternity Action, have joined calls to exempt pregnant women from all charges under the new bill, because of the potential risk to their lives and the lives of their babies.

About 15 per cent of all pregnant women will have childbirth complications that require emergency obstetric care, the World Health Organisation (WHO) estimates, meaning that giving birth without the option of accessible and affordable emergency health care actively endangers lives.

Doctors of the World (DOTW) UK, a humanitarian medical organisation which runs a free clinic in London for those unable to access mainstream healthcare, has gathered data on their patients which reveal that two-thirds of patients reported difficulty accessing healthcare in the past year because they did not know how to, faced administrative barriers or were denied access.

Lucy Jones, manager of the DOTW UK clinic, said: “Our experience is that confusion, misinformation and fear mean vulnerable people are not able to access essential care when they need it.”

“More barriers will only make it harder for the most vulnerable to access vital healthcare, including pregnant women who could be too frightened to go to A&E.”

And she added, “Doctors and nurses should be focusing on treating the sick not checking everyone’s status to see whether they should be charged… GPs must not become border guards.”

An advisor to the Royal College of Midwives, Janet Fyle, has echoed this sentiment, warning that midwives are being “used as immigration police” under current confusing rules about who should pay and who should not.

Current rules state that maternity services should not be withheld to any woman, however an overseas visitor identified as chargeable and wishing to receive maternity or antenatal care must pay for any services they receive.

Thousands of immigrant women are already thought to have been affected by current NHS charges for pregnancy and delivery care, with some cases running up costs of several thousand pounds.

The charity Maternity Action has conducted research based on interviews with 15 midwives and overseas visitors’ officers – the people whose job it is to pursue payment from those who are not eligible for free NHS care.

The research found that some women who fear charges they cannot afford are running away from antenatal units or giving false addresses.

Interviewees reported the story of one woman who was medically in need of a caesarean section but gave birth at home because she could not afford the charges.

The research also highlighted that hospitals interpret the charging rules differently, with some overseas visitors’ officers chasing up payments ‘vociferously’, while others give women a ‘shopping list of charges’ so that they can buy aspects of pregnancy or childbirth care according to what they can afford.

The Immigration Bill was introduced to stamp out so-called ‘health tourism’, where non-UK nationals travel here specifically to access free health services, however seven years of data from DOTW UK’s clinic shows that service users had, on average, been living in the UK for three years before they tried to access healthcare.

Almost half the patients reported no knowledge or understanding of the health system in the UK and their right to care and less than two per cent of people using the service had left their country of origin for personal health reasons.

“The scale of so-called ‘health tourism’ has been hugely exaggerated,” Lucy Jones said. “Most of our service users came to this country to work, or to seek safety from persecution, not to get medical care.”

Countries like Spain, France, Italy, Belgium, the Netherlands and Portugal have some charges for immigrant healthcare but, unlike the UK, do not charge pregnant women for antenatal care or childbirth.

Sierra Leone has run a Free Health Care Initiative for pregnant and breastfeeding women and children under five since 2010.

So why do we charge women in the UK?

A UK Home Office spokesman said that no woman should be denied access to maternity care as a result of their immigration status.

Yet when price is added to the long list of obstacles that already face immigrant women trying to access vital health care, many will find themselves forced to put their own lives and the lives of their babies at risk.