Perinatal outcomes among migrant women with no recourse to public funds or irregular status: A retrospective cohort study using the eLIXIR 'born in South London' data linkage

PROBLEM: Restrictive immigration policies limit maternity care access and exacerbate poverty and isolation among migrant women. BACKGROUND: In the UK, many migrant women face No Recourse to Public Funds (NRPF), restricting welfare access and making them liable for maternity care charges. Population-level evidence on perinatal outcomes remains limited. AIM: To examine perinatal outcomes among migrant women with NRPF compared with UK-born women, migrants with recourse to public funds, and migrants with unknown visa status in an ethnically diverse urban UK population. METHODS: We conducted a retrospective analysis of linked maternity and neonatal electronic health records (eLIXIR -Born In South London) from 2018 to 2023, including 44,634 pregnancies. Multivariable regression estimated adjusted risk ratios (aRR) controlling for sociodemographic and clinical characteristics. FINDINGS: Migrant women with NRPF had higher risks of adverse maternal outcomes (emergency caesarean aRR 1.74, 95% CI 1.55-1.95; severe maternal morbidity 1.49, 1.33-1.67). Their infants were more likely to have low Apgar scores (1.53, 1.07-2.16) and less likely to receive skin-to-skin contact (0.92, 0.88-0.97). Infants of women with NRPF did not show higher risk of neonatal death (1.44, 0.85-2.29), whereas infants of women with unknown visa status had the highest risks of preterm birth (1.24, 1.13-1.35), low birthweight (1.28, 1.17-1.39), and neonatal death (2.27, 1.81-2.86). CONCLUSION: Migrant women with NRPF and infants of women with unknown visa status face disproportionate risks of adverse outcomes. Addressing these inequities requires inclusive maternity care, accurate migration data collection, and reconsideration of NRPF and charging policies.