The role of social risk factors and engagement with maternity services in ethnic disparities in maternal mortality: a retrospective case note review

Eleanor Cosstick, Rachel Nirmal, Fiona Cross-Sudworth, Marian Knight, Sara Kenyon

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Abstract

Background: Reasons for ethnic disparities in maternal death in the UK are unclear and may be explained by differences in social risk factors and engagement with maternity services. Methods: In this retrospective systematic case note review, we used anonymised medical records from MBRRACE-UK for all Other than White, and White European/Other women plus a random sample of White British/Irish women who died in pregnancy or up to 1 year afterwards from 01/01/2015 to 12/31/2017. We used a standardised data extraction tool developed from a scoping review to explore social risk factors and engagement with maternity services. Findings: Of 489 women identified, 219 were eligible for the study and 196 case notes were reviewed, including 103/119 from Other than White groups, 33/37 White European/Other and a random sample of 60/333 White British/Irish. The presence of three or more social risk factors was 11⋅7% (12/103) in Other than White women, 18⋅2% (6/33) for White European/Other women and 36⋅7% (22/60) in White British/Irish women. Across all groups engagement with maternity services was good with 85⋅5% (148/196) receiving the recommended number of antenatal appointments as was completion of antenatal mental health assessment (123/173, 71⋅1%). 15⋅5% (16/103) of Other than White groups had pre-existing co-morbidities and 51⋅1% (47/92) had previous pregnancy problems while women across White ethnic groups had 3⋅2% (3/93) and 33⋅3% (27/81) respectively. Three or more unscheduled healthcare attendances occurred in 60⋅0% (36/60) of White British/Irish, 39⋅4% (13/33) in White European/Other and 35⋅9% (37/103) of Other than White women. Evidence of barriers to following healthcare advice was identified for a fifth of all women. None of the 17 women who required an interpreter received appropriate provision at all key points throughout their maternity care. Interpretation: Neither increased social risk factors or barriers to engagement with maternity services appear to underlie disparities in maternal mortality. Management of complex social factors and interpreter services need improvement. Funding: National Institute for Health Research (NIHR) Applied Research Collaboration West Midlands.

Original languageEnglish
Article number101587
Number of pages12
JournalEClinicalMedicine
Volume52
Early online date29 Jul 2022
DOIs
Publication statusPublished - Oct 2022

Bibliographical note

Funding Information:
MK reports grants from Heathcare Quality Improvement Partnership, National Institute for Health Research MRC and Wellbeing of Women; MK has an honorarium for Hooker Distinguished Visiting Professorship McMaster University.

Funding Information:
This research is supported by the National Institute for Health Research (NIHR) Applied Research Centre (ARC) West Midlands: SK is part funded and FCS fully funded. MK and SK are NIHR Senior Investigators. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. The Maternal, Newborn and Infant Clinical Outcome Review Programme, delivered by MBRRACE-UK, is commissioned by the Healthcare Quality Improvement Partnership (HQIP) on behalf of NHS England, NHS Wales, the Health and Social Care division of the Scottish government, The Northern Ireland Department of Health, and the States of Jersey, Guernsey, and the Isle of Man. The MBRRACE-UK collaboration are grateful to the contribution of the many healthcare professionals and staff from the health service and other organisations who were involved in the notification of the maternal deaths, the provision of medical records which are required for the national confidential enquiries and supported the execution of this study. The authors would like to acknowledge the assistance of all MBRRACE-UK administration and programming teams.

Funding Information:
This research is supported by the National Institute for Health Research (NIHR) Applied Research Centre (ARC) West Midlands: SK is part funded and FCS fully funded. MK and SK are NIHR Senior Investigators. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. The Maternal, Newborn and Infant Clinical Outcome Review Programme, delivered by MBRRACE-UK, is commissioned by the Healthcare Quality Improvement Partnership (HQIP) on behalf of NHS England, NHS Wales, the Health and Social Care division of the Scottish government, The Northern Ireland Department of Health, and the States of Jersey, Guernsey, and the Isle of Man.

Funding Information:
FCS declares that this work was completed while employed as a research fellow at the University of Birmingham - funded by the National Institute for Health Research (NIHR) Applied Research Collaborative (ARC) West Midlands – Maternity Theme.

Funding Information:
SK reports a funded post from the University of Birmingham; is an NIHR grant holder, and is a collaborator on HQIP funded projects; was on the Steering Committee for NIHR funded trial- Impacted fetal head; was Chair on PreSePT Steering Committee of Health Foundation study; is Deputy Chair of HEE/NIHR Integrated Clinical Academic (ICA) Programme Pre-doctoral Clinical Academic Fellowship Scheme Panel.

Keywords

  • Access to maternity services
  • Ethnic minorities
  • Maternal death
  • Risk factors
  • Maternal co-morbidities
  • Interpreter services

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