Secondary care, maternity care and sexual health
Hospitalisation and the asylum seeker and refugee patient/service user
Most asylum seeker and refugee patients/service users can cope with hospitalisation without any difficulties. However, for some, certain aspects of the hospital experience can be extremely alienating and threatening, even for those asylum seekers and refugees without a reported trauma history.
Guidance on helping asylum seekers and refugees when admitted in hospital
- Avoid intimidating asylum seeker and refugee patients with a large number of staff surrounding their bed. Large ward rounds may be very threatening to some.
- Avoid frequent room changes and beds, where possible.
- Try minimising relocations as much as possible. Frequent moves around wards can remind asylum seekers of their migration experience.
- Explain why you are repeating blood tests to alleviate any anxiety.
- Where possible it is important to nominate a named nurse or medical representative to enable rapport and trust and this person can be the one who conveys information to the patient.
- Facilitate an asylum seeker or refugee's access to a health advocate or other appropriate professional to assist them in making major health decisions and to prevent them from feeling overwhelmed.
- Be prepared to repeat information, particularly if the client appears confused. Gain consent from an asylum seeker to inform the accommodation provider about their admission to hospital.
- Plan the discharge; where necessary providing a supporting letter to prevent dispersal to another area will ensure the continuity of care.
- Use a trained interpreter
Many refugee women will have had minimal exposure to formal hospital-based antenatal care. Previous deliveries may have taken place at home, often with the assistance of a traditional birthing assistant. Members of the extended family may have had a pivotal role in the postnatal care of mother and baby. Certain traditional foods or practices that may be difficult to access in the UK may be thought to be necessary in both the antenatal and postnatal period.
Pregnant women may be unfamiliar with the type of care available in the UK. If possible, offer a choice of a female health worker and interpreter. Interpreters should also be provided at antenatal classes. A hand-held antenatal record should be given, as for other pregnant women, which is particularly useful if women asylum seekers move accommodation. A woman who is pregnant as a result of rape will need especially sensitive support. She may face particular difficulties relating to her baby, although this is not universal. Women in many cultures are used to being supported by female family members when giving birth, and will feel their absence. Husbands and male partners are rarely the major sources of support and may be in an unfamiliar role. Dispersal can increase isolation, with separation from potential support networks.
Refugee women may have higher-risk pregnancies owing to some of the following factors:
- multiple spontaneous or elective abortions
- previous still birth
- neonatal death
- short spacing intervals between pregnancies
- female genital mutilation (see Female Genital Mutilation, p.87)
- recurrent UTI (possibly associated with female genital mutilation)
- pelvic infections (endemic, seldom treated, or resulting from
- sexual assaults or complications of FGM)
- pregnancy weight <45 kg
- anaemia <10 g/dh sickle cell disease, thalassaemia
- psychosocial issues
Women may also have complications related to nutritional and vitamin D deficiency, and infectious diseases such as schistosomiasis and latent TB.
Watch this short film describing the situation of pregnant women asylum seekers in the UK featuring Juliet Stevenson.
Dignity in Pregnancy for Asylum-Seeking Woman' (Refugee Council, 2013)
To find your nearest maternity service use the location search on the NHS website.
It is important to remember that some women and men of all ages may have experienced sexual violence either during the conflict in the country of origin or during migration, or at both times. This is used as a weapon; many victims may have HIV/AIDS. In many cultures stigma, fear and breaking confidentiality makes this a diffictult topic for anyone to report or disclose to health care professionals. Health care professionals should try to ask general or indirect questions. Burnett and Fassil suggest that making a short statement and then asking a question may be easier. For example 'I know that some people in your situation have experienced sexual violation. Has this ever happened to you?'
If an asylum seeker or refugee has become a victim of, or has AIDS, many organisations provide support and information. These include:
National AIDS and Sexual Health Line
Telephone number: 0800 567 123
(Free phone calls may be charged if made from mobile phones)
7 days a week, 24 hours a day
A 24-hour, free and confidential telephone service with advice about HIV and AIDS, sexual health, STD's, local services, clinics and support services.
Telephone number: 020 7713 0222
Women living with HIV answer the PW helpline. Helpline opening hours: Monday—Friday 10am — 4pm, late night opening to 8pm on Thursdays. PW offer to ring back free of charge.
Positively Women is the only national charity providing support for women living with HIV by women living with HIV:
- Providing specialist support by women living with HIV
- Enabling women to make informed choices
- Challenging stigma and discrimination
Terrence Higgins Trust
You can call THT between 10am and 10pm on Monday to Friday, and from 12 noon to 6pm on Saturday and Sunday.
Their advisers can provide emotional support if you are worried about your sexual health or have concerns about living with HIV, and can help you access services local to you across the UK.
Tel: 0845 1221 200
Global Network of People Living with HIV
The overall aim of GNP+ is to work to improve the quality of life of people living with HIV and AIDS. The organisation's focus is on building the capacity of people with HIV and AIDS on the global, regional and national level.
Tel: +31 20 423 4114 (Netherlands)
International Treatment Preparedness Coalition
The International Treatment Preparedness Coalition (ITPC) is a worldwide coalition of people living with HIV and their advocates. The ITPC advocates universal and free access to treatment for AIDS for all HIV positive people and greater input from HIV positive people in decisions that affect their lives. They work to achieve these goals at the local, regional and international level.
UNAIDS, the Joint United Nations Programme on HIV and AIDS, brings together the efforts and resources of ten UN system organisations to the global AIDS response.
African HIV Policy Network
The AHPN is an alliance of African community-based organisations and their supporters working for fair policies for people living with HIV in the UK. It also provides training, support, research and information. The AHPN is the only African organisation in the UK whose work is dedicated to policy, advocacy and representation at national level. Its major focus is on HIV and the sexual health of Africans in the UK.
Tel: 020 7017 8910
NAM National AIDS Manual
Aidsmap delivers reliable and accurate HIV information across the world to HIV-positive people and to the professionals who treat, support and care for them.
Tel: 020 7840 0050 (Monday—Friday, 9.30am — 5.30pm)
Tel: 0151 237 3989
Sahir supports people living with HIV or affected by HIV. They provide counselling and complementary therapies, training and information, a range of support services and access to other related services – for example, asylum issues, social work and welfare rights.
Please telephone to make an appointment to complete a membership form. All services are free and confidential to our members.
Office Opening Hours: Monday to Wednesday 10am – 8pm; Thursday and Friday 10am – 5pm
Lets talk FGM app
Lets Talk FGM is an Oxford Health iPad app designed to facilitate discussions about female genital mutilation (FGM) between health professionals and the people they serve. This app is only available on the App Store for iOS devices.
City of sanctuary maternity stream
Maternity Stream of the City of Sanctuary was started by a group of asylum seeking and refugee women who volunteered as Health Befrienders for the Refugee Council in Leeds.