Reading for refusal in UK maternity care: entangling struggles for border and reproductive justice

Abstract

Research has shown that women with insecure immigration statuses in the United Kingdom (UK) are more likely to register later in their pregnancy with National Health Service (NHS) maternity care providers. This late engagement with healthcare services is framed in academic debates as one of the key reasons for poor outcomes for these women and their children during and after birth. Interventions, therefore, have focused on how to remove barriers to accessing maternity care for these women. In this paper, we argue that this approach fails to account for the agency of the women adequately, which needs to be understood in the context of state harms and violence towards women with insecure immigration statuses and, in particular, their reproductive lives. We seek to shift these debates by framing this lack of early engagement with state-provided maternity services as a form of refusal that denotes an active disengagement by bordered women from intersecting structures of harm and oppression that are embedded in the UK’s National Health Service, particularly through the charging regime. We argue that the politics of refusal in this case are embedded in struggles not only for border but also reproductive justice. Drawing on participant observation and data from secondary sources, we illustrate how refusal of early antenatal care opens pathways for bordered women to seek the care-ful conditions they need and want during pregnancy.