In 2017, we started a joint project with Birth Companions to investigate whether the human rights of women facing severe and multiple disadvantage are respected during pregnancy, birth and postnatal care.
We conducted in-depth interviews with 12 women and 26 professionals and birth supporters. Our report and executive summary, Holding it all together, were published in June 2019. We found some good practice but too many examples where women’s fundamental rights were not upheld, sometimes with devastating consequences.
Birthrights and Birth Companions are now working with NHS England, the Royal Colleges and other partners to identify what action is needed so that all women receive safe, respectful and personalised maternity care.
“In particular moments when I needed care and support…I couldn’t communicate.”
All of the women we interviewed experienced at least three disadvantages at the same time; eight experienced five or more. The most common disadvantages were unstable or unsuitable housing, social isolation, trauma or abuse, not having enough money to meet everyday needs, mental or physical health issues, unemployment and being an asylum-seeker.
These are the core themes in our report:
- Choice and consent
- Trauma and dignity
- Asylum and immigration
- Housing and hardship
- Specialist midwives and continuity of carer
- Navigating multiple systems and services
“It reinforces to them that they have no value… It’s like saying, ‘Actually, you only mattered up to the point you were pregnant. You’re almost like a vessel and then once the baby is out, we are not worried about you anymore.”
What do we know already?
Evidence shows women with multiple complex needs:
- are less likely to access maternity care or receive less of it
- have poorer maternal and infant outcomes
- are more likely to experience perinatal mental health problems
- are over-represented in maternal deaths in London
- women from deprived areas are at three times the risk of dying during pregnancy compared to women in the most affluent areas
- Black women are five times more likely to die during pregnancy than white women, with Asian women twice as likely to die
What needs to change?
We welcome the vision of Better Births to achieve maternity care that is “safer, more personalised, kinder, professional and more family friendly”. The NHS Long Term Plan is another important step forward, including a commitment that “action to drive down health inequalities is central to everything we do”. We hope our research adds to the imperative to make these aspirations reality and will be publishing our recommended areas for action shortly.
With thanks to Trust for London for supporting the collaborative research, and to the Baring Foundation for supporting our peer partnership work with Birth Companions.