NHS North East London want to ensure all women and pregnant people have choice when using maternity services. As part of this, we worked with Healthwatch and Maternity Voices Partnerships to understand what motivates choice when it comes to maternity care, and the demand for and nature of culturally sensitive maternity care provision in north east London.
Through online surveys and face to face interviews in antenatal clinics, children’s centres, foodbanks, nurseries and faith groups, we spoke with 403 people to hear about their experiences of maternity care and understand whether they felt they could make choices, why they chose to have their maternity care at their chosen hospital, birth centre or a home birth, and how they felt issues of cultural sensitivity and associated barriers impacted their choice.
Findings identified that we are still seeing an ongoing division in maternity experience relating to health inequality. Due to sensitive questioning of the maternity choice engagement we are able to understand a closer identification of particular communities facing intersectional disadvantage. Findings indicate:
- Referral by GP or self-referral correlates to the level of choice and co-production experienced by maternity service users.
- Fluency in English is a well-known marker of inequality, and this is seen across our boroughs.
- Being a single parent, although now less stigmatised, remains a marker of inequality because of the GP referral pathway.
- Service users from Black African, Turkish, Pakistani and Eastern European communities are less likely to experience choice of maternity unit because they rely on GP referral.
- Respondents of Black ethnicities experience a double barrier to maternity care because they are more likely to value cultural symmetry but less likely to experience this.
- Polish and Pakistani respondents were less likely to report having access to professionals who speak their language.
- Antenatal classes have suffered a pandemic impact. They are no longer widely available free at the point of access, and this might negatively impact service users facing inequality.
- Antenatal provision is at times perceived to be rushed and lacking engagement from maternity health professionals.
Following these findings, recommendations include areas focused on: scoping of GP and self-referral structures, management of antenatal service capacity and clear information for service users on antenatal clinic waiting times, increase training for staff on cultural sensitivities and trauma informed care, improved interpreting services for those with less than conversational English, improved parking facilities for units where car in the main mode of transport and greater awareness of the nature of health inequality across North East London.
NEL LMNS are working with maternity units, Healthwatch, local voluntary and community groups and service users to deliver on the recommendations and actions required in direct response to findings. The recommendations from this report will add to the ongoing actions and delivery outlined in the Maternity Equity and Equality strategy and action plan, published in December 2022. The insights from both these pieces of engagement, and subsequent reports, will inform improvements in maternity care for all our communities, reducing health inequalities and improving health outcomes.