Maternity care experiences of women from minority ethnic groups
Research type
Research Study
Full title
The maternity care experiences of women from ethnic minority backgrounds living in areas of social deprivation in Liverpool: A grounded theory study.
IRAS ID
314138
Contact name
Sarah Farrell
Contact email
Sponsor organisation
Liverpool Women's Hospital NHS Foundation Trust
Duration of Study in the UK
1 years, 5 months, 10 days
Research summary
Women from minority ethnic backgrounds are more likely to die in childbirth, and more likely to have a stillbirth, preterm birth or infant death compared to White British women. Women from minority ethnic groups report their experience of maternity care to be poorer than White British women. Some reasons have been suggested by research already, such as women entering the maternity system later in their pregnancy, and language and cultural factors, but there is a lot that is not yet known about why outcomes and experience vary significantly depending on ethnicity. Liverpool has an increasing multi-ethnic population, which is not reflected in the staff diversity at the Liverpool Women’s Hospital. Liverpool is also one of the most deprived cities in the UK and deprivation also results in poorer maternity outcomes. People from minority ethnic backgrounds often live in areas of deprivation. There is little research already published about the maternity care experiences of women from minority ethnic backgrounds.
This study intends to explore the maternity care experiences of women from minority ethnic backgrounds, living in deprived areas of Liverpool defined using data from the Indices of Deprivation and the Cheshire and Merseyside Partnership, to understand the strengths and weaknesses of the local maternity provision in meeting their needs. Women and significant family members will be interviewed in a location of their choice, with due regard for the safety of the researcher, using an open-ended approach. Midwives that have experience caring for women from minority ethnic backgrounds will also be interviewed.
The findings of this study will be fed back to the local maternity service. They will be used to inform new strategies including potentially new interventions to improve care. These will also be used as the basis for further study and form part of the emerging information in midwifery literature.
Lay Summary:
The maternity care experiences of women from ethnic minority backgrounds living in areas of social deprivation in Liverpool: A grounded theory study Study Team: Midwife Researcher supported by a Professor of Maternal and Newborn Health and Senior Lecturer in Maternal and Newborn Health.
Funder: Liverpool Women’s Hospital NHS Trust
Sponsor: Liverpool Women’s Hospital NHS Trust Why was the research needed?
Ethnic disparity in maternal health outcomes in the UK has been well documented over recent years. For example, Black women’s risk of maternal mortality is four times that of White women. Poorer experiences of maternity care have been reported by women from minority ethnic groups in other areas of the UK, compared with White women. Experiences of midwives who care for women from minority ethnic groups has not been widely researched. Some studies have found systemic inequalities, with women ‘falling through gaps’, language barriers persisting and racial discrimination impacting care. In Liverpool, maternal outcomes are similar for women from minority ethnic backgrounds and White women, but voices of those from minority ethnic groups are not widely reflected in feedback. In this study, we sought to explore their maternity experiences, to enable better understanding of where needs are being met effectively and areas where care could be improved.
Research aim
To better understand the recent maternity care experiences of women living in Liverpool, with a specific focus on women from ethnic minority backgrounds living in areas of social deprivation.
Methods
A qualitative grounded theory approach explored maternity experiences of minority ethnic women in an area of the North-West of England between November 2022 and August 2023. Thirteen mothers of young babies were interviewed, eight with interpreters, to elicit views and understanding of maternity experiences. Fifteen midwives were also interviewed, who were working in different areas of maternity services and at 4 different levels of seniority, as well as one midwife lecturer. Interviews were transcribed, anonymised and coded using a constant comparative approach.
Results
The overall category, or theme, identified was ‘striving towards equity and women centred care’, supported by four sub-categories:
1. ‘They didn’t let me down’
When compassionate midwives tailored care to meet individual additional needs and ensure equity, women felt safe. Occasionally racism impacted on care provision, and midwives lacked mandatory cultural competency training, which they felt would be beneficial.
2. ‘Empowered by information’.
Information provision enabled women to feel reassured and make decisions about their care. Midwives proactively overcame language barriers, through unrestricted use of interpreting services, providing translated written material and modifying explanations to make them easier to understand. Despite these efforts, information inequity remained for women who didn’t speak English.
3. ‘It affects them worse’
Staffing and workload challenges affected care provision of all women, particularly in busy areas. Women from minority ethnic groups were disproportionally affected. Women often felt neglected, alone and frightened in busy environments, particularly if they needed an interpreter because of the additional time required.
4. ‘If people speak out it will help other people’
Women were reluctant to complain about the negative experiences they encountered, and midwives agreed that women from minority ethnic groups were not proportionally represented in feedback.
Recommendations
Recommendations were made to introduce mandatory cultural awareness training, re-establish translated parent education classes, and increase translation of written clinical advice to ensure culturally sensitive care provision and equitable information provision. Further research needs to identify additional means of effective information provision in busy clinical areas. Barriers need to be explored in areas not currently routinely using interpreting services with women who do not speak English. Continued and increased diligence is needed to seek feedback from all racialised minority groups to identify areas in need of improvementREC name
London - Surrey Research Ethics Committee
REC reference
22/PR/0985
Date of REC Opinion
5 Oct 2022
REC opinion
Further Information Favourable Opinion