Introduction:

Equality and Diversity in maternity services is critical to providing the best possible care for women and their families. Chris Evans, Senior Consultant at Apira who has supported multiple maternity system projects for our customers, talks about some of his experiences and why he feels diversity is affecting maternity care.

Personally I think equality and diversity within maternity services is about taking account of the differences between people and groups of people and placing a positive value on those differences. Pregnancy-related mortality rates among women who are Black, Asian, and mixed ethnicity are over three and two times higher, respectively, compared to the rate for White women, according to data provided via multiple platforms and NHS Trusts. Unfortunately, they also have higher rates of still births, low birthweight births, or births for which they received late or no prenatal care compared to White women. It is also worth noting maternal death rates increased during the COVID-19 pandemic and racial disparities widened for Black women.

Problem:

The Government and NHS have taken actions to halve the rate of stillbirths, neonatal deaths, maternal death rate and brain injuries by 2025. The latest figures show the stillbirth rate has reduced by over 25% since 2010 and the neonatal mortality rate has reduced by 29%, surpassing the ambition for a 20% reduction by 2020. However, while some progress has been made, there is still an imbalance but the reasons for this remain unclear, meaning further action and research does need to be done to tackle this.

The current data shows mortality rates between women from Asian ethnic groups are twice as high as white women and even higher for black women. According to recent studies it has also been found that black women are 40% more likely to experience a miscarriage than white women.

Unfortunately, data shows that a considerably higher proportion of babies of Black African, Black Caribbean, Pakistani and Bangladeshi ethnicity are born to mothers living in more deprived areas, this information tells us there is a high chance that they are disproportionately experiencing the higher rates observed with increasing deprivation compared to babies of White ethnicity born to mothers who were more likely to be living in less deprived areas. According to the data only 5-6% of babies of Black African, Black Caribbean, Pakistani and Bangladeshi ethnicity were born to mothers living in the least deprived quintile compared to 22% of babies of White ethnicity.

The data provided highlights several issues including, multiple disadvantages, confirming the need for national strategies to tackle disparities in maternity care experienced by women and people from ethnic minority groups and those living in deprived areas.

There is work being conducted by MBRRACE-UK investigating inequalities in stillbirth rates by ethnicity, including an exploration of cause of death . The current MBRRACE-UK perinatal confidential enquiry, which will report in 2023, has been expanded to include mothers of both Black and Asian ethnicity. The enquiry is reviewing the quality-of-care provision to identify areas where care could be improved and to assess whether the care provided for these communities is equitable. The findings of this work will further support the national aims to improve maternity care for these high-risk groups.

What the NHS is doing and how

The NHS is working to improve equity for mothers and babies and equality in experience for staff. The NHS has set out why this work is needed, the aims of this work and how the NHS will achieve its aims in two documents:

Guidance for Local Maternity Systems: Equity and Equality: Guidance for Local Maternity Systems. Based on the five health inequalities priorities in the 2021/22 Planning Guidance, this will help Local Maternity Systems align their Equality and Equality Action Plans with Integrated Care Systems health inequalities work. The guidance includes an analysis of the evidence, interventions to improve equity and equality, resources, indicators and metrics.
Four pledges to women, babies and staff: NHS pledges to improve equity for mothers and babies and race equality for staff. The four pledges help create a shared understanding of why work on equity and equality is needed, and the aims and outcomes of this work. The four pledges can help ‘set the scene’ in local co-production work.

Over the past few years, the NHS has gradually moved towards the use of digital technology to help improve health outcomes and support national targets in the Long-Term Plan. The Maternity Transformation Programme advocates this as the main driving force in achieving the visions outlined in the Better Births Report, such as patient-centered care which will promote maternity equality and tailored support for healthcare workers.

What can be done?

The implementation of digital services has helped improve the quality of data within Maternity Services across the UK, and it has also helped encourage patient engagement which can have huge benefits when caring for higher risk patients and to empower both patients . Benefits include:

Safety – Validation of clinical information by the woman. Consistent shared data across settings.
Personalised – Specific to the woman – Her actual record. Legible information she wants to see and can understand.
Professional – Effective, efficient, economic, empathetic. Released time to care. A direct connection with the woman.
Kinder & more family friendly – Accessible and portable. Able to understand her maternity journey at a time when it suits her.

However, should there be poor engagement or lack of access implementing a digital system, there is a risk that higher risk or vulnerable groups, who are more likely to be in greater need could be overlooked. Therefore, this needs to be a priority during the overall implementation plan to ensure that digital interventions are inclusive of all pregnant people. Apira considers this an essential consideration during planning implementation and treats it as a priority to ensure that digital interventions are inclusive of all pregnant people.

One of the key phases during implementing a digital system within Maternity is ensuring the project has appointed the appropriate people to ensure each workstream is well supported and resourced. Digitising maternity services is transforming the way maternity teams work, therefore having an experienced project team that can work alongside a Digital Midwife leading this change of digitising records and notes is essential. This means teams will no longer be reliant on paper-based processes and will provide teams with the key elements required such as building strong relationships with both the digital and clinical colleagues that will be involved. Apira believe an empathetic, versatile style of project management is required for such an extensive change to ensure the new system has been delivered safely and securely, whilst minimising service disruption and enabling adoption.

Apira has been providing Consultancy to the NHS for over a quarter of a century, with a track record of delivering a vast array of Digital change projects and programmes including Maternity, with expertise in Business Cases, Procurement, Implementation, Transformational change, and Optimisation / Adoption.

If you would like to discuss how Apira could help you along your digital journey please get in touch with our Director of Growth, Rory Dennis – rory.dennis@apira.co.uk

Author: Chris Evans

Chris has a wealth of programme/project management experience with extensive experience in development of digital clinical system business cases, procurements and deployments including Trust EPR, and Maternity EPR. He has previously worked for Trusts across the North West including Warrington and Halton Hospitals NHS Trust, Alder Hey Childrens Hospital, Liverpool Heart and Chest Hospital NHS Foundation Trust, and more recently at the Northern Care Alliance NHS Foundation Trust (NCA). Chris has also been responsible for producing project / programme returns to NHS England and acting as a key interface to NHS England regional and national leads.

Opinion – How diversity is affecting maternity care

Introduction:

Problem:

What the NHS is doing and how

What can be done?

Author: Chris Evans