Experience of and access to maternity care in the UK by immigrant women: a narrative synthesis systematic review

Abstract

One in four births in the UK is to foreign-born women. In 2016, the figure was 28.2%, the highest figure on record, with maternal and perinatal mortality also disproportionately higher for some immigrant women. Our objective was to examine issues of access and experience of maternity care by immigrant women based on a systematic review and narrative synthesis of empirical research.Review methodsA research librarian designed the search strategies (retrieving literature published from 1990 to end June 2017). We retrieved 45 954 citations and used a screening tool to identify relevance. We searched for grey literature reported in databases/websites. We contacted stakeholders with expertise to identify additional research.ResultsWe identified 40 studies for inclusion: 22 qualitative, 8 quantitative and 10 mixed methods. Immigrant women, particularly asylum-seekers, often booked and accessed antenatal care later than the recommended first 10 weeks. Primary factors included limited English language proficiency, lack of awareness of availability of the services, lack of understanding of the purpose of antenatal appointments, immigration status and income barriers. Maternity care experiences were both positive and negative. Women with positive perceptions described healthcare professionals as caring, confidential and openly communicative in meeting their medical, emotional, psychological and social needs. Those with negative views perceived health professionals as rude, discriminatory and insensitive to their cultural and social needs. These women therefore avoided continuously utilising maternity care.We found few interventions focused on improving maternity care, and the effectiveness of existing interventions have not been scientifically evaluated.ConclusionsThe experiences of immigrant women in accessing and using maternity care services were both positive and negative. Further education and training of health professionals in meeting the challenges of a super-diverse population may enhance quality of care, and the perceptions and experiences of maternity care by immigrant women.

“We couldn’t talk to her”: a qualitative exploration of the experiences of UK midwives when navigating women’s care without language

“…Despite a 38% worldwide reduction in maternal mortality, it is apparent that inequalities continue (WHO et al, 2019). Recurrent factors attributing in part to poor outcomes for immigrant women in the United Kingdom (UK) include lack of awareness of the availability of maternity services, lack of understanding of the purpose of antenatal appointments and limited English language proficiency (Higginbottom et al, 2019).…”

“…informed decision-making is a sizeable human rights element of reproductive health, but women commonly describe communication failures with health workers during pregnancy and birth (Khosla et al, 2016). Available health service reports indicate nearly 300,000 adults of Indian, Pakistani, Bangladeshi and Chinese ethnicities in England and Wales have experienced communication barriers with health-care professionals (HCPs) (Gill et al, 2011) and this is similar for women with limited to no English proficiency attempting to access maternity services (Higginbottom et al, 2019).…”

An exploration of migrant women’s perceptions of public health messages to reduce stillbirth in the UK: a qualitative study

“…However there remains a considerable disparity in outcome within the population, with Black, Asian and Minority Ethic [BAME] and in particular migrant women continuing to have higher rates of stillbirth compared to white women [2]. The reasons for these inequalities in stillbirth rates are not clear, but are likely to be multifaceted and include underlying structural racism, socioeconomic disadvantage and associated stress and coping mechanisms, access and acceptability of health care and accessibility to public health messages around reducing perinatal mortality [3,4] Previous research has identified that migrant women's experience of maternity care in the UK is generally poorer than that of women born in the UK [5,6].…”

Involving service users in Births and their outcomes: a retrospective birth cohort data linkage study analysing daily, weekly and yearly cycles and their implications for the NHS

“…It would have enhanced the PI&E in the study to have engaged additional younger women and more women from different cultural backgrounds, such as vulnerable and disadvantaged communities [ 94 ]. Inequalities in power relationships within and beyond healthcare [ 95 ] and poorer outcomes, particularly for Black women, but also for Asian and other ethnic communities and migrant women should be addressed [ 85 ]. Organisations and doula groups focusing specifically on the needs of women of colour [ 96 , 97 ] and advocating for women and families facing multiple social disadvantage [ 50 ] are increasingly accessible as social media open up instant communications and networking.…”