Access and engagement with maternity, social care and mental health services for perinatal migrant women with no recourse to public funds and irregular status: A cross-sectional study using the eLIXIR born in South London, UK, maternity-child data linkage

OBJECTIVES: In the UK, an estimated two million migrants are irregular or subject to No Recourse to Public Funds (NRPF) visa conditions, restricting welfare access and often requiring payment for NHS maternity care. The impact on maternity and perinatal service use remains poorly quantified. STUDY DESIGN: Retrospective cross-sectional study. METHODS: We used linked electronic health records from maternity, neonatal, and mental health services in South London (eLIXIR-BiSL cohort). The sample included 56,690 women with 67,308 pregnancies (Oct 2018-Oct 2023). Migration status was categorised as UK-born, migrants with recourse to public funds, NRPF, or unknown visa status. Adjusted risk ratios (aRRs) were estimated using generalised linear models, controlling for sociodemographic and clinical characteristics. RESULTS: Compared with UK-born women, migrants, particularly those with NRPF, had lower engagement with services. Women with NRPF were less likely to access early antenatal care (aRR 0.36 [0.33-0.38]), attend maternity triage (0.89 [0.82-0.96]), or birth in midwife-led settings (0.51 [0.36-0.71]). They were more likely to access care late (3.61 [3.33-3.92]), receive inadequate antenatal care (1.41 [1.30-1.53]), transfer providers (1.54 [1.36-1.74]), and experience prolonged postnatal stays (1.38 [1.21-1.57]). Women with NRPF had lower mental health care contact before (0.05 [0.03-0.08]) and during pregnancy (0.51 [0.37-0.69]), and reduced engagement with social care (0.36 [0.17-0.70]) and the criminal justice system (0.30 [0.19-0.44]). CONCLUSIONS: Migrants with NRPF or unknown visa status face persistent barriers to maternity and mental health care. Inclusive reforms are needed to address inequity.