Sheffield Hallam University is one of the nine universities, and I will be leading a programme of research to help improve outcomes for women and babies with a focus on women from migrant, ethnic minority and deprived communities.
As a registered midwife and a researcher with more than 25 years’ experience researching maternal health inequalities, I know how vital this new UK-wide research collaboration is.
Maternal deaths in the UK have increased with persistent disparities over the past two decades. We know mothers and babies from Black and Asian minority ethnic groups and those from socio-economically deprived areas have a much higher risk of death and serious complications in pregnancy, birth and the postnatal period.
The most recent statistics show that Black women were nearly three times more likely to die during pregnancy, birth and in the postnatal period and Asian women almost twice as likely as their white British counterparts.
Mortality for women living in the most deprived areas was two times higher than those living in the least deprived areas. Similarly, stillbirth or neonatal death were significantly higher in Black and Asian babies, or in those from the most deprived areas.
Alarmingly, this information on maternal and neonatal health inequalities has been evident for many years. Knowing the magnitude of maternal and infant health disparities, the first step to tackling such inequalities, is to understand the exact nature and the reasons behind them. Deep understanding of issues and the reasons they exist are essential to help create appropriate and targeted interventions. It is well known that ethnicity and deprivation are the two major determinants of health, however the mechanism through which these disparities have been exerted is not very clear.
Research has demonstrated that high quality care and better systems could have prevented at least half of observed perinatal complications and deaths experiences associated with racial, ethnic and poverty related inequalities. Appropriate interventions are needed to be developed with the communities who need them to ensure they are sensitive to those experiencing the most inequalities.
Health inequalities, including diabetes and mental ill health, have been attributed to genetic predisposition, environmental exposures and changing lifestyle factors such as diet and physical activity. Another contributing feature is suggested to be a lack of training for healthcare providers to be competent in culturally sensitive care, and also in clinical assessment of mothers and babies from diverse communities.
While it is important, the prevailing emphasis on poor outcomes often ignores positive aspects of Black, Asian and impoverished communities. There is potential to build on community assets by engaging with families to understand the challenges and the opportunities for making a difference collectively. The value of working closely with communities and building on common understandings and values between various stakeholders, investigators, policy makers and service providers in a true sense of collaboration, is gradually being realised.
In the case of migrant pregnant women and families, providing bespoke information and support including enhancing health literacy and providing community peer support may be helpful in improving quality of care. Additionally, education and appropriate training for healthcare professionals during undergraduate and post-qualification in practice, is imperative to embed a greater understanding of cultural safety and upskilling staff in providing trauma aware, culturally sensitive and compassionate care for mothers and families in vulnerable situations.
Knowing what we know, it is a moral imperative that national policy makers and service providers collaborate with researchers and communities to co-design and provide practical solutions for such important maternity challenges.
The newly announced NIHR Maternity Disparities Consortium is a step in the right direction. This highly ambitious and timely initiative will support the development of high quality, large-scale research to drive improvements in health and social care priority areas.
Recognising the value of appropriate care in the first one thousand days of life, and even before that, bringing a wide range of expertise and disciplines together with community engagement at the heart, provides a great opportunity to join the dots and formulate a strategic vision and programme to tackle health inequalities for mothers and babies.
I am delighted to lead Sheffield Hallam’s collaborative team of ethnically and professionally diverse colleagues including partners from Bournemouth University and Doncaster City Council as part of this ambitious programme. I truly believe we can bring about long-lasting, positive changes for the women and babies who need it most.
