In an exclusive investigation, Sian Norris reports how migrant women subject to NHS charges have had to pay to access abortion, while other family planning services are free

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NHS Trusts have charged up to 64 women more than £29,000 to access abortion care since October 2017, an exclusive investigation by Byline Times can reveal today. 

The data obtained through freedom of information requests made by Byline Times found that some women were charged more than £1,000 to access abortion at their NHS Trust, with the majority of women facing bills between £300-£600. The total bill across 15 Trusts was £29,533.71.

The women were charged according to the National Health Service Charges to Overseas Visitors Regulations 2017, which stipulate that anyone who is not ‘ordinarily resident’ in the UK must pay for most aspects of healthcare. 

Experts have warned that the system of charging some migrant women for abortion care risks forcing women to seek illegal means to end an unwanted pregnancy. Abortion remains governed by criminal law in Britain, although women have a legal right to abortion in the UK according to the exemptions laid out in the 1967 Abortion Act. 

“Not being able to pay for an abortion because of your migration status doesn’t mean you don’t need an abortion,” said Rachael Clarke, Chief of Staff at the British Pregnancy Advisory Service (BPAS). “There are plenty of women who might struggle to afford to return to their home country to access abortion care, or they may come from a country where accessibility to abortion is minimal, such as Poland. It means women will turn to illegally buying pills online – doing so is a crime that carries a life sentence”. 

To be considered ‘ordinarily resident’, a person’s residence in the UK must be “lawful, adopted voluntarily, and for settled purposes”. People subject to immigration control need to have indefinite leave to remain in the UK in order not to be charged under the regulations, and there is an exemption for asylum seekers and refugees, as well as victims of modern slavery. 

Women who are undocumented, whose visa has expired, who don’t pay the NHS surcharge — for example because they are only here for a short time — or who have had an asylum application refused, are not entitled to free abortion healthcare. 

A Government spokesperson clarified that “the NHS will determine, based on individual circumstances, whether an abortion is urgent taking into account considerations such as the stage to which the pregnancy has progressed and whether the recipient can reasonably be expected to leave the UK”.

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Multiple Barriers

The charging system imposes a range of barriers on women in need of abortion care. 

Many women who are not entitled to free healthcare are often unfamiliar with the UK’s healthcare system. They may not be registered with a GP or have an NHS number, or they may have struggled to register — an investigation last year found that 24% of GPs would not register a patient without proof of address, proof of ID or legal immigration status. A woman needs two registered medical practitioners to confirm continuing the pregnancy will harm her physical or mental health, in order to access an abortion in Britain. 

Once a woman finds a healthcare provider, the second barrier is the price tag. 

“The cost in itself is a huge deterrent,” explained Anna Miller, Head of Policy and Advocacy at Doctors of the World. “By default, these women don’t have a legal right to work or to get benefits, so having an unexpected bill is stressful at the best of times. They often have no feasible way to pay the bill, which can make them vulnerable to exploitation”. 

The final barrier is the ‘hostile environment’ policy programme introduced by former Home Secretary Theresa May. Migrant patients are at risk of being reported to the Home Office if they do not pay for the treatment within three months. 

“If a woman has an NHS debt on her Home Office file, that can be used as primary grounds to refuse an application for leave to remain,” explained Miller. “It puts women in a catch-22. They have to clear the debt in order for the application to progress, but they can’t work or claim benefits to raise money to pay the debt until they get their immigration status sorted”. 

These barriers create delays – and when it comes to abortion care, such delays can mean the difference between having a medical abortion and a more costly and complex surgical abortion, or not being able to access a termination at all. Abortion is only available up to 24 weeks of pregnancy in Britain, and only for medical exemptions during the final trimester. 

While Doctors of the World campaigns to end all forms of NHS charging, Miller argues that “there’s a particularly strong case for exempting abortion care from charges. Charging delays access to timely treatment and there’s a time limit on abortion”.

The Department for Health and Social Care also confirmed that no one should be denied, or have delayed, maternity services due to charging issues.

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‘It’s Not Accessible Unless it’s Free’

Our exclusive investigation comes as the overruling of Roe v Wade in the US has highlighted the fragility of abortion rights globally. 

“We have all been horrified by what is happening in the US, but it’s important to remember that women around the world have been denied their reproductive rights for years,” said Louise McCudden, MSI Reproductive Choices’ UK advocacy and public affairs advisor. “From Senegal and Madagascar to countries closer to home, such as Poland, Malta and Northern Ireland, where despite decriminalising abortion in 2019, many services are still not available. Abortion is essential healthcare and it is vital that everyone who needs it, is able to receive the care they need”.

“Women can get an IUD or the contraceptive implant fitted on the NHS, no matter what their migration status,” explained Clarke. “There’s no other way of describing this policy but as a moral judgement. There’s no logical line between allowing women to have the pill for free, but not abortion”. 

The charging system inhibits the right to choose for some of the most vulnerable women in society. 

“The end result is that it doesn’t make abortion a viable option for a lot of our patients,” said Miller. “When you are charging someone hundreds of pounds for abortion care when they don’t have a right to work, when they don’t have a right to benefits, they don’t have the option. Financial considerations should not come into whether or not you have an abortion and that’s why it’s so important abortion care is free to everybody. It’s not accessible unless it’s free”. 

Most women do not access abortion care in hospitals, with abortions performed by charities such as the BPAS and MSI Reproductive Choices on behalf of the NHS as well as privately. BPAS, for example, performed nearly half (43%) of all abortions in England and Wales in 2020, and 44% of all NHS funded abortions. 

“If women come to us and cannot afford to pay privately, and they are not eligible for NHS care, we find a way to treat them,” said Clarke. “Including through conversations with local NHS commissioners and via charitable donations. That’s our priority for the women we see”. 

“We would urge anyone forced to travel to access abortion care who is worried about the cost to contact us and we will do everything we can to support them,” said McCudden.

A Government spokesperson from the Department for Health and Social Care told Byline Times: “While some migrants or visitors to the UK may be required to contribute towards NHS treatment costs, we’ve always been clear that urgent care – which may include abortion – should never be delayed or withheld over charges. Patients should be told if costs apply to them but they should not be discouraged from receiving treatment”.

Since publishing this article, a further freedom of information response was received on 19 July from a Trust that charged six women a total of £11,323.56 for abortion care – bringing the total to up to 64 women and £29,533.71.

This article was produced by the Byline Intelligence Team – a collaborative investigative project formed by Byline Times with The Citizens. If you would like to find out more about the Intelligence Team and how to fund its work, click on the button below.

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