Addressing ethnic disparity in antenatal care: a qualitative evaluation of midwives’ experiences with the MAMAACT intervention

Abstract

Background: In Denmark, 13% of all children are born by non-Western immigrant women. The public antenatal care has not adapted to this increased diversity of women. Compared to women coming from Western countries, non-Western immigrant women have an increased prevalence of severe maternal morbidity and higher risks of maternal death, stillbirth and infant death. Suboptimal care is a contributing factor to these ethnic disparities, and thus the provision of appropriate antenatal care services is pivotal to reducing these disparities and challenges to public health. Yet, little is known about the targeted interventions which have been developed to reduce these inequities in reproductive health. The MAMAACT intervention, which included a training course for midwives, a leaflet and a mobile application, as well as additional visit time, was developed and tested at a maternity ward to increase responses to pregnancy warning signs among midwives and non-Western immigrant women. Aim: To explore the feasibility and acceptability of the MAMAACT intervention among midwives and identify factors affecting midwives' delivery of the intervention. Methods: Eight mini-group interviews with midwives (n = 18) were undertaken. Systematic text condensation was used to analyse data. Results: Three main categories were identified, which were 'Challenges of working with non-Western immigrant women', 'Attitudes towards and use of the leaflet and mobile application', and 'Organisational factors affecting the use of the MAMAACT intervention'. Conclusions: The MAMAACT intervention was found to be feasible as well as acceptable among midwives. Women turning to relatives for pregnancy-related advice, time constraints during midwifery visits, incomplete clinical records and lack of professional interpreter assistance impacted midwives' delivery of the MAMAACT intervention. Midwives displayed a readiness for the MAMAACT intervention; however, there is a need to further examine how contextual factors may impact the use of the intervention in antenatal care. Trial registration: ClinicalTrials.gov, Retrospective Registration (07/2/2020), registration number NCT04261400.

A systematic review of the experiences of minority language users in health and social care research

“…This maternal health theme included three papers which specifically investigated maternal health in relation to minority populations (Strohschein et al ., 2010; Huang et al ., 2019; Johnsen et al ., 2020). One of the papers was a systematic review published in 2019 and two papers were qualitative studies published in 2010 (Strohschein et al ., 2010) and 2020 (Johnsen et al ., 2020).…”

“…This maternal health theme included three papers which specifically investigated maternal health in relation to minority populations (Strohschein et al ., 2010; Huang et al ., 2019; Johnsen et al ., 2020). One of the papers was a systematic review published in 2019 and two papers were qualitative studies published in 2010 (Strohschein et al ., 2010) and 2020 (Johnsen et al ., 2020). The systematic review was a review of 10 qualitative papers which focussed on the language barriers or differences in socio-economic status, and clinical practices that conflicted with local fears and traditional customs.…”

“…The authors highlight the need to be culturally as well as linguistically aware and noted that the research process is influenced by cultural background. In the qualitative study conducted in 2020 (Johnsen et al ., 2020), eight mini-group interviews with midwives (n = 18) to explore the feasibility of the MAMAACT intervention. This involved a training course for midwives, a leaflet, and a mobile application, as well as additional visit time.…”

Hypoxic ischemic encephalopathy in offspring of immigrant women in Sweden: A population‐based cohort study

“…Our material did not include premature births; but post‐term pregnancies were more common among women born in low‐income countries. Higher frequencies of post‐term pregnancies are found in some ethnic groups 27,28 . The reason is not well understood or investigated but it has been suggested that there might be a genetic predisposition.…”

“…Higher frequencies of post-term pregnancies are found in some ethnic groups. 27,28 The reason is not well understood or investigated but it has been suggested that there might be a genetic predisposition. Only 13% of the total effect on Apgar score <7 at 5 minutes was mediated by variables addressed in our study, and 9% of the mediated path was through cohabitation.…”