Discrimination in Maternity Care Access

A woman pregnant with twins was turned away from the closest hospital when her waters broke. She was alone and was left with no choice but to drive herself to her primary care hospital. She believed she was refused care due to her identity as a Traveller. This is not an isolated case. Gypsy, Roma and Traveller (GRT) women regularly report experiences of discrimination when accessing maternity care. GRT is an official UK government-recognised umbrella term for multiple ethnically distinct communities that face similar socioeconomic challenges. It includes English, Scottish and Welsh Gypsies, Romany Gypsies, Irish Travellers, and European Roma. Grouping ethnicity categories aggregates data, potentially obscuring differing health outcomes across culturally unique groups.

Barriers to Access of Maternity Care

One factor preventing GRT women from accessing antenatal care is distrust and fear of authorities as a result of historic and systemic discrimination. Discrimination correlates with women failing to be heard when raising concerns. Registering with a general practitioner (GP) presents a further challenge across the GRT community. A 2021 report by Mattey Mitchell Josie Garrett found that only 6 out of 100 GP surgeries in England would register a GRT patient and 74 GPs “broke NHS England guidance and refused to register” them due to a lack of identification or a fixed address. Such poor access to GP services has been found to reduce engagement with health visitors.

Poor Maternal and Infant Outcomes Reflect Disadvantages

Already over 27 years ago, evidence from the enquiry Why Mothers Die: 1997-1999 suggested that GRT women possibly have “the highest maternal death rate among all ethnic groups”. They are almost twice as likely to experience a miscarriage as the general population and are 20 times more likely to experience the death of a child. Breastfeeding rates are also notably low within the GRT community and can exacerbate health inequalities.

Living on Unauthorised Sites: Additional Challenges  

A minority of the GRT community pursue a nomadic lifestyle, and those living on unauthorised sites face frequent evictions by the police. For pregnant women, this is associated with increased stress, anxiety and negatively impacts the provision of care.  Qualitative evidence shows poor continuity of care when moving between local authority areas. For example, one participant in a focus group run in 2018 by the charity Maternity Action reported travelling over 150 miles each way to attend antenatal appointments and give birth after being refused care locally. Continuity of care may reduce instances of caesarean births, of which rates are unusually high among the GRT mothers. Another issue is restricted access to basic sanitation facilities, which increases instances of maternal dehydration and potentially leads to hospitalisation as a consequence. Some local authorities may provide a Portaloo to combat this; however data gathered via correspondence with GRT teams in Surrey, Bristol and Brighton indicate that Portaloo provision is inconsistent.

Local Authority Areas Demonstrate Pockets of Good Practice

Funding and provision of targeted GRT maternity care differs by local authority area. In the Mothers’ Voices focus group, a community worker recalled the impact of a specialist health visitor on the GRT community in Brighton. Only four GRT women had previously engaged with health services over a period of six months, but when a specialist health visitor attended GRT sites this figure increased to 127 women over the same period. In 2019, the first NHS-funded GRT outreach project was launched in the county of Surrey. A report provided by Children and Family Health Surrey via a freedom of information request assessed the impact of this project. In the first year, 14 antenatal visits, 24 new birth visits, and 25 6-8-week reviews were conducted. The report highlights the importance of inter-agency collaboration and engagement with community-led groups for long-term sustainability of the project.

Targeted Maternity Services Impact Wider Health Outcomes

Bristol City Council in the West of England is an example of inter-agency collaboration. It has a dedicated GRT inter-agency team that includes a specialist health visitor and a simple text website. Research shows this has developed trusting relationships with GRT communities, leading to vaccine uptake and increases in appointment attendance. Another local, albeit small scale, case study comes from Cornwall, where a specialist midwifery serviced four GRT mothers in 2019. This led to an increase in whooping cough vaccinations from 0 to all 4 mothers being vaccinated. Overall, specialist care providers develop a greater understanding of disadvantages affecting GRT communities, building trust and engagement in healthcare services.

The Data Gap

There is a distinct lack of data on GRT communities, creating challenges in effective policy development. In May 2025, NHS England recommended that health bodies include GRT categories in ethnicity data. The NHS data dictionary has not yet been updated to reflect this. Advocacy groups have been campaigning for the change since the category ‘Gypsy or Irish Traveller’ was included in the 2011 census. According to the Women and Equalities Committee this insufficient data collection impacts funding and the provision of GRT-specific policies.

National Framework in England

In July 2025, Wes Streeting, the Secretary for Health and Social Care published the government’s “Fit for the Future: 10 Year Health Plan for England”. It has a strong focus on improving maternity services, but does not directly mention GRT women. Plans to improve accessibility to healthcare services are largely focused on the NHS app. Due to high levels of digital exclusion within the GRT community, this may further limit engagement with healthcare services. The Women and Equalities Committee highlights a pattern of short-term funding for small-scale projects. The Committee also noted limited national scaling of successful pilot projects, although it recognised that needs differ between local authority areas.

National Framework in Scotland

Since December 2021, the Scottish Government has funded Community Health Workers (CHWs) specifically recruited from the GRT community. Community engagement in healthcare delivery promotes trust and engagement with healthcare professionals. Over a 20-month period, CHWs have engaged approximately 1,000 individuals from the estimated 15,000-20,000 GRTs living in Scotland. There is no empirical breakdown of services accessed so it is unclear how many women have accessed maternity services specifically, but case studies of CHWs promoting cervical screenings and access to contraception suggest positive impacts for more equality in maternal health.

A Lack of Data and Intersecting Disadvantages

Concerning the issue of data collection, institutional discrimination is seen as a factor preventing GRT women from declaring their ethnicity due to fear of discrimination. This contributes to a lack of visibility in datasets and disguises disadvantages, contributing to GRT women and communities being consistently overlooked in policymaking. The intersectional nature of disadvantages indicates single-issue policy interventions may be insufficient to reduce maternal health inequalities. Evidence from localised GRT-focused inter-agency strategies suggest that trust-based provision may improve engagement with maternity and wider healthcare services.