Maternity Choice

This project was additionally commissioned by North East London Local Maternity and Neonatal Service following the development of the Maternity Equity and Equality Action plan 2022. Themes developed from this extensive engagement had a focus on global majority community views and led to a request for insight from NEL Healthwatch into: 

• the demand for and nature of culturally sensitive Maternity care provision within NEL 
• the reasons for the choice of Maternity Unit to evidence any contributing factors 

Methodology 

We heard from 403 Maternity service users across North East London through a live survey link between December 2022 and February 2023. Additionally, a one-week snapshot engagement across Maternity Units and community antenatal clinics took place in February 2023 where teams of researchers and volunteers were able to engage with Maternity service users directly. 

Findings 

We are still seeing an ongoing division in maternity experience relating to health inequality. Due to sensitive questioning, we can deliver a closer identification of particular communities facing intersectional disadvantage:

• referral by GP seems to lead to a lower level of choice and co-production experienced by Maternity service users than self-referral mechanisms 
• Service users from Black African, Turkish, Pakistani and Eastern European communities are less likely to experience a choice of maternity unit 
• Fluency in English is a well-known marker of inequality, and we see this here. 
• Being a single parent, although now less stigmatised, remains a marker of inequality
• 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.

Recommendations

• Creating greater awareness of the nature of health inequality across North East London. 
• Further research into GP referral structures 
• Further research into self-referral choice mechanisms. 
• Management of capacity issues within antenatal provision. 
• Clear information about antenatal waiting times and the impact of delayed arrival. 
• Training for staff in engagement and empathy (and trauma-informed care, particularly for previous baby loss as with the previous equity and equality recommendations) 
• Cultural sensitivity training for Maternity staff caring for service users from Black, Polish and Pakistani communities 
• Interpreting services for any service user with less than conversational English 
• Improved parking facilities where a car is the main mode of transport.