Episode Two: Reproductive Justice
Rachel: Welcome to Between Borders! We are a collective of researchers exploring the challenges around precarious migration and researching it. We reflect on how people working - or doing research - in this area can better support people who are moving or have moved across borders.

I’m Rachel Benchekroun. In today’s episode, we will be asking: how does precarious migration in the UK speak to questions about reproductive (in)justice? Or, in other words, in what ways can the living conditions imposed on asylum-seeking, refugee, and other migrant families be understood as an assault on their reproductive rights and needs? We’ll also be asking what strategies do people forge, and what other avenues can we make available in order to open up new possibilities for reproductive justice in the UK? I’ll be talking with Pip McKnight, Mariam Malik and Júlia Fernandez. Júlia, can you explain what reproductive justice is? And why is it important to think about this in the context of precarious migration in the UK?

Júlia: Hi! Yes, of course. So we can describe ‘reproductive justice’ as a framework for thinking about how various forms of structural violence operate through reproductive health and rights policies, shaping reproductive bodies, subjectivities and experiences. The term reproductive justice, coined by Black feminists in the US, reframed reproductive politics through an intersectional lens and demanded recognition of Black women’s full reproductive and sexual rights. Reproductive justice then essentially argues that reproduction is always shaped by power structures, so that class, race, patriarchy, citizenship and other forms of discrimination shape people’s reproductive experiences. Debates surrounding reproductive politics and justice frame this episode’s discussion in very important ways. We think that ‘all politics are reproductive politics’ and in the context of our research and practice, we think that ‘all migration politics are reproductive politics’ as well, so that the social and political tensions of the UK's current migration governance framework are materialized in the everyday experiences of people migrating to the UK who are trying to build lives and families and homes here.
Rachel: Thank you, Júlia. Pip, can you tell us a bit about your research, and how it relates to reproductive injustice?

Pip: Sure! So I’m a midwife by background and current research fellow in forced migration, health inequalities and gender-based violence at the University of Birmingham and my PhD is exploring Cultural Safety in childbirth in the UK asylum system. This work was led in part by my time as a specialist midwife caring for pregnant people living in a Home Office Initial Accommodation centre. In this role I came to understand the multiple ways maternity care and the asylum system work against each other to the detriment of the birthing person. I think reproductive justice is pertinent to the experiences of people giving birth in the asylum system given the multiple threats, like structural threats they face in navigating maternity and immigration systems. Both these systems perpetrate attacks on birthing people’s agency in different ways. The asylum system robs those in it of choices about their lives - their ability to decide where to live, their right to work in order to pull themselves out of enforced poverty in the asylum system, and to build social connections. And the maternity care system, while it’s ultimately aimed at the preservation of life, has let down people living with immigration precarity by failing to address structural barriers to care or to mainstream this knowledge of what these barriers are. In the latest MBRRACE report, which is the big annual enquiry into maternal morbidity and mortality in the UK, immigration status was reported as a major determinant of maternal health outcomes. And it describes both a passive lack of knowledge of the barriers faced by those with precarious migration status among maternity caregivers but also an active hostility from some. And I’m interested in the potential of Cultural Safety as a healthcare ethic and an outcome to address reproductive injustice experienced by those in the asylum system. And I think Cultural Safety is useful as it addresses power and agency, racism and discrimination and it also allows those receiving care to define for themselves what makes them safe.

Rachel: That’s really interesting, thanks Pip. Mariam, can you tell us about your research and how it relates to reproductive justice?

Mariam: Yeah, absolutely. So I come at it from a Human Geography perspective. What Human Geography really offers us is that it makes material something that can otherwise feel quite inaccessible as a point of inquiry. So for example, Pip just talked about immigration status actually being a major determinant of maternal health outcomes in this context. And so actually how do we understand that in a material sense, that’s playing out in the middle of people’s lives, rather than being this abstract theoretical thing.

Rachel: Thank you so much Mariam, that’s really helpful to understand. Júlia, can you tell us about your research and how it relates to this question?

