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