The Covid-19 pandemic has highlighted and exacerbated ethnic health inequalities in the UK, with data showing that different minority ethnic groups were two to four times more likely to die from Covid-19 than their white counterparts. What is less well understood is the impact of the pandemic on already existing health inequalities for minority ethnic migrant women in particular. The reasons for migrant women’s health inequalities and experiences of health care are complex and are often not captured in the data.
Available data provides a breakdown of inequalities primarily based on gender, ethnicity, socio-economic status and geographical regions. In some areas of research, migrant experiences are subsumed within the broader categories of ethnicity and gender. Where there is a focus on migrants, research generally highlights specific groups, for example refugees, asylum seekers and those that have no recourse to public funds.
Why is it important?
'The Migration Observatory data shows that in 2019, women and girls constituted 52 per cent of international migrants in the UK, just over half of migrant population.'
The migrant population in the UK has increased over the past 20 years for different reasons, including employment opportunities and immigration policy changes. The Migration Observatory data shows that in 2019, women and girls constituted 52 per cent of international migrants in the UK, just over half of migrant population. Over the years, I have worked with different organisations in the Northwest of England on migrant women’s experiences of both statutory and voluntary support services. The work shows that migrant women’s particular experiences are impacted by the intersections of gender with different factors, such as (but not limited to) ethnicity, socio-economic and immigration statuses, length of stay, prior experiences in their country of origin, culture and language. These factors affect their health and mental wellbeing, how they access services and use community resources for better health outcomes. Other studies nationally and internationally have similar findings.
How can social prescribing better support migrant women?
Social prescribing models use holistic approaches to address health inequalities and support people’s health and wellbeing, working with statutory providers and voluntary, community and social enterprise (VCSE) organisations. In 2020, the government published social prescribing guidance to help improve migrant health by highlighting socio-cultural, religious factors and other determinants of health that services should consider to effectively support their health. By considering wider factors, beyond clinical interventions, social prescribing initiatives have potential to be effective in improving migrant women’s health and wellbeing. But there is more to do to enable what the government calls ‘good social prescribing.’
'Collaboration with migrant women at place level enables services to have a better understanding of their specific needs, which will in turn help create social prescribing models that work for them.'
First, the work must start from the needs of the women themselves. Inequalities are experienced differently in different areas, and organisations need to reflect on how they centre migrant women’s diverse experiences in policy, service design and delivery at place level. Collaboration with migrant women at place level enables services to have a better understanding of their specific needs, which will in turn help create social prescribing models that work for them.
Second, alongside centring the needs of the women, health and care services should use intersectional approaches, as migrant women population is not a homogenous group. So, organisations must consider the intersections of gender with various categories and structures of exclusions within health services. Institutional structures and practises can exclude people and reinforce inequalities. An intersectional approach enables providers to be mindful of these differences and how they manifest in accessing health services and provide services that truly meet the needs of all migrant women.
'Minority ethnic organisations often have knowledge and understanding of some of the contributory factors that intersect and affect migrant women.'
Third, statutory services need to value the expertise that minority ethnic VCSE organisations bring to social prescribing and consider how link workers can effectively work with them. The value of VCSE has long been recognised and was further reinforced during the pandemic where demand for services increased significantly. Minority ethnic organisations often have knowledge and understanding of some of the contributory factors that intersect and affect migrant women. These organisations have a key role to play, but they need to have the right resources and funding that are sustainable. In the current terrain where health inequalities are a priority, their role and contributions are paramount.
And finally, link workers are a significant and valuable part of social prescribing and the connection between services and those in need. However, a review of the role of social prescribing link workers in primary care in The King’s Fund report on the Additional Roles Reimbursement Scheme (ARRS) highlighted concerns around regional differences in how well link workers’ roles are understood and integrated across different health care services. These are challenges which may further compound negative experiences and struggles to access health care for some migrant women. Health and care services should carefully consider how they effectively work with link workers, so they can better support migrant communities.
In conclusion, social prescribing is crucial and the points I have raised here are not exhaustive, instead, they provide important considerations for health and care organisations and their partners for addressing inequalities and supporting migrant women’s health and wellbeing.