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NHS charging for ‘overseas visitors’ is recognised as deterring migrants from accessing necessary health care. Even though maternity care does not have to be paid in advance, fear of four-figure bills and Home Office sanctions against people with unpaid debts has significant adverse effects on women affected. Undocumented migrant women, without the right to work or benefits, are among the most excluded and vulnerable people living in the UK today, risking destitution especially in pregnancy. Despite government guidance, hospital charging procedures pay scant attention to the welfare of vulnerable migrants, with women who are unable to pay harassed by debt collectors. Charging such women deters them from accessing maternity care and has a negative impact on their physical and mental health. The article, based on a study of women who were charged, argues that charging for maternity care undermines NHS principles and inherently discriminates against women.

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Primary health care centers have been proposed to meet the health care needs of rural America.