Black And Minority Ethnic Women Research Articles

What does justice mean to black and minority ethnic (BME) victims/survivors of gender-based violence?

ABSTRACT This paper addresses how ‘justice’ is understood, sought, and experienced by Black and Minority Ethnic (BME) victims/survivors of Gender Based Violence (GBV) within the UK. The key aims of this paper are to explore (a) experiences of GBV for BME victim/survivors, (b) their experiences and perceptions of justice, and (c) factors enabling, or posing barriers to justice, including immigration status. We situate BME women’s experiences and conceptualisations of justice within an ecological approach [Hagemann-White, C., et al. 2010. “Factors at Play in the Perpetration of Violence Against Women, Violence Against Children and Sexual Orientation Violence – A Multi-Level Interactive Model (Part of the Feasibility Study to Assess the Possibilities, Opportunities and Needs to Standardise National Legislation on Gender Violence and Violence Against Children for the European Commission – JLS/2009/D4/01.” Publications of the European Union, Luxembourg] and within Bourdieu’s conceptualisation of ‘social capital’ [1986. “The Forms of Capital.” In Handbook of Theory and Research for the Sociology of Education, edited by J. Richardson, 241–258. Westport, CT: Greenwood]. We found that migrant women lack access to vital aspects of social capital, that make access to justice particularly challenging, and that immigration status poses key barriers in migrant women’s experiences of accessing justice.

Migration, ethnicity and mental health: evidence from mothers participating in the Millennium Cohort Study

ObjectivesOver a quarter of UK births are to women who were born outside of the UK. Black and Minority Ethnic (BME) women are disproportionately affected by poor mental health and inequitable access to mental health care in the perinatal period, yet the influence of the migrant status (mothers' UK vs. non-UK birth) is poorly understood. This study aimed to explore the relationship between ethnicity, migration and mental health indicators among mothers participating in a large nationally representative cohort study. Study designThis is a secondary analysis of data from the Millennium Cohort Study. MethodsLogistic regression quantified the crude and adjusted effects of self-reported ethnicity and migrant status on prevalence of psychological distress and treatment for anxiety/depression at 9-month and 5-year postpartum. ResultsWe found substantial variation in the prevalence of distress according to ethnicity and migrant status, with Indian and Pakistani women at greatest risk. Despite equal or greater risk, BME and migrant women were less likely to report treatment for anxiety/depression. Mutually adjusted analyses showed ethnicity to be a stronger predictor of both outcomes than migrant status; however, at 5 years, being a migrant independently predicted lower odds of treatment, for a statistically similar level of distress. ConclusionsMigrant women are likely to be at high risk of poor mental health in the perinatal period and beyond, yet may face significant barriers to accessing mental health care. A better understanding of ethnicity and migration as interrelated risk factors for perinatal mental ill-health is needed to help National Health Service organisations develop policy and practice that is flexible and responsive to diversity.

Black and Minority Ethnic women's decision-making for risk reduction strategies after BRCA testing: Use of context and knowledge

Within the field of breast cancer care, women concerned about their family history are offered genetic testing and subsequent treatment options based on several factors which include but are not limited to personal and family cancer disease histories and clinical guidelines. Discussions around decision-making in genetics in Black and Minority Ethnic (BME) groups are rarely documented in literature, and information regarding interactions with genetics services is usually discussed and linked to lack of scientific knowledge. As such, counselling sessions based only on scientific and medical information miss out the many reasons participants consider in making health decisions, information which can be used to encourage BME women to engage in cancer genetics services. 10 BME women with a mixed personal and family history of breast and ovarian cancer backgrounds, were interviewed in a study exploring issues of knowledge about familial breast cancer syndromes, to understand how they created and used familial knowledge for health decisions, with a particular focus on attitudes towards risk reducing strategies.Study results show that our participants are not unique in the ways they make decisions towards the use of cancer genetics and risk reduction strategies and as such, there are no specific ethnically defined pathways for decision-making. Our participants demonstrated mixed biomedical, social and individual cultural reasons for their decision-making towards risk reduction surgeries and treatment options which are similar to women from different ethnicities and are individual rather than group-specific. Narratives about suspicion of scientific utility of genetic knowledge, the perceived predictive value of mutations for future cancers or the origin of mutations and family disease patterns feature heavily in how participants evaluated genetic information and treatment decisions. The diversity of results shows that our participants are interested in engaging with genetic information but use multiple sources for evaluating the extent of involvement in genetic services and the place of genetic information and treatment options for themselves and their families. Genetic information is considered within various bio-social scenarios before decision-making for risk reduction is undertaken. BME women are shown to undertake evaluative processes which clinicians are encouraged to explore for better patient support. Continuing to focus on links between superficial and un-representative meanings of ethnicity, ethnic identity and attitudes and behaviours by only searching for differences between ethnic groups, are unhelpful in further understanding how women from those diverse backgrounds make decisions towards risk reduction interventions. Future research must find ways of investigating and understanding populations in ways that are not focussed solely on ethnic differences but on how meaning is created out of social circumstances and experiences.

