(Photo credit: Dundee Midwifery Unit at Ninewells Hospital/gov.scot.flickr)
Hamed Chapman
The NHS Race and Health Observatory is calling for the development of a central data repository to map improvements around reducing poor outcomes in maternal and neonatal healthcare for Black, Asian and ethnic minority women.
“It is imperative that health teams, the NHS, integrated care boards, and all other providers of perinatal services take stock of this report and commit to effective action to address maternal health inequalities and more research as a priority,” says consultant obstetrician and Deputy Chair of the Observatory’s maternal working group, Daghni Rajasingam.
“There is an urgent need for programmes across England that are designed to address, track, and evaluate maternal inequalities going forward. It is not acceptable that one of the leading causes of maternal mortality is also linked to mental illness, and women from ethnic minority communities are once again disproportionately affected,” Rajasingam warned.
New research carried out by the independent health organisation, the University of Liverpool, and the University of Warwick, found few maternal policies developed by hospital trusts and other providers have a focus on addressing ethnic health inequalities across maternity care.
The lack of a national, central focus, diversity of research, and national commitment are outlined in a new report, published earlier this month, “Mapping existing policy interventions to tackle ethnic health inequalities in maternal and neonatal health in England: A systematic scoping review with stakeholder engagement.”
Oluwaseun Esan, the principal investigator of the study from Liverpool University, said that a “specific policy on reducing ethnic health inequalities” for Black, Asian and minority ethnic women is urgently required, as is “increased investment in research on interventions” that address the inequalities in outcomes.
Assistant Professor, Abimbola Ayorinde, at Warwick Medical School, University of Warwick, said that it was “disappointing that in over 40 years of published evidence we only found 19 interventions aimed broadly at tackling ethnic inequalities” and that this suggested “paucity of robust evidence as well as lack of clear records of interventions in this area.”
The research found that the majority of interventions reviewed did not include a specific focus on race, ethnicity or action plans to improve the disparate outcomes for Black, Asian and ethnic minority women, pregnant people, and babies in maternity and neonatal care. Additionally, no evaluation of interventions that aim to tackle institutional or interpersonal racism, such as tackling ethnic stereotyping or supporting people with experience of discrimination in healthcare, was found. In the UK, Black women are four times more likely to die during pregnancy or childbirth compared to White women, with women from Asian backgrounds facing twice the risk of maternal mortality. Overall, poor evaluation and design were a factor in most interventions.
Director of the NHS Race and Health Observatory, Habib Naqvi, said the findings “highlight the need for a more joined up and holistic approach to tackling ethnic and racial inequalities in maternal health.”
“Interventions must be evaluated, and their impact on marginalised groups must be considered. The review highlights the need to create systemic changes in research funding and design to ensure that any efforts to implement interventions are not wasted through a lack of robust design principles, evaluation, and dissemination planning,” Naqvi said.
