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Background: The London borough of Camden has long been home for many refugees, asylum seekers, and undocumented migrants (RASUs). Over time, it has witnessed an increase in the population of these migrant groups, accompanied by notable changes in the obstacles they encounter when seeking health services, particularly maternity care. We explore how the ‘hostile environment’ policies affect access to and delivery of quality maternity services for RASUs. Methods: This study was conducted over eight months (November 2021–July 2022) both remotely and face-to-face, in various locations in Camden and in the Maternity Department at University College London Hospital, UK. Healthcare professionals (HCPs) and community organisations (COs) were identified as two major stakeholders involved in the care provision for RASUs. 33 semi-structured interviews were conducted (with 22 HCPs and 11 COs) to understand their experiences of delivering care to this population. Results: There was consensus among HCPs and COs that the current immigration policies undermined their duty of care, personal morals, and the principles of the NHS. These policies have created a restrictive environment, making it increasingly difficult for migrants to navigate the healthcare system and creating an atmosphere of distrust, propagating fears of being charged. This has led to HCPs and COs going beyond their remits to ensure that RASUs are accessing and engaging with maternity care, regardless of an individual's status and despite any potential repercussions for themselves. Conclusion: In the face of an intensifying hostile environment under the UK government, supporting RASUs cannot be solely reliant on political measures. We need to advocate for healthcare navigator roles, health justice partnerships, specialist teams, and comprehensive training for service providers. HCPs and COs should be adequately supported in their endeavours to ensure RASUs have access to standardised, high-quality maternity care.

IntroductionDigitalisation offers innovative solutions within maternity services; however, vulnerable groups risk being overlooked. University College London Hospital's (UCLH) successful implementation of a digital maternity app, MyCare, gives women access to test results, information about appointments, and enables communication with healthcare professionals (HCPs). Yet, little is known about access and engagement among vulnerable pregnant women.MethodologyResearch was conducted over a 3-month period (April–June 2022) in the Maternity Department at UCLH, UK. MyCare datasets were analysed, and anonymised surveys completed by vulnerable pregnant women and HCPs.ResultsLower rates of utilisation and engagement with MyCare were seen in vulnerable pregnant women especially among refugee/asylum seekers, those with mental health issues, and those facing domestic violence. Non-users were also more likely to be individuals from ethnic minority backgrounds, with a lower average social-deprivation-index decile, whose first language was not English, and with a significant history of non-attendance to appointments. Patient and HCP surveys highlighted various barriers to MyCare engagement, including a lack of motivation, limited language options, low e-literacy levels, and complex app interfaces.ConclusionThe use of a single digital tool, without a formulated pathway to identify and assist those not accessing or engaging with it, risks unequal care provision which may exacerbate health inequalities. This research advances the idea that digital exclusion is not necessarily a matter of access to technology, but an issue of a lack of engagement with these tools. Therefore, vulnerable women and HCPs must be integral to the implementation of digital strategies, to ensure no one is left behind.