Book Review: Borders,Citizenship,and Pregnancy

In the era of restrictive immigration policies, Gwyneth Lonergan's book Borders, Citizenship, and Pregnancy: Migrant Women's Experiences of Pregnancy and Maternity Care in the UK, is timely and serves as an intervention to border control, and shows the effect of state-controlled migration on the maternal care experience of regular and forced migrant women. The central question posed by the book is who does the state allow to reproduce, give birth, and receive healthcare with full rights and dignity, and who is excluded from such rights and privileges? To answer the question, the author frames pregnancy as political and not purely medical, arguing that pregnancy cannot only be understood as a biomedical process, especially for migrant women whose access to reproductive care is shaped by state policies. Pregnant migrant women who are non-citizens are excluded from certain reproductive rights and maternal care privileges.

This book is relevant to studies on state migration regimes and citizenship as it situates maternal and reproductive care within broader international migration discourse. Using the analytical frameworks of reproductive justice and stratified reproduction as intersecting and overlapping frameworks, the book examines migrant women's experience of care. One of the strengths of the book is how it frames the concept of reproductive justice. The book not only asks whether women technically have access to reproductive care, but the author also asks whether they have state recognition, safety, and all the resources needed to make reproductive choices. The choices are limited for pregnant migrant women. The book makes a strong argument that reproductive rights are stratified along racial, gendered, and citizenship hierarchies that reproduce structures of national and transnational inequality.

Another conceptual theme raised in the book connects the political economy of health and international migration, which contributes to the literature. The book examines how neoliberal policies regarding citizens’ rights and responsibilities towards their health became intertwined with the National Health Service (NHS). This raises questions on how retrenchment of the welfare state across countries shapes international migration enforcement and creates different experiences of reproductive injustice amongst migrant women. A significant contribution of the book shows how the UK's immigration policy on maternity care not only creates a stratified system of inequality at the structural level, but also creates stratified hierarchies of class, migration, and refugee status among migrant women. It is surprising to observe that privileges also exist amongst the migrant women. This empirical finding also adds to the quality of the book by showing that stratified systems of inequality do not exist only between citizens and migrants but also between migrants.

Scholarship on international migration examines how migration and refugee status create labor-market exclusion for migrants. Lonergan situates reproduction and maternity care as sites where migrants experience state-sponsored restrictions, such as access to adequate housing, state welfare benefits, and participation in the labor market. The book highlights how the different levels of systemic exclusion work together to create and enforce bordering and restrictions at each level.

The method of data collection is one of the book's strengths. The author combined primary and secondary data to provide a comprehensive analysis of the role of the state in shaping access to maternal care. The book is grounded in state policies on immigration and health care, the NHS staff, third-sector workers, and the experiences of migrant mothers. The author conducted fieldwork, analyzed the United Kingdom's immigration policy documents, conducted semistructured interviews, and participated in focus groups. The author interviewed 41 migrant mothers and 16 NHS employees. Combining the UK state policy documents on immigration with interviews with migrant women and the NHS staff provided a grounded human and personal experience of how state migration policies impact the health and well-being of pregnant migrant women and their families.

The critique of state migration policy is one of the book's significant contributions to policy debates on international migration. The author critically examined how the UK state policies on maternity care create stratified and racial inequality for migrant women, contributing to the high rate of maternal mortality. Studies examining the relationship between migration and maternal mortality are very limited in the migration and health literature. In this book, Lonergan analyzed how the “ideal birthing citizen” policy framework creates racial disparities in the maternal experiences and maternal health outcomes of Black women in England, which accounts for the high rate of maternal mortality among this demographic.

Despite its empirical strengths, the book has limitations. The book had limited engagement and counterarguments between those who work for the state and those who use the state healthcare services. The tone of the book is academic. It is also politically engaged. The balance between the book's critical perspective and its detailed policy reform is lacking. The book is more interpretive than analytical of technocratic reform policies, and it does not highlight comparative arguments by immigration administrators and policymakers. A comparative argument could address a policy reform question, such as how the state healthcare system should handle its legal verification process.

Secondly, the sample demographic did not completely capture the overall argument on the rate of maternal mortality among Black women. The racial demographic of the migrant women who shared their pregnancy experience was not evenly distributed to capture the racial discourse on the impact of the UK's migration policy and the NHS maternity services on the rate of maternal mortality. Perhaps the reason for this limitation lies in the author's positionality and the interview method. This calls for future research on how race shapes the maternity care experience of migrant women outside the UK context and a state comparative analysis of the role of the state migration regime on maternal mortality.

Despite these limitations, the structure of the book is organized. It highlights its overall argument that every woman should have equal reproductive rights and access to maternal care, irrespective of migration status, citizenship status, and/or race. Borders, Citizenship, and Pregnancy is an important and timely book that incorporates maternity care into migration scholarship, effectively connecting international migration studies with scholars and policymakers engaged in interdisciplinary work in sociology, global public health, gender studies, feminist geography, and political science.