Júlia: I’m a social anthropologist and I have been working with people seeking asylum in the UK, mainly as a researcher, but also as a volunteer doula with pregnant people and new mothers. During my PhD, I carried out research with mothers living in asylum accommodation in London, aiming to offer an account of the difficulties of caring in uncaring environments, looking at the workings of migration control through the lens of mothering and caring. I was concerned with how contemporary British asylum governance impacts the intimate lives of asylum-seeking families, and with the ways that mothers in those families forged ways to care for their children while living in very precarious, uncertain and temporary conditions. What I did is examine the everyday lives in the asylum housing system, which is currently managed by the Home Office through contracts with profit-driven, private companies. People are housed in hotels and similar facilities with inadequate living conditions and can be relocated anytime, anywhere in the UK. I realized how, for these mothers, caring for and raising their children in these conditions was always intertwined with how British borders operate in an everyday sense. I found that the Asylum Support System, and specifically, the provision of asylum accommodation is an extension of bordering techniques that make the ‘hostile environment’ possible. The UK’s policy approach to asylum and migration in the last decade and a half makes life extremely difficult by policing and denying access, for some to the everyday basic benefits and public sector services that are routinely available to others. The mothers I worked with actually they believed that the asylum housing system was purposely designed to ‘make them and their children sick, so that they would leave’. In this sense, it is a less noticeable form of state hostility towards migrant women, which often goes unnoticed.

In this context, exploring what it means to be a mother, and what it takes to be a good one (so what it takes to provide your kids with the good life you imagine) when one lives in asylum housing, touches upon questions of reproductive justice. And those have to do with how the UK government removes asylum seekers from the mainstream benefits system and makes them dependent on a very particular support scheme that provides inadequate living conditions.

So reproductive justice then is threatened by this process of deterioration and debilitation of people’s reproductive work, of disruption of their maternal aspirations, of their projects to build and raise families, and then which takes place when one enters the asylum system and receives the mandate to inhabit asylum housing. And I think that care, caring for one’s family is a powerful site for thinking how lives are differently valued and how the right to parent, to raise children in safe and healthy environments, free from violence is not granted to everyone, which is one of the tenets of the reproductive justice framework.

Rachel: Thank you so much, Júlia, that’s really interesting. Pip, could you give us an overview of the infrastructures of migration governance and how these interact with reproductive justice?

Pip: Sure. Well, I first became aware of this disconnect between migration and maternal health infrastructures on my very first day in my job as a newly qualified community midwife. In community, you have caseloads that are usually attached to a GP, and I had three caseloads to start with, and I was taking handover for these three caseloads, one of which was a Home Office Initial Accommodation centre. And my colleague as she was giving this hand-over, she said something along the lines of ‘good luck with that one, these women they just never turn up and then they disappear’ or something along those lines. It just felt pretty wild at the time to hear someone say that in a clinical setting because usually you wouldn’t have a group of people who would just ‘disappear’, usually once they are in the system, there is a duty of care to both the parent and the unborn, and if someone were to drop out of the system, you would need to follow that up. So there was this really strange kind of exception, and then you know the sort of casual acceptance that they just sort of move on without a trace. But then once I got going in my role, I found the people living in the Home Office centre did indeed rarely turn up or if they did make an initial appointment, by the time the next appointment rolled around they would have moved on. And when you did try to follow it up it was difficult to get through to the centre, it was really hard to communicate with the Home Office contractors, or to get any information about where they’d gone, so if you had test results to pass through to the new midwife or anything like that. So it was odd that they would just disappear. So long story short, we did work to eventually create a specialist service that better addressed some of these barriers, but this was done very anecdotally because there was a lack of research, and there was no clear clinical guideline on how to best provide a service to people seeking sanctuary in the UK.

But in terms of reproductive justice, what I found was reproductive choices were frequently denied to this group. So it was not uncommon for pregnancies to be the result of sexual violence or sex trafficking. Many experienced difficulties accessing reproductive healthcare, from the country of origin, through transit, and then once in the UK these choices remained difficult to access. This was because of the two systems not really working together. Appointments weren’t communicated due to chaotic systems within the Home Office accommodation, or maternity services had an inappropriate reliance on digital tools, so like assuming everybody has a smart phone or that they had data or wifi. And then due to the dispersal system, pregnant people were moved frequently and they’d be dropped suddenly in a new area with no geographic orientation and sort of told, find another GP, they’ll refer you to a new midwife and then you start your care under that new Trust. Once somebody did have an appointment, the interpreters wouldn’t be booked because of poor referral mechanisms from the Home Office contractors, and you did have access to a telephone interpreting service but this would be totally inappropriate for taking complex and often traumatic histories. There is a Home Office protocol for protecting people in the late stages of pregnancy from dispersal and I was actually involved in negotiating that protected period, but you’d find many Home Office staff and contractors were not aware of their own policies so people are moved sometimes days or weeks away from their due dates, causing dangerous disruptions to their care. And in maternity care, the only central guidance available is the NICE guideline for complex social factors but this just lumps people in the asylum system in with people recently arrived in the country and those who don’t speak English, so all in a very small section of the guideline. So there is no guidance on the particular immigration restrictions and the resulting barriers to maternity care that those in the asylum system experience. So it’s really no wonder that these barriers remain so poorly understood.

