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

最近的研究报告称，非洲/加勒比黑人妇女的产妇死亡率比白人妇女高出惊人的五倍，南亚(特别是巴基斯坦人和孟加拉人)妇女的产妇死亡率比白人妇女高出近两倍。新冠肺炎疫情加剧了这些本来就存在的不平等，研究发现，超过一半的新冠肺炎孕妇入院治疗，死亡的8名孕妇中有7名来自少数民族群体。这些数字表明，目前生殖和产妇保健不平等的程度构成了严重的公共卫生危机，需要从根本上重新考虑研究和政策。围绕移民地位的结构框架进一步影响到国民保健制度免费服务的可及性和资格，加剧了少数民族妇女获得公平医疗保健的障碍。那些法律地位不明确、不确定或不安全的人受到移民管制，只能通过医疗收费安排获得NHS服务；获得状况不稳定的护理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止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歧视，因此那些少数民族背景的人在未经核实的情况下可能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新冠肺炎之前引发了有争议的政策倡议，与这种健康差距相关的问题越来越多地放在政策议程的首要位置(例如，皇家妇产科学院--他是这项研究提案的主要合作者)。虽然政策关注是受欢迎的，但缺乏足够丰富的方法来集中妇女的经验，同时在与移徙身份有关的障碍内将这些经验与背景联系起来。此外，也没有证据表明保健专业人员在处理移徙身份依赖护理的法律和道德影响方面所起的作用。该项目将有助于填补这些显著的空白，总体目标是利用对向少数民族和移民妇女提供的生殖、产前和产后护理的研究，以帮助克服公平生殖和产妇保健的障碍。我们的研究将询问法律偏见和种族偏见之间的复杂交集，这些偏见被证明会在整个生殖生命过程中产生医疗保健障碍。借助一个由哲学、生物伦理学、法律和社会学学者和实践者组成的具有国际和比较经验的跨学科团队的专业知识，我们将通过将妇女的经历与将在妇女积极参与下产生的人种学案例研究进行对话，来审问将妇女的经历纳入背景的理论和法律框架。这种多方面的方法将提供对不同生殖阶段、生活经验和行动地点的洞察和理解。我们将推进方法创新框架，开发“呼吁和回应”方法，共同制作感官档案，参与以艺术为基础的参与性研讨会，以鼓励不同行为者(少数民族和移民妇女、NHS专业人员、政策和倡导利益攸关方、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。该项目还将为从事跨学科、定性项目的早期职业和研究生研究人员提供方法学培训，从而促进AHRC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.