Alshawish E, Marsden J, Yeowell G, Wibberley C. Investigating access to and use of maternity health-care services in the UK by Palestinian women. British Journal of Midwifery.. 2013; 21:(8)571-577

Ameh CA, van Den Broek N. Increased risk of maternal death among ethnic minority women in the UK. The Obstetrician & Gynaecologist.. 2011; 10:(3)177-182

Aquino MRJV, Edge D, Smith DM. Pregnancy as an ideal time for intervention to address the complex needs of black and minority ethnic women: views of British midwives. Midwifery. 2015; 31:(3)373-379

Bharj K, Salway S. Addressing ethnic inequalities in maternity service experiences and outcomes: responding to women's needs and preferences. A race equality better health briefing paper. 2008;

Chinouya MJ, Madziva C. Late booking amongst African women in a London borough, England: implications for health promotion. Health Promotion International.. 2017; 34:(1)123-132

Critical Appraisal Skills Programme. CASP qualitative checklist. 2018. (accessed 10 June 2019)

D'Souza L, Garcia J. Improving services for disadvantaged childbearing women. Child: Care, Health and Development. 2004; 30:(6)599-611

Dahlgren G, Whitehead M. Concepts and principles for tackling social inequities in health: levelling up.Copenhagen: World Health Organization; 2006

Tackling health inequalities in infant and maternal health outcomes report-report of the Infant Mortality National Support Team.London: UK Government; 2010

Garcia R, Ali N, Papadopoulos C, Randhawa G. Specific antenatal interventions for Black, Asian and Minority Ethnic (BAME) pregnant women at high risk of poor birth outcomes in the United Kingdom: a scoping review. BMC Pregnancy and Childbirth.. 2015; 15:(1)

Gardner PL, Bunton P, Edge D, Wittkowski A. The experience of postnatal depression in West African mothers living in the United Kingdom: A qualitative study. Midwifery.. 2014; 30:(6)756-763

Goodwin L, Hunter B, Jones A. The midwife–woman relationship in a South Wales community: experiences of midwives and migrant Pakistani women in early pregnancy. Health Expectations.. 2018; 21:(1)347-357

Henderson J, Gao H, Redshaw M. Experiencing maternity care: the care received and perceptions of women from different ethnic groups. BMC Pregnancy and Childbirth.. 2013; 13:(1)

Jayaweera H, Hockley CA, Redshaw ME, Quigley MA. Millennium cohort study first survey.Oxford: University of Oxford; 2007

Jomeen J, Redshaw M. Ethnic minority women's experience of maternity services in England. Ethnicity and Health.. 2013; 18:(3)280-296

Saving lives, improving mothers' care-lessons learned to inform maternity care from the UK and Ireland: confidential enquiries into maternal deaths and morbidity 2015-17. In: Knight M, Bunch K, Tuffnell D, Shakespeare J, Kotnis R, Kenyon S, Kurinczuk JJ. Oxford: National Perinatal Epidemiology Unit, University of Oxford; 2019

Liberati A, Altman G, Tetzlaff J, Gotzsche C, Ionnidis P, Moher D. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elabortation. PLOS Medicine.. 2009; 6

Marmot M. Social determinants of health inequalities. The Lancet. 2005; 365:(9464)1099-1104

Marmot MG, Allen J, Goldblatt P, Boyce T, McNeish D, Grady M, Geddes I. Fair society, healthy lives: strategic review of health inequalities in England post-2010.London: Institute of Health Equity; 2010

Marmot M, Bell R. Fair society, healthy lives. Public Health.. 2012; 126:S4-S10

Marmot M, Allen J, Boyce T, Goldblatt P, Morrison J. Health Equity in England: the Marmot review 10 years on.London: Institute of Health Equity; 2020

Matthews D. The impact of ethnicity on health inequalities. Nursing Times.. 2015; 111:(44)18-20

McLeish J, Redshaw M. Mothers' accounts of the impact on emotional wellbeing of organised peer support in pregnancy and early parenthood: a qualitative study. BMC Pregnancy and Childbirth.. 2017; 17:(1)

Muglu J, Rather H, Arroyo-Manzano D, Bhattacharya S, Balchin I, Khalil A, Thangaratinam S. Risks of stillbirth and neonatal death with advancing gestation at term: a systematic review and meta-analysis of cohort studies of 15 million pregnancies. PLOS Medicine.. 2019; 16:(7)

Moller AB, Patten JH, Hanson C, Morgan A, Say L, Diaz T, Moran AC Monitoring maternal and newborn health outcomes globally: a brief history of key events and initiatives. Tropical Medicine and International Health.. 2019; 24:(12)1342-1368

National Audit Office. Maternity services in England. 2013. (accessed 7 July 2019)

National Heart, Lung and Blood Institute. Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. 2018. (accessed 10 June 2019)

Better births: improving outcomes of maternity services in England – a five year forward view for maternity care.: NHS England; 2016

Implementing Better births: a resource pack for local maternity systems.: NHS England; 2017

Office of National Statistics. Ethnicity and national identity in England and Wales: 2011. 2012. (accessed 18 April 2019)

Puthussery S. Perinatal outcomes among migrant mothers in the United Kingdom: is it a matter of biology, behaviour, policy, social determinants or access to health care? Best Practice and Research Clinical Obstetrics and Gynaecology. 2016; 32:39-49

Whitehead M. Tackling inequalities: a review of policy initiatives. In: Benzeval M, Judge K, Whitehead M. London: King's Fund Publishing; 1999

Ethnic health inequalities in the UK's maternity services: a systematic literature review

02 February 2021
Volume 29 · Issue 2



Black, Asian, and minority ethnic (BAME) women have significantly higher morbidity and mortality rates in the UK as well as poorer experiences of care. To date, a systematic literature review has not been undertaken in the UK to explore ethnicity based health inequalities.


To explore the maternal health inequalities encountered by BAME women in the UK in relation to their experiences and use of services.


A systematic literature search was conducted via five databases (PubMed, MEDLINE, CINAHL, MIDIRS and BNI). Inclusion-exclusion criterion and a keyword strategy were implemented to screen for literature published between 2013–2018.


A total of eight studies with various ethnicities and geographical locations were included. Five themes emerged following thematic analysis: communication, midwife-woman relationship, healthcare services and systems, culture and social needs.


The review identified consistency within and across the five themes. Maternity services and systems is a predominant theme that has a residual effect on the remaining four themes.

Maternal and infant mortality and morbidity have progressively declined in the last decade throughout the world (Moller et al, 2019), and there have been many improvements in the quality of maternity care in the UK. However, disparities remain between ethnic groups (Ameh and van Den Broek, 2011; National Audit Office, 2013; Matthews, 2015). Black, Asian and minority ethnic (BAME) women face limitations in access to maternity services in the UK and experience poorer health outcomes compared to white British women (Garcia et al, 2015). The most recent confidential enquiry into maternal mortality reported that black women are five times more likely; mixed-ethnicity women are three times more likely; Asian women are twice as likely to die in pregnancy then white women (Knight et al, 2019). Moreover, black women are up to twice as likely to have a stillbirth at all gestational ages (Muglu et al, 2019).

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