Rachel: Thank you so much for sharing that insight, Pip. Júlia, what are your perspectives on this?

Júlia: So I think that when we talk about migration in the UK, we need to look at all those political, legal, social, material infrastructures that sustain and reproduce certain conditions of migration, but that also shape people’s reproductive lives, as my colleagues have been also talking about. In its many shapes, the current politics of migration governance, what they do is they delegitimize, they criminalise, they precaritize people’s aspirations to build a life in the UK, right? In my research, I looked at how this “hostile environment” affects people’s lives and bodies, debilitating their ability to reproduce and sustain that life, and it does so by disproportionately stripping them of their rights and forcing them to live under the constant threat of expulsion, of poverty and destitution - so creating differentiated conditions of possibility for living and for caring for your family in the UK. For the mothers I met living in asylum housing, this hostility towards migration was experienced through a lack of access to everyday means for social reproduction. They talked about the challenges that their housing circumstances posed to how they were able to care for their children: their limited living spaces, the lack of adequate facilities, such as a kitchen or a place to cook to prepare food for your family, or the strict schedules, the rationed supply of food, of nappies, formula milk and laundry powder, all of this was part of the everyday stripping of their autonomy and humanity that actually occurs throughout the whole process of seeking asylum in the UK, but that we can see encapsulated in the domestic space, which should be a place where you are able to care for your children, a place of safety and nurture.

For these women, the lack of adequate housing creates anxieties and dilemmas that are very gendered actually, about how to care for their families, about the meanings of care, and about their capacity to care and the limits of the care they were able to provide, sometimes reaching to the core of their sense of self as mothers and of how to be a good mother when they could not raise their children in dignifying conditions. So they questioned whether they were being good mothers for having brought their children to the UK, or whether it was better to return home or stay in the asylum system.

Rachel: Thanks Júlia. Mariam, what are your thoughts on how migration infrastructures shape reproductive justice?

Mariam: So I work in the NHS in London as a Speech and Language Therapist. And I think for some years now my political analysis of health has been shaped by my encounters in the clinic, very much so. And it’s also how I arrived at this as a point of a research enquiry. For years I think I have been in a deep witnessing of how very young children’s lives are shaped in and amidst the social conditions of their lives, so I think material and emotional possibilities are met with the wider socio-political landscapes of the moment. Across my therapeutic practice, in a very visceral way, through this witnessing, the processes of structural harm play out in the middle of people’s lives. But I think being located in the NHS, some of the ways that we witness these infrastructures play out, is like for example that deputising through everyday bordering practices. But in terms of how the structures shape reproductive justice, I think the sustained financial and housing precarity, for example, the uncertainty, just the sheer level of uncertainty, and that intersection of motherhood and early childhood, when we know that actually the child’s developmental possibilities, and their neurobiology is very much developing in that early period of life, some researchers I know call it the fourth trimester. Those first two years of life where actually the social conditions of children’s life are absolutely shaping and in dialogue with their neurobiology. It also speaks to and kind of echoes wider issues in terms of gender and care, care being a very very gendered process. So I think where it still sits under this kind of, I think care often is looked at as a pre-political site, particularly when it comes to early childhood. Very little speaks to childhood as a political site of enquiry. So I think that naturalised and undervalued nature of care work really comes to the fore. But I think in particular the echoes of ​​Britain’s relationship with the migrant mother is a historical site of vulnerability that Black feminist thinkers in particular have been talking about for a very long time, you know so I’m thinking here like Heart of the Race, the really brilliant work by Stella Dadzie and her colleagues, at that point, really speaks to something that hasn’t gone away, right, like actually what it does is over time it takes different forms and organises itself differently. So I think that the migration infrastructures and their shaping of reproductive justice is very pervasive, and I think it really does ask all of us, particularly I would argue those of us in the public sector, to sort of really take a look at where and how that intersects with our work and practice. My feeling is it intersects more than we often are able to really comprehend.
Rachel: Thank you. I think that’s really important to think about. Actually that brings us on to our final question: How might your work be useful in policy and practice? Pip, did you want to go first?

