In 2012, the UK government's Home Office, under the leadership of then Conservative party and Home Office Secretary Theresa May, outlined a series of policies aimed, in May's words, at creating a ‘really hostile environment for illegal migration’ (Kirkup and Winnett, 2012). Formalized in subsequent pieces of legislation on immigration in 2014 and 2016, these policies sought to implement a range of practices aimed at reducing the number of migrants living in the UK who had not been granted legal right to remain. The policy also created new procedures aimed at identifying those without legal right to remain. Measures were put in place to restrict migrants’ ability to access education, rental accommodation, driving licenses, bank accounts, and healthcare. These measures became known as the ‘Hostile Environment’ policies and have been roundly criticized by activists, religious leaders, and academics as profoundly cruel, with the UK human rights organization Liberty stating that ‘It's impossible to have a hostile environment which doesn't result in human rights abuses’ (Liberty, 2020).

This chapter explores one aspect of the broader set of hostile environment policies: those that affect access to maternity care for pregnant migrants. Although healthcare during pregnancy is defined by the UK government as ‘immediately necessary’ and therefore should never be withheld even if a woman has no means of payment, the fear of being asked for payment upfront has meant women without a legal right to remain in the UK may delay or avoid accessing needed healthcare. This chapter situates ‘accompaniment’ as a central part of activist responses to hostile environment policies for pregnant and birthing people as local projects aimed at resisting the Hostile Environment policy and the vulnerability faced by pregnant and birthing women seek to support women navigating ‘hostile healthcare’ in the UK. These projects also demonstrate how natural, alternative, or home birth movements – movements often associated with white, middle-class women's efforts to ‘choose’ place of birth and birth attendant – are linking birth politics to the concerns articulated by reproductive justice activists, in what Oparah with Black Women Birthing Justice (2015) call struggles for ‘birth justice’.