Maternity Choices
We also wanted to find out why mothers-to-be had chosen the particular maternity unit at which their baby had been, or was expected to be, born.
Across the whole of North East London, we heard from 403 Maternity service users 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.
We found that there remains 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 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.
Our report is being used by NHS North East London to inform the development of their 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.
You can read the full Healthwatch report for North East London, and the report specifically about Havering by clicking the links below:
The North East London Maternity and Neonatal Service (LMNS) said:
"... this research was able to focus on more detail regarding maternity choice and culturally sensitive maternity provision in north east London. This insight and analysis helps us, as an LMNS, set actions for improvement and deliver meaningful change, in direct response to local ask.
"Much like the equity and equality engagement undertaken last summer, it was invaluable having you all work together to hear a collective response from our communities. Once again, you reached audiences we never would have been otherwise able to reach, and the analysis was thorough and extensive, so thank you for all your contributions."
