Abstract
Migrant and ethnic inequalities in maternal and perinatal mortality persist across high-income countries. Addressing social adversity and inequities across the childbirth trajectory cannot be left to chance and the good intentions of practitioners. Robust, evidence-based tools designed to address inequity by enhancing both the quality of provision and the experience of care are needed. An inductive modelling approach was used to develop a new evidence-based conceptual model of woman-midwife relationships, drawing on data from an ethnographic study of relationships between migrant Pakistani women and midwives, conducted between 2013 and 2016 in South Wales, UK. Key analytic themes from early data were translated into social-ecological concepts, and a model was developed to represent how these key themes interacted to influence the woman-midwife relationship. Three key concepts influencing the woman-midwife relationship were developed from the three major themes of the underpinning research: (1) Healthcare System; (2) Culture and Religion; and (3) Family Relationships. Two additional weaving concepts appeared to act as a link between these three key concepts: (1) Authoritative Knowledge and (2) Communication of Information. Social and political factors were also considered as contextual factors within the model. A visual representation of this model was developed and presented. The model presented in this paper, along with future work to further test and refine it in other contexts, has the potential to impact on inequalities by facilitating future discussion on cultural issues, encouraging collaborative learning and knowledge production and providing a framework for future global midwifery practice, education and research. At the outset of the underpinning research, a project involvement group was created to contribute to study design and conduct. This group consisted of the three authors, an Advocacy Officer at Race Equality First and an NHS Consultant Midwife. This group met regularly throughout the research process, and members were involved in discussions regarding ethical/cultural/social issues, recruitment methods, the creation of participant information materials, interpretation of data and the dissemination strategy. Ideas for the underpinning research were also discussed with members of the Pakistani community during community events and at meetings with staff from minority ethnic and migrant support charities (BAWSO, Race Equality First, The Mentor Ring). Local midwives contributed to study design through conversations during informal observations of antenatal appointments for asylum seekers and refugees.
Highlights
Migrant and ethnic inequalities in maternal and perinatal mortality persist across high‐income countries
The remainder of this paper describes the development of this new social–ecological model of woman–midwife relationships, which conceptualizes interpersonal and social and ecological factors that may serve as barriers or facilitators to a positive woman–midwife partnership approach to maternity care
The development of the inductive model was undertaken in three phases, which are described : (i) Phase 1: the ‘underpinning research’; (ii) Phase 2: searching for congruence with existing models of healthcare relationships; and (iii) Phase 3: creating a new social–ecological model of woman–midwife relationships
Summary
Migrant and ethnic inequalities in maternal and perinatal mortality persist across high‐income countries. Ethnic inequalities exist in perinatal outcomes, where UK mortality rates remain exceptionally high for babies of Black and Black British ethnicity: Stillbirth rates are over twice those for babies of White ethnicity and neonatal mortality rates are 45% higher.[4] For babies of Asian and Asian British ethnicities, stillbirth and neonatal mortality rates are both around 60% higher than for babies of White ethnicity.[4] Migrant women and babies are at increased risk of mortality and morbidity; nearly a quarter of maternal deaths between 2015 and 2017 were women born outside the United Kingdom,[3] and UK mortality reports call for ‘continued focus on action to address these disparities’[3]
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