After migration

When I was trying to decide on a topic for my dissertation, one of my priorities was making sure it was relevant, up to date, useful. As it's turned out, there are few topics that are currently more relevant than migration.

The news is flooded with stories about migrants - people so desperate to get away from dire situations that they're taking great risks and going to great lengths to do so, without being sure of the reception they'll get at the other end. It's not a new phenomenon, but it seems that it is a growing one.

Getting to a new country is only half the battle and I wanted to explore part of this, part of how migrants cope after their arrival, so I set out to examine one aspect of this - access to healthcare, specifically antenatal care. It seems like most of my friends are pregnant at the moment and I began to wonder: what would it be like to be pregnant in a foreign country, with an unfamiliar health system, unfamiliar people and an unfamiliar language?

To do this, I set off back to Belfast for a month, to a context that I was very familiar with. I remember roughly the time that migration started to increase in Belfast. As I was growing up, it seemed like a very white, very 'Northern Irish' place. It seemed like everyone I knew came from families that had been in Northern Ireland for generations. I first noticed a change around the mid 2000s, when men with skin far darker than the average Northern Irish native (which is generally so white it could blind you) appeared, selling the Belfast Telegraph at the traffic lights. I was later to learn that they were mostly Eastern European. In 2004, the European Union expanded to included countries such as Poland and Slovakia and in 2007, it expanded further to include Romania and Bulgaria. As a result, migration from those countries to the UK increased hugely. It interested me: how did these people find living in Northern Ireland, a place so unique in its historical and political context?

During my research, I interviewed eighteen mothers, mostly, but not all, from Eastern Europe, talking to them about their experiences of Northern Ireland, of healthcare, of being pregnant and giving birth. All the mothers had had some form of antenatal care, though with significant variation - some had only seen a GP a few times, others had seen GPs, midwives, physios and attended antenatal classes.

As a very brief overview of the anthropological theory, without using big words (other than anthropological - sorry), which I barely even understand...I wanted to investigate the barriers to antenatal care that were caused by the social structures, both within Northern Irish society and within healthcare. I wanted to find out if these barriers were fixed and rigid, or whether the mothers were able to manoeuver within them, to make do despite the constraints.

The main barriers I found were:

Language - poor English lead to reluctance to see health professionals and difficulty in communication, often leading to suboptimal healthcare. Interpreters were available, but often inefficiently organised.

Lack of knowledge - for those who have grown up with the NHS, they generally know how it works. For those who haven't, it can be difficult to navigate. The GP is the gateway to most services, but in many countries, there is no equivalent of a GP, instead, if you have a heart problem, you see a cardiologist, if your child is sick, you see a paediatrician, if you're pregnant, you see a maternity specialist. GP and other services may be misused or underused if their use is not understood.

Racism and marginalisation - Northern Ireland has been labeled the "race hate capital of Europe" and racist incidents have increased exponentially over the last ten years, which can lead to exclusion from public services, often even self-exclusion or reluctance to seek help.

Lack of faith in the health system - many of the mothers had had bad experiences of the NHS, for numerous reasons and this had led to a reluctance to seek medical care. One mother would return to her home country annually and would see her doctor for a check up there instead of seeing a doctor in Northern Ireland.

Despite these constraints, I found that the mothers were resilient - they managed, they made do. If they weren't confident in their language ability, they would write lists before seeing the GP, if they didn't know something, they would ask their friends or look it up online and they would share knowledge, if they experienced racism, they would do what they could to remove themselves from those situations.

There is no one easy way to make access easier for migrants, largely due to the fact that they come from numerous countries and backgrounds but I learned one overarching lesson: Migrants can be tenacious, not passively accepting limiting structures. So, solutions need to start from a place of asking - how can we facilitate what they are already doing to survive? How can we minimise the barriers and maximise their chances to act? This is an issue that is only going to increase in the coming years, and now is the time to address it.

#migration #migrant #antenatalcare #northernireland