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      Experiencing maternity care: the care received and perceptions of women from different ethnic groups

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          Abstract

          Background

          According to the Office for National Statistics, approximately a quarter of women giving birth in England and Wales are from minority ethnic groups. Previous work has indicated that these women have poorer pregnancy outcomes than White women and poorer experience of maternity care, sometimes encountering stereotyping and racism. The aims of this study were to examine service use and perceptions of care in ethnic minority women from different groups compared to White women.

          Methods

          Secondary analysis of data from a survey of women in 2010 was undertaken. The questionnaire asked about women’s experience of care during pregnancy, labour and birth, and the postnatal period, as well as demographic factors. Ethnicity was grouped into eight categories: White, Mixed, Indian, Pakistani, Bangladeshi, Black Caribbean, Black African, and Other ethnicity.

          Results

          A total of 24,319 women completed the survey. Compared to White women, women from minority ethnic groups were more likely to be younger, multiparous and without a partner. They tended to access antenatal care later in pregnancy, have fewer antenatal checks, fewer ultrasound scans and less screening. They were less likely to receive pain relief in labour and, Black African women in particular, were more likely to deliver by emergency caesarean section. Postnatally, women from minority ethnic groups had longer lengths of hospital stay and were more likely to breastfeed but they had fewer home visits from midwives. Throughout their maternity care, women from minority ethnic groups were less likely to feel spoken to so they could understand, to be treated with kindness, to be sufficiently involved in decisions and to have confidence and trust in the staff.

          Conclusion

          Women in all minority ethnic groups had a poorer experience of maternity services than White women. That this was still the case following publication of a number of national policy documents and local initiatives is a cause for concern.

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          Most cited references41

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            Inequalities in maternal health: national cohort study of ethnic variation in severe maternal morbidities

            Objective To describe on a national basis ethnic differences in severe maternal morbidity in the United Kingdom. Design National cohort study using the UK Obstetric Surveillance System (UKOSS). Setting All hospitals with consultant led maternity units in the UK. Participants 686 women with severe maternal morbidity between February 2005 and February 2006. Main outcome measures Rates, risk ratios, and odds ratios of severe maternal morbidity in different ethnic groups. Results 686 cases of severe maternal morbidity were reported in an estimated 775 186 maternities, representing an estimated incidence of 89 (95% confidence interval 82 to 95) cases per 100 000 maternities. 74% of women were white, and 26% were non-white. The estimated risk of severe maternal morbidity in white women was 80 cases per 100 000 maternities, and that in non-white women was 126 cases per 100 000 (risk difference 46 (27 to 66) cases per 100 000; risk ratio 1.58, 95% confidence interval 1.33 to 1.87). Black African women (risk difference 108 (18 to 197) cases per 100 000 maternities; risk ratio 2.35, 1.45 to 3.81) and black Caribbean women (risk difference 116 (59 to 172) cases per 100 000 maternities; risk ratio 2.45, 1.81 to 3.31) had the highest risk compared with white women. The risk in non-white women remained high after adjustment for differences in age, socioeconomic and smoking status, body mass index, and parity (odds ratio 1.50, 1.15 to 1.96). Conclusions Severe maternal morbidity is significantly more common among non-white women than among white women in the UK, particularly in black African and Caribbean ethnic groups. This pattern is very similar to reported ethnic differences in maternal death rates. These differences may be due to the presence of pre-existing maternal medical factors or to factors related to care during pregnancy, labour, and birth; they are unlikely to be due to differences in age, socioeconomic or smoking status, body mass index, or parity. This highlights to clinicians and policy makers the importance of tailored maternity services and improved access to care for women from ethnic minorities. National information on the ethnicity of women giving birth in the UK is needed to enable ongoing accurate study of these inequalities.
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              Ethnic and social inequalities in women's experience of maternity care in England: results of a national survey.

              To examine ethnic and social inequalities in women's experience of maternity care in England. A 2007 national survey of women (16 years or over) about their experience of maternity care. Multiple logistic regression analysis, controlling for several maternal characteristics, was used to examine inequalities by ethnicity, partner status and education. Sample of records of 149 NHS acute trusts and two primary care trusts (PCTs) providing maternity services in England. A total of 26,325 women responded to the survey (response rate 59%). Ethnic minority women were more likely than White British women to access services late, not have a scan by 20 weeks, and experience complications during pregnancy and birth. They were more likely to initiate breastfeeding and say they were treated with respect and dignity. Single women responded more negatively to almost all questions than women with a husband/partner. They were less likely to access care within 12 weeks of pregnancy (OR 0.45, 95% CI 0.39-0.52), have a scan at 20 weeks (OR 0.49, 95% CI 0.39-0.63), attend NHS antenatal classes (OR 0.56, 95% CI 0.49-0.65), have a postnatal check-up (OR 0.67, 95% CI 0.60-0.75), and initiate breastfeeding (OR 0.57, 95% CI 0.51-0.62), and were more likely to experience complications. Women completing education at 19+ years were more likely to access services early (OR 1.21, 95% CI 1.04-1.40), attend antenatal classes (OR 1.48, 95% CI 1.31-1.67), have a postnatal check-up (OR 1.19, 95% CI 1.07-1.32) and initiate breastfeeding (OR 3.88, 95% CI 3.56-4.22) than those completing education at 16 years or younger, and were less likely to experience complications. Ethnic minority women, single mothers, and those with an earlier age at completing education access maternity services late, have poorer outcomes, and report poorer experiences across some--though not all--dimensions of maternity care. Ethnic differences were absent or inconsistent between groups for some aspects of care. We recommend these findings are used by commissioners, trusts and healthcare professionals to inform improvements in maternity services for high-risk groups and reduce inequalities.
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                Author and article information

                Contributors
                Journal
                BMC Pregnancy Childbirth
                BMC Pregnancy Childbirth
                BMC Pregnancy and Childbirth
                BioMed Central
                1471-2393
                2013
                22 October 2013
                : 13
                : 196
                Affiliations
                [1 ]Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Old Road, Oxford OX3 7LF, UK
                Article
                1471-2393-13-196
                10.1186/1471-2393-13-196
                3854085
                24148317
                ba11b87b-f804-4b13-b7b5-575f81e2a9b7
                Copyright © 2013 Henderson et al.; licensee BioMed Central Ltd.

                This is an open access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 15 April 2013
                : 7 October 2013
                Categories
                Research Article

                Obstetrics & Gynecology
                ethnic groups,maternity care,pregnancy,health care surveys,england
                Obstetrics & Gynecology
                ethnic groups, maternity care, pregnancy, health care surveys, england

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