Why it is unethical to charge migrant women for pregnancy care in the NHS

Pregnancy care is chargeable for migrants who do not have indefinite leave to remain in the United Kingdom. Women who are not “ordinarily resident,” including prospective asylum applicants, some refused asylum-seekers, unidentified victims of trafficking, and undocumented people are required to pay substantial charges in order to access antenatal, intra-partum, and postnatal services as well as abortion care within the NHS. In this paper we consider the ethical issues generated by the exclusion of pregnancy care from the raft of services which are free to all. We argue that charging for pregnancy care amounts to sexdiscrimination, since without pregnancy care, sex may pose a barrier to good health. We also argue that charging for pregnancy care violates bodily autonomy, entrenches the sex-asymmetry of sexual responsibility, centres the male body, and produces health risks for women and neonates. We explore some of the ideological motivations for making maternity care chargeable, and suggest that its exclusion responds to rising xenophobia. We recommend that pregnancy care always be free regardless of citizenship or residence status, and briefly explore how these arguments bear on the broader moral case against chargeable healthcare for migrants

Charging migrant women for pregnancy care is a worrying sign of the times [weblog article]

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Osteoporosis in postmenopausal women living with HIV

The widespread availability of effective antiretroviral therapy (ART) has transformed HIV from a life-limiting condition to one with near-normal life expectancy. HIV is associated with an increased risk of osteopenia and osteoporosis, with people living with HIV (PLHIV) potentially experiencing these conditions at a younger age than their HIV-negative counterparts. The mechanisms driving bone disease in HIV are complex and include: an increased prevalence of traditional risk factors; other comorbid conditions; and HIV-associated factors such as viral effects, systemic inflammation, and ART-related factors. One-third of PLHIV in the United Kingdom are female, and increasing numbers of women living with HIV (WLHIV) are reaching menopausal age. Oestrogen decline in the context of an elevated background risk of poor bone health results in WLHIV being at greater risk of osteoporosis than women without HIV. European HIV guidelines therefore recommend routine screening of postmenopausal WLHIV using FRAX(©) for clinical risk factors, with or without bone mineral density scanning. Data support the use of calcium and vitamin D supplementation, and bisphosphonates in the treatment of osteoporosis in PLHIV. Additionally, some patients with confirmed osteoporosis may benefit from a switch to an ART agent with a better bone safety profile. However, there remains a notable paucity of data on HIV and menopause, including the impact of hormone replacement therapy on the bone health of WLHIV. In conclusion, it is important that clinicians are aware that postmenopausal WLHIV are a group at particular risk of bone disease, who require proactive screening and advice about preventative measures

The health of recent migrants from resource-poor countries

The care of people who have recently migrated from resource-poor countries requires careful consideration by healthcare providers. Innovative approaches are called for to reduce the significant inequalities in health compared with UK-born and long-term migrant populations. Primary care physicians are best positioned to improve the early diagnosis of imported infections such as tuberculosis, HIV, malaria, hepatitis and enteric infections, thus avoiding the high cost of emergency presentations with advanced disease. Culturally sensitive approaches are required when managing stigmatizing diseases. Common non-communicable conditions and psychiatric morbidity should not be overlooked. Pregnant women who have recently entered the country are at risk of worse birth outcomes. A significant number of people are denied free UK National Health Service care despite their entitlement, or they do not seek it owing to a lack of awareness of their right to care; increased familiarity among healthcare workers with current recommendations may help to minimize disparities in access to care

A postal survey of data in general practice on the prevalence of Acquired Brain Injury (ABI) in patients aged 18–65 in one county in the west of Ireland

