Saving Mothers' Lives: - Public Health Agency for Northern Ireland

Migrant women
4. All pregnant mothers from countries where women may experience poorer overall general
health, and who have not previously had a full medical examination in the United Kingdom,
should have a medical history taken and clinical assessment made of their overall health,
including a cardio-vascular examination at booking, or as soon as possible thereafter. This
should be performed by an appropriately trained doctor, who could be their usual GP. Women
from counties where genital mutilation, or cutting, is prevalent should be sensitively asked
about this during their pregnancy and management plans for delivery agreed during the
antenatal period.
Rationale
An increasing number of migrant women are seeking maternity care in the UK. Women who have recently
arrived from countries around the world, particularly those from Africa and the Indian sub-continent, but
also increasingly from central Europe and the Middle East, may have relatively poor overall general health
and are at risk from illnesses that have largely disappeared from the UK, such as TB and rheumatic
heart disease. Some are also more likely to be at risk of HIV infection. All of these conditions, alone or in
combination, contributed to a number of the maternal deaths identifi ed in this Report. None of the women
who died of these causes had a routine medical examination during their pregnancy and the opportunity for
remedial treatment was lost.
Further, the prevalence of female genital mutilation, or cutting, amongst the pregnant population is
increasing due to inward migration of women from countries or cultures where it is still routine practice,
despite almost universal international condemnation at government level. It can affect women’s
pregnancies in a number of ways and the deaths of at least four women were directly or indirectly
associated with the consequences of such procedures in this triennium. Specialist services and reversal
procedures are available for these women in their antenatal period, which make childbirth and postnatal
recovery easier.
Baseline and auditable standard
• Number and percentage of pregnant women new to the UK, and who have not previously had a
full medical examination in the UK, who have had a complete medical history taken and physical
examination performed during their pregnancy and which is recorded in their notes.
Baseline measurement by April 2008, review December 2009 by when 100% coverage should be attained.
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