Pip: Well, so Cultural Safety, I will admit my obsession at the moment, but there is, I feel like there is a real opportunity, because there is this move towards a better approach to caring for non-majority groups beyond the models that we tend to use at the moment of cultural competency and cultural awareness which have a tendency towards ‘ethnonursing’, which is acquiring knowledge of cultural practices without really understanding or accounting for the fact that culture is dynamic and it’s shaped by many different factors such as race, dis/ability, sexual or gender diversity, class, power, experience. At its core with Cultural Safety is an anti-oppressive practice, which I think really has the potential to address these issues of reproductive justice that we’ve been talking about - obstetric racism, problems that MBRACE found in their report on maternal mortality and morbidity, of stereotyping and micro or even macro aggressions and really has the potential to rehumanise maternity care, benefiting both the care giver and the care receiver. I feel like, in light of recent maternity care scandals, this really could be transformative for the NHS and those most at risk of poor maternal outcomes.

Rachel: So Mariam, how do you feel your work might be useful in policy or practice?

Mariam: I feel what my work has allowed me to engage with is this deep witnessing of development in early childhood, essentially always happening in dialogue with the social conditions of children's lives and never outside of this. So I think my work sits at this weird intersection of healthcare, but also I’ve always worked in the community, always within the NHS but in the community, so it becomes this really interesting middle ground of healthcare as an institution where it’s trying to attend to people’s lives in the community. I think that opens me up to witnessing something that I’ve been trying to give language to to be honest with you for the last 8 years that I’ve been doing this work. And I think the potential for the healthcare worker as a broad idea, to sort of find the tools to lean into that agency and give some of that witnessing language I think is one of the really important things that I like to try and practise myself but also speak to others about doing. I think there is an onus on everyone who sits at these intersections to meet with and attend to the tension of our work, and how often it’s not designed with children who are experiencing such extreme and also state-led marginality at the heart of their practice. And I think children’s experiences are often unaccounted for, particularly children who are experiencing immigration precarity in relation to the precariously situated migrant mother, and the way that these women are treated structurally, I think often the children are actually quite invisibilised, so we might be thinking about their maternity outcomes, but we’re not necessarily thinking about how does that play out in children’s lives, what’s playing out there and how is that shaping things for these children. So I think for me this work speaks to a broader commitment to health justice. I think in terms of the policy and practice, my most hopeful site of enquiry is how healthcare workers can be in practice of this commitment to health justice, and how we can organise ourselves differently, because ultimately we are the system, we embody the system, so what does it look like if we are all a bit more aware and attending to these sorts of enquiries through our work.

Rachel: Thank you so much. Hopefully this podcast can help to achieve some of that dialogue between practitioners, policymakers and researchers.

Mariam: I hope so, Rachel!

Rachel: Júlia, how do you feel your work contributes to practice and policy?
Júlia: I think that basically, generating new knowledge that as an ethnographer and also as a doula, build around the more intimate impacts of hostile migration politics so that something that’s often disregarded, and specifically, on the failures of the asylum housing system for the possibilities to sustain life. I think by foregrounding the lived experiences of mothers seeking asylum, we are more able to emphasize this urgent need for a policy reform that is grounded in reproductive justice so that insights into how current practices and policies of housing allocation and management for people seeking asylum undermine the dignity, safety and bodily autonomy of mothers and their families, we can call for democratic accountability measures or more care-centered housing policies that prioritize human rights and social justice over corporate profit or deterrence mechanisms in migration governance. And I think besides contributing to improve support and access to safe and adequate housing for people with insecure migration status, I think it’s also relevant to keep contributing to debates surrounding reproductive justice in the UK by raising questions about who has the right to mother and to care in dignifying conditions, and how can we bring attention to what is needed in order to sustain the life of others when we live in such harmful spaces. So we would be bringing the right to raise children in safe environments into conversation with issues like housing justice and food justice, access to healthcare, migrants rights, etc, as they are part of the structures of inequality that impact on people’s ability to provide appropriate care and to build a life in the UK.

Rachel: Thank you so much, Julia. I think it’s been really fascinating talking with all of you today, and I really appreciate how you’ve helped us to understand more about this concept of reproductive justice and what that means for women, mothers and families in the context of precarious migration, thinking about not only during pregnancy but also during early childhood and beyond, and thinking about the broader implications, as you’ve said Julia, housing and other sectors that affect and are affected by the challenges that mothers are facing who are positioned precariously. So there are lots of implications as you’ve highlighted for policymakers and for health practitioners like yourselves, and I think you’ve given us a lot of food for thought in terms of research.

Pip, Julia and Mariam, thank you so much for sharing your findings on reproductive justice with me. And thank you to our listeners! This is the first mini-series of Between Borders, and we would really like to hear from you, our listeners. Please use the short feedback form in the episode notes to tell us what you liked, what you think we could improve, and what you’d like to hear more of. And please do get in touch if you’d like to discuss today’s topic with us. Thanks very much, and tune in to the next episode!