Aquino M, Edge D, Smith D. 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

Bawadi H, Al-Hamdan Z, Ahmad M. Needs of migrant Arab Muslim childbearing women in the United Kingdom. Journal of Transcultural Nursing. 2020; 31:(6)591-597

Bowler I. ‘They're not the same as us': midwives’ stereotypes of South Asian descent maternity patients. Sociology of Health and Illness. 1993; 15:(2)157-178

Chekroud A, Everett J, Bridge H, Hewstone M. A review of neuroimaging studies of race-related prejudice: does amygdala response reflect threat?. Front Hum Neurosci. 2014; 8

Cooke A, Smith D, Booth A. Beyond PICO: The SPIDER tool for qualitative evidence synthesis. Qualitative Health Research. 2012; 22:(10)1435-1443

Critical Appraisal Skills Programme. CASP qualitative studies checklist. 2018. (accessed 21 April 2020)

Department of Health. Midwifery 2020. Delivering expectations. 2010. (accessed 10 February 2022)

Devine P, Forscher P, Austin A, Cox W. Long-term reduction in implicit race bias: A prejudice habit-breaking intervention. Journal of Experimental Social Psychology. 2017; 48:(6)1267-1278

Drewniak D, Krones T, Wild V. Do attitudes and behaviour of health care professionals exacerbate health care disparities among immigrant and ethnic minority groups? An integrative literature review. International Journal of Nursing Studies. 2017; 70:89-98

Fitzgerald C, Hurst S. Implicit bias in healthcare professionals: a systematic review. BMC Medical Ethics. 2017; 18

Fitzgerald C, Martin A, Berner D, Hurst S. Interventions designed to reduce implicit prejudices and implicit stereotypes in real world contexts: a systematic review. BMC Psychology. 2019; 7

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

A qualitative study exploring British Muslim women's experiences of motherhood while engaging with NHS maternity services. 2017. (accessed 17 February 2022)

Hassan S, Leavey C, Rooney J, Puthussery S. A qualitative study of healthcare professionals' experiences of providing maternity care for Muslim women in the UK. BMC Pregnancy and Childbirth. 2020; 20:(1)

Healthcare Safety Investigation Branch. Maternity investigations. Part of a national action plan to improve maternity care. 2020. (accessed 4 January 2021)

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

Higginbottom G, Evans C, Morgan M, Bharj K, Eldridge J, Hussain B. Experience of and access to maternity care in the UK by immigrant women: a narrative synthesis systematic review. BMJ Open. 2019; 9

Black people, racism and human rights.London: The House of Commons and the House of Lords; 2020

Jomeen J, Redshaw M. Ethnic minority women's experience of maternity services in England. Ethnicity & 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 2014-16. 2018. (accessed 10 February 2022)

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. 2019. (accessed 10 February 2022)

Moher D, Liberati A, Tetzlaff J, Altman D. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. Journal of Clincal Epidemiology. 2009; 62:(10)1006-1012

National Maternity Review. Better Births. Improving outcomes of maternity services in England. A five year forward view for maternity care. 2016. (accessed 10 February 2022)

NHS. Maternity Transformation Programme. 2020. (accessed 4 January 2021)

NHS Improvement. National tariff payment system. A set of prices and rules to help commissioners and providers of NHS care provide best value to their patients. 2020. (accessed 4 January 2021)

National Institute for Health Research. Search our evidence. 2020. (accessed 17 April 2020)

National Perinatal Epidemiology Unit. Research. 2020. (accessed 17 April 2020)

Nursing and Midwifery Council. The code. Professional standards of practice and behaviour for nurses, midwives and nursing associates. 2018. (accessed 4 January 2021)

Nursing and Midwifery Council. Standards of proficiency for midwives. 2019. (accessed 3 January 2021)

Public Health England. Place based approaches for reducing health inequalities: main report. 2019. (accessed 3 January 2021)

Royal College of Midwives. High quality midwifery care. 2014. (accessed 10 January 2021)

Richards J, Kliner M, Brierley S, Stroud L. Maternal and infant health of Eastern Europeans in Bradford, UK: a qualitative study. Community Practitioner. 2014; 87:(9)33-36

White A, Logghe H, Goodenough D Self-awareness and cultural identity as an effort to reduce bias in medicine. Journal of Racial and Ethnic Health Disparities [online]. 2018; 5:(2018)34-49

World Health Organization. Maternal and reproductive health. 2020. (accessed 4 January 2021)

Williams D, Lawrence J, Davis B, Vu C. Understanding how discrimination can affect health. Health Services Research. 2019; 54:1374-1388

Factors contributing to maternal health inequalities for women who are not white British in the UK

02 March 2022
Volume 30 · Issue 3



Women of non-white British ethnicity have a higher maternal mortality risk for reasons not yet fully understood, and report significant concerns about stereotypes, racism and overall dissatisfaction in care. This study aimed to examine what midwives perceive to be contributing factors to ethnic disparity in maternity care.


A systematic search of the literature was conducted to find contemporaneous, relevant studies which were appraised for inclusion and quality. Four qualitative studies were included.


Midwives spoke about practical, cultural and logistical concerns that contribute to health inequalities; none mentioned racism. Three themes emerged: relationship barriers, logistical barriers and a sense of us vs them. Three areas of us vs them were explored: ‘incongruent expectations’, ‘structural racism, stereotypes and implicit bias’ and ‘culture vs professional accountability’.


Further research into the impact of implicit bias is needed to adequately address health inequalities for non-white British women. A national strategy could be used to set expectations for women accessing UK maternity services early in pregnancy. Midwives need to be empowered and supported to thoroughly document women's choices so that their professional responsibilities are met.

In pregnancy and 6 weeks postnatally, the risk of maternal mortality in the UK is significantly higher for women who are not of white ethnicity (Knight et al, 2018). Women from ethnic minorities express dissatisfaction with maternity care, stereotyping, racism, language barriers and unmet expectations (Henderson et al, 2013; Jomeen and Redshaw, 2013; Higginbottom et al, 2019; Bawadi et al, 2020). Public Health England (PHE, 2019) recognises health inequalities as a major concern and is attempting to reduce them (NHS, 2020). Midwives are tasked with providing individualised care to women (Nursing Midwifery Council (NMC), 2019) and are encouraged to develop awareness of inequalities using self-reflection to recognise where their personal delivery of care may disadvantage non-white British women (Knight et al, 2019). When considering inequalities within their practice, midwives may focus their efforts on tackling issues they perceive to be key contributing factors. Hence, it is important to understand what midwives perceive are contributing factors to health inequalities for non-white British women.

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