Abstract Background Very little is known about the prevalence of acquired brain injury (ABI) in Ireland. ABI prevalence has previously been obtained from Belgian general practitioners using a postal survey. We attempted to ascertain the prevalence of ABI in County Mayo through a postal survey of all general practitioners in the county. The specific objectives of this project were to: 1. identify whether general practitioners are a. aware of patients with ABI aged 18–65 in their practices b. able to provide prevalence data on ABI in patients aged 18–65 c. able to provide data on age, gender and patient diagnosis 2. analyse prevalence of ABI from any available data from general practitioners. Methods A pilot postal survey was performed initially in order to assess the feasibility of the study. It was established that general practitioners did have the necessary information required to complete the questionnaire. A main postal survey was then undertaken. A postal questionnaire was administered to all general practices in County Mayo in the west of Ireland (n = 59). The response rate was 32.2% (n = 19). Results General practitioners who replied on behalf of their practice could provide data on patient age, gender and diagnosis. In the nineteen practices, there were 57 patients with ABI. The age-specific prevalence of ABI in the area surveyed was estimated at 183.7 per 100,000. The mean patient population per practice was 2,833 (SD = 950). There were found to be significantly more patients with ABI in rural areas than urban areas (p = 0.006). There were also significant differences in the ages of patients in the different ABI categories. Patients whose ABI was of traumatic origin were significantly younger than those patients with ABI of haemorrhagic origin (p = 0.002). Conclusion Although this is a small-scale study, we have ascertained that general practitioners do have data on patients with ABI. Also, some prevalence data now exist where none was available before. These can be used to form the basis of a more substantial programme of university/community partnership research which could provide medical and psychosocial benefits for people with ABI and their families.</p

A postal survey of data in general practice on the prevalence of Acquired Brain Injury (ABI) in patients aged 18–65 in one county in the West of Ireland

Background: Very little is known about the prevalence of acquired brain injury (ABI) in Ireland. ABI prevalence has previously been obtained from Belgian general practitioners using a postal survey. We attempted to ascertain the prevalence of ABI in County Mayo through a postal survey of all general practitioners in the county. The specific objectives of this project were to: 1. identify whether general practitioners are a. aware of patients with ABI aged 18–65 in their practices b. able to provide prevalence data on ABI in patients aged 18–65 c. able to provide data on age, gender and patient diagnosis 2. analyse prevalence of ABI from any available data from general practitioners. Methods: A pilot postal survey was performed initially in order to assess the feasibility of the study. It was established that general practitioners did have the necessary information required to complete the questionnaire. A main postal survey was then undertaken. A postal questionnaire was administered to all general practices in County Mayo in the west of Ireland (n = 59). The response rate was 32.2% (n = 19). Results: General practitioners who replied on behalf of their practice could provide data on patient age, gender and diagnosis. In the nineteen practices, there were 57 patients with ABI. The age-specific prevalence of ABI in the area surveyed was estimated at 183.7 per 100,000. The mean patient population per practice was 2,833 (SD = 950). There were found to be significantly more patients with ABI in rural areas than urban areas (p = 0.006). There were also significant differences in the ages of patients in the different ABI categories. Patients whose ABI was of traumatic origin were significantly younger than those patients with ABI of haemorrhagic origin (p = 0.002)

Osteoporosis in postmenopausal women living with HIV

The widespread availability of effective antiretroviral therapy (ART) has transformed HIV from a life-limiting condition to one with near-normal life expectancy. HIV is associated with an increased risk of osteopenia and osteoporosis, with people living with HIV (PLHIV) potentially experiencing these conditions at a younger age than their HIV-negative counterparts. The mechanisms driving bone disease in HIV are complex and include: an increased prevalence of traditional risk factors; other comorbid conditions; and HIV-associated factors such as viral effects, systemic inflammation, and ART-related factors. One-third of PLHIV in the United Kingdom are female, and increasing numbers of women living with HIV (WLHIV) are reaching menopausal age. Oestrogen decline in the context of an elevated background risk of poor bone health results in WLHIV being at greater risk of osteoporosis than women without HIV. European HIV guidelines therefore recommend routine screening of postmenopausal WLHIV using FRAX(©) for clinical risk factors, with or without bone mineral density scanning. Data support the use of calcium and vitamin D supplementation, and bisphosphonates in the treatment of osteoporosis in PLHIV. Additionally, some patients with confirmed osteoporosis may benefit from a switch to an ART agent with a better bone safety profile. However, there remains a notable paucity of data on HIV and menopause, including the impact of hormone replacement therapy on the bone health of WLHIV. In conclusion, it is important that clinicians are aware that postmenopausal WLHIV are a group at particular risk of bone disease, who require proactive screening and advice about preventative measures