Poverty Proofing Maternity Services
Research type
Research Study
Full title
‘Poverty-Proofing’ maternity care; a qualitative and survey study to improve access to care and pregnancy outcomes.
IRAS ID
333371
Contact name
Judith Rankin
Contact email
Sponsor organisation
Newcastle Upon Tyne Hospitals NHS Foundation Trust
Duration of Study in the UK
0 years, 9 months, 28 days
Research summary
Research Summary:
Pregnant people living in low incomes in the UK are at increased risk of poorer birth outcomes, along with adverse physical and mental health. They are also less likely to engage in maternity care services, and report poor quality interactions. This study aims to understand barriers to engagement in maternity care services amongst low-income women in Newcastle, in order to identify a range of practical solutions/actions that will increase access to these services.
To further understand barriers, the study aims to:
1. Identify barriers to accessing maternity care in Newcastle using semi-structured interviews with 20 healthcare professionals and VCSE groups to identify ways of improving services' accessibility to low-income women. Interviews will be 1:1 and last approx. 45-60 minutes and will be recorded and transcribed verbatim.
2. Identify barriers to accessing maternity care in Newcastle using semi-structured interviews with 20 women/partners (>16 years old), who are currently or recently pregnant (0-18 months) living on low incomes. Interviews will be 1:1, but the pregnant women can bring her partner into the interview, and last approx. 45-60 minutes and will be recorded and transcribed verbatim.
3. Undertake a survey, last approx. 15 minutes, on the costs of pregnancy and accessing care for women, which will be aimed to be completed by 50 women. The survey will be online and paper copies available to eliminate digital exclusion.
The findings from this study will help to develop a toolkit of relevant practical changes that will be put in place to improve access to maternity care for women living on low incomes in Newcastle, and these findings will be shared with PPI groups in Liverpool (LiLaC), Coventry (PHRESH) and Bristol to inform the relevance of this work to their local context.Summary of Results:
The research team conducted 17 interviews with professionals (healthcare staff, voluntary and community practitioners and local authority staff), who were working with pregnant women. Data analysis identified three overarching themes:
1. Structural barriers included digital exclusion, language barriers for those where English was not a first language and a reduction is service funding and understaffing.
2. Interactional barriers included a lack of social support, a lack of fathers/partners support, and a level of discrimination and racism experienced within services.
3. Individual barriers included the hidden costs of pregnancy, the costs of travel to and from appointments, fear and unfamiliarity of services, and additional support needed for those with complex needs.
The research team also conducted 17 interviews with pregnant women, and those who had recently had their baby, who were living on low incomes. Data analysis identified four key barriers to accessing maternity care for pregnant women living on low incomes.
1. Costs of accessing maternity care. This included the cost of travel to and from appointments using public transport or driving and paying for parking. Also included additional challenges for those who do not have recourse to public funds.
2. Appointments. Having older children was a barrier, as they were unable to bring older children to appointments, or struggled to find appropriate childcare. The use of digital technologies for to book appointments was difficult for women who did not have access to these apps.
3. Communication. Translation and interpretation services for those where English is not a first language was a challenge to navigate, as they were not always used, and if they were they were not always professional. The overuse of medical language in appointments was also a barrier for women.
4. Service dissatisfaction. Feeling disrespected or having a poor experience would impact women wishing to engage with services. This also applied to women who felt they were not being listened to or heard during their appointments.
Alongside this, a cost analysis survey was conducted which was completed by 38 women and/or partners. The survey explored the cost of travel to and from appointments, the cost of time off work for appointments, the cost of food and/or drink at appointments, and any cost for childcare for older children. These questions were also asked of their companion (i.e., their partner, family member or friend). From this analysis showed that on average it cost £27.78 (GBP 2025) per visit, while the mean total opportunity cost (the total hours spent travelling to and from the appointment and time attending the appointment) was 4 hours and 41 minutes.
Finally, co-production workshops were held with key stakeholders (three with practice and policy partners and one with public partners) to review preliminary themes, interpret the findings and develop recommendations of service improvement.
At time of writing, one manuscript has been published, one manuscript is currently under review, and two toolkits of recommendations will be published later in 2026.REC name
London - Surrey Research Ethics Committee
REC reference
24/PR/0820
Date of REC Opinion
19 Jul 2024
REC opinion
Favourable Opinion