Addressing Disparities in Perinatal Care: Insights from Amma Birth Companions
In the realm of perinatal care, every person giving birth deserves to feel supported, heard, and empowered to make informed decisions throughout their childbirth journey. However, a recent study conducted by Amma Birth Companions sheds light on the harsh reality faced by refugee, asylum-seeking, and migrant women who are navigating the maternity care system.
Released on March 21, 2024, Amma’s ‘Birth Outcomes & Experiences Report‘ focuses on instances of discrimination, communication barriers, and high rates of intervention that exacerbate existing disparities in maternity care.
The report, which analyses the childbirth experiences of 100 individuals supported by Amma over a two-year period, provides a platform for voices that are often marginalised in discussions surrounding maternal health. Through case studies, testimonials, and observations from Amma’s team of birth and postnatal companions, it underscores the urgent need for reform within the perinatal healthcare system.
The report highlights how systemic racism, inadequate communication, limited choice, and a lack of person-centred care negatively affects the birth experiences of women who already face multiple inequities. Stressing the urgency of addressing racial disparities in the NHS, the report echoes wider trends showing disproportionately negative outcomes in pregnancy and childbirth for individuals of Black, Brown, and mixed ethnicities in the UK.
It also acknowledges the harmful impact of underfunded maternity care and calls for collaboration across healthcare and government to enhance conditions for both staff and patients. The report emphasises the need for a commitment from the Scottish Government to prioritise greater investment into maternity services.
Key findings from the report include:
- In 2021-22, birth companions noted instances of practice issues and discrimination in over a third (37%) of recorded cases, citing issues including delayed pain relief, restricted choice, disrespectful behaviour, and misinformation.
- Three in four (74%) of those who required an interpreter faced issues including a lack of availability; staff understanding and willingness to use interpreters; and technical issues.
- Induction rates rose from 46% in 2021 to 48% in 2022, 11 percentage points higher than NHS Greater Glasgow & Clyde figures. The average gestational age at the time of induction was 38 + 5 weeks.
- The average Caesarean section rate was 51%, spiking from 38% in 2021 to 60% in 2022. In 2022, Amma’s rate of Caesarean sections was 18 points higher than NHS figures, also surpassing overall rates reported by Public Health Scotland when broken down by ethnicity.
Maree Aldam, CEO of Amma Birth Companions, emphasises the report’s call to action, stating, “These findings force us to critically reflect on the systemic and structural inequalities that have already been proven to cause harm to both mothers and babies.” Aldam underscores the importance of understanding the human stories behind the statistics and advocates for greater investment in maternity services to effect lasting change.
In addition to shedding light on the challenges faced by refugee and migrant women, the report offers concrete recommendations to address systemic shortcomings. Cultivating anti-racist healthcare practices, increasing awareness of the rights of individuals with varied immigration statuses, and prioritising person-centered and trauma-informed care are amongst the key recommendations put forth by Amma Birth Companions.
The report’s release has sparked responses from key stakeholders, including Mary Ross-Davie, Director of Midwifery at NHS Greater Glasgow & Clyde, who acknowledged the need for action in light of the reported experiences. Ross-Davie pledged to implement recommendations aimed at addressing inequalities and enhancing the quality of care for refugee and asylum-seeking pregnant women.
By amplifying the voices of refugee, asylum-seeking, and migrant women, Amma has provided invaluable insights that must inform efforts to create a more inclusive, compassionate, and equitable maternity care system for all. It is imperative that healthcare providers, policymakers, and other stakeholders heed these findings and take meaningful action to ensure that no one is left behind in their journey to motherhood.
View the report.
Amanda Purdie is Head of Advocacy & Communications at Amma Birth Companions.