The attitudes of midwives towards NHS fee-charging and data-sharing policies for migrant mothers in the UK: A Q-methodology study

Barclay, Ella

Abstract

In 2012, the UK government announced its intentions to create a “hostile environment” for its undocumented residents. As part of this, fee-charging and data-sharing practices were introduced within maternity care for individuals not “ordinarily resident” within the state. Despite efforts to separate the provision of care from the identification of chargeable persons, evidence indicates that midwives are often responsible for implementing these policies. This has transformed the attitudes of midwives into key health determinants for migrant women, yet they remain under-researched. In response to this knowledge deficit, a Q-methodological approach was taken to capture and analyze midwives' attitudes towards fee-charging and data-sharing practices. Twenty-one midwives were purposively recruited and asked to rank a range of statements relating to these policies and their wider impact, based on level of agreement. These statement rankings were then factor analyzed and four distinct belief clusters were identified: Dismayed Policy Sceptics, Medical Tourism Critics, NHS Value Preservers, and Citizen Partisans. Although some areas of consensus were evident, the interpretation of these factors highlighted significant variation in midwives’ experiences of fee-charging policies in daily practice. Contrary to previous literature, the Medical Tourism Critics reported feeling grateful that such policies existed, as they protected the NHS from exploitation. Though this constituted a minority opinion, it indicated the need to improve current practices, rather than overhaul existing policies. Reflecting on these findings, this paper presents recommendations to improve efficiency and alleviate conflict around the implementation of fee-charging policies within maternity care.

• Journal Article Type: Article
• Acceptance Date: Nov 21, 2024
• Online Publication Date: Dec 13, 2024
• Deposit Date: Dec 4, 2024
• Publicly Available Date: Jan 3, 2025
• Journal: Women's Reproductive Health
• Print ISSN: 2329-3691
• Electronic ISSN: 2329-3713
• Publisher: Taylor & Francis
• Peer Reviewed: Peer Reviewed
• DOI: https://doi.org/10.1080/23293691.2024.2434221
• Keywords: Hostile environment; healthcare charging; maternity care; undocumented migrants; midwives
• Public URL: https://uwe-repository.worktribe.com/output/13506754
• Publisher URL: https://www.tandfonline.com/journals/uwrh20