Reproductive Borders and Bordering Reproduction: Access to Care for Women from Ethnic Minority and Migrant Groups

最近的研究报告说，与白人妇女相比，非洲黑人/加勒比族裔背景的妇女的产妇死亡率有惊人的五倍差异，南亚族裔背景的妇女（特别是巴基斯坦人和孟加拉国人）的产妇死亡率几乎有两倍差异。COVID-19大流行加剧了这些先前存在的不平等现象，研究发现，超过一半的感染COVID-19的孕妇住院，8名死亡的孕妇中有7名来自少数民族群体。这些数字表明，目前生殖和孕产妇保健不平等的程度构成了严重的公共健康危机，需要对研究和政策进行彻底的重新思考。围绕移徙身份的结构框架进一步影响了国民保健制度免费保健的可及性和资格，加剧了少数民族妇女获得公平保健的障碍。法律地位不明确、不确定或不安全的人受到移民控制，只能通过健康收费安排获得国民保健服务；身份不稳定的人获得医疗服务甚至可能导致拘留和/或驱逐出境。法律地位的不确定性不仅阻碍了移徙妇女获得她们有权获得的护理，而且模棱两可的合法移徙往往被种族化，这样，来自少数民族背景的人可能在未经核实的情况下被推定为没有资格获得护理。这些严重不平等的证据已经在COVID-19之前引发了有争议的政策举措，与这种健康差异相关的问题越来越多地处于政策议程的前沿（例如，皇家妇产科学院是本研究提案的主要合作者）。虽然政策关注是受欢迎的，但一直缺乏足够丰富的方法来集中妇女的经历，同时将这些经历置于与移民身份相关的障碍中。关于保健专业人员在处理移徙身份相关护理所涉法律和伦理问题方面的作用，也缺乏证据。该项目将帮助填补这些明显的空白，其总体目标是利用对少数民族和移民妇女提供的生殖、产前和产后护理的研究，帮助克服公平生殖和孕产妇保健方面的障碍。我们的研究将询问法律和种族偏见之间的复杂交集，这些偏见被记录为在整个生殖生命过程中产生医疗保健障碍。利用哲学、生物伦理学、法律和社会学学者和实践者的跨学科团队的专业知识，具有国际和比较经验，我们将通过将其与将在妇女积极参与下产生的民族志案例研究进行对话，来询问将妇女经验置于背景下的理论和法律框架。这种多方面的方法将对不同的生殖阶段、生活经验和行动地点提供见解和理解。我们将推进一个方法上的创新框架，开发“呼叫与响应”方法，共同制作感官档案，参与以艺术为基础的参与式研讨会，鼓励不同行为者（少数民族和移民妇女、NHS专业人员、政策和倡导利益相关者、感兴趣的公众）之间的对话，以提高认识，加深理解，并为未来的政策战略奠定基础。该项目还将向从事跨学科定性项目的早期职业研究人员和研究生研究人员提供方法培训，从而促进人权中心的研究和研究培训目标。

Recent research has reported a startling five-fold difference in maternal mortality rates among women from Black African/Caribbean ethnic backgrounds and almost two-fold difference among women from South Asian (particularly Pakistanis and Bangladeshis) ethnic backgrounds compared to White women. The COVID-19 pandemic has exacerbated these pre-existing inequalities with studies finding that over half of pregnant women with COVID-19 were hospitalised and seven of the eight pregnant women who died were from ethnic minority groups. These figures demonstrate that the current levels of reproductive and maternal health care inequalities constitute a serious public health crisis which requires a radical rethink of research and policy. Structural frameworks around migration status further impact the accessibility and eligibility of free NHS care, intensifying the barriers to equitable healthcare for ethnic minority women. Those with ambiguous, uncertain, or insecure legal status are subject to immigration controls and are only able to access NHS services through health charging arrangements; accessing care with precarious status can even lead to detention and/or deportation. Not only does uncertainty about legal status deter migrant women from accessing care to which they are entitled, but ambiguous legal migration is often racialised, such that those from an ethnic minority background may be presumed to be ineligible for care without verification. Evidence of these serious inequalities has already spurred on controversial policy initiatives pre-dating COVID-19, and issues related to such health disparities are increasingly at the forefront in policy agendas (e.g. the Royal College of Obstetricians and Gynaecologists - who is a key collaborator of this research proposal). Whilst policy attention is welcome, there has been an absence of sufficiently rich approaches that centralise women's experiences whilst contextualising these within the barriers associated with migration status. There is also lack of evidence on the role of health care professionals in engaging with legal and ethical implications of migration status dependent care. The project will help fill in these notable gaps, with an overarching aim of utilising research into the reproductive, antenatal, and postnatal care provided to ethnic minority and migrant women to help overcome barriers to equitable reproductive and maternal healthcare. Our research will interrogate the complex intersections between legal and racial prejudice, which are documented to produce barriers to healthcare across the whole of a reproductive life course. Drawing on the expertise of an interdisciplinary team of philosophy, bioethics, law, and sociology scholars and practitioners, with international and comparative experience, we will interrogate the theoretical and legal frameworks that contextualise women's experiences, by bringing them into dialogue with ethnographic case studies that will be produced with the active participation of women. This multifaceted approach will give insights and understanding of different reproductive stages, sites of lived experience and action. We will advance a methodologically innovative framework, developing the 'Call and Response' method, co-producing a sensory archive, engaging in arts-based participatory workshops, to encourage dialogue across different actors (minority and migrant women, NHS professionals, policy and advocacy stakeholders, interested publics), to heighten awareness, deepen understanding, and ground future policy strategies. The project will also provide methodological training to early career and postgraduate researchers working on interdisciplinary, qualitative projects, thereby furthering both AHRC research and research training objectives.