Exploring the lived experience of breast cancer diagnosis and treatment amongst Gujarati speaking Indian women

Breast cancer is the most commonly diagnosed cancer in females, affecting women of all ethnic groups. Until now, very little research has captured the psychosocial impact of the disease amongst Black and Minority Ethnic (BME) women, and that which has been conducted has been restricted to English-speaking participants. The aim of this qualitative study was to explore the experiences of five Gujarati-speaking Indian women with regard to their breast cancer diagnosis and treatment; all five had Limited English Proficiency (LEP) and lived in the UK. Individual semi-structured interviews were conducted in Gujarati, with the assistance of an interpreter. Interpretative Phenomenological Analysis (IPA) of the data revealed 3 key themes: making sense of the cancer, importance of support and body image concerns. The findings show that these women’s experiences were influenced by culturally specific concerns, especially in relation to knowledge of breast cancer and language barriers. This study has implications for healthcare professionals in terms of providing culturally competent care and support to BME women with LEP.

Pregnancy as an ideal time for intervention to address the complex needs of black and minority ethnic women: Views of British midwives

Introductionmaternal health inequalities exist across the world. In the United Kingdom, whilst there are variations within and between groups, Black and Minority Ethnic (BME) women tend to have worse maternal health outcomes than White British women. However, there is limited information about BME women׳s experience of maternity services. Midwives are central to the provision of safe maternity care but little is known about their perceptions of ethnically-based inequalities in maternal healthcare. Therefore, this study explored a cohort of midwives׳ experiences of providing care for BME women, focussing on their views on the relationship between maternal health inequalities and service delivery. Methodsusing a specifically-designed topic guide, 20 semi-structured interviews were conducted with qualified midwives in one National Health Service (NHS) Trust in the North West of England over a two-month period. Data were subsequently transcribed and thematically analysed. Resultsthree main and seven sub-themes were identified. Firstly, ‘language’ summarised difficulties midwives experienced in engaging with women whose English was limited. Secondly, ‘expectations of maternity care’ outlined the mismatch between midwives and women׳s expectations of maternity care. Finally, ‘complex needs extending beyond maternity care’ highlighted the necessity of inter-agency working to address women׳s care holistically when their needs transcend the scope of maternity services. DiscussionMidwives׳ accounts indicated that they strive to provide equitable care but encountered numerous barriers in doing so. Paradoxically, this might contribute to inequalities in service delivery. In midwives׳ view, unrestricted access to interpretation and translation services is essential for provision of effective, holistic maternity care. Participants also advocated education for both women and midwives. For the former, this would improve BME women׳s understanding of health and care systems, potentially leading to more realistic expectations. Improving midwives׳ cultural competence would better equip them to respond to the needs of an ethnically diverse population. Finally, midwives highlighted that many minority women׳s complex care needs were identified during pregnancy. Hence, they regarded pregnancy as an ideal time for interventions to improve the health of women and their families and, as such, antenatal care cannot be treated as an isolated event. According to midwives in this study, delivering safe, effective maternity services in the 21st century requires greater collaboration with the women they care for and other health and care agencies (including independent sector providers).

Qualitative Account of a Relationship Story Between the URC and BME Women

Women in the United Reformed Church (URC) have long participated in behind-the-scenes activities and are increasingly taking on leadership roles. For Black and Minority Ethnic (BME) women, however, while they are increasingly involved in local congregations, the picture is different in the wider Church at a national level. This qualitative study is based on a group of BME women (Cascades of Grace) formed to empower BME women in the URC. Two questionnaires were issued from which findings and analysis are drawn. In this work I engage voices from different theological perspectives on the story of the Syrophoenician/Canaanite woman that is found in Matthew 15:21-28 and Mark 7:25-30 (see Appendix 1). Womanist theology is the primary theological perspective used in this study. I reflect on a story from the Bible because in different, but significant ways, the URC is rooted in the Bible. BME women, too, rely on the Bible, often to counteract negative stereotyping, which at times has been used to justify their marginalization.

Black and South Asian women’s experiences of breast cancer: A qualitative study

Breast cancer is one of the most common forms of cancer in the UK, and affects women of all ethnic groups. The psychosocial impact of breast cancer has been well documented. However, research conducted in this area has been primarily focused on white women. There is very little work within the breast cancer literature that captures the experiences of black and minority ethnic (BME) women. The aim of this qualitative study was to explore the experiences of breast cancer diagnosis and treatment in black and South Asian women living in the UK. Individual semi-structured interviews were conducted with 22 English-speaking breast cancer survivors (11 black and 11 South Asian women). Thematic analysis of the data revealed five key themes, namely social support, spirituality, body image concerns, healthcare experiences and life after cancer. The findings showed that although the BME women shared similar concerns to white women, their experiences were also influenced by cultural specific concerns. This study has implications for healthcare professionals and recognises the need to provide culturally sensitive care and support to BME women, tailored specifically to their values and beliefs.

The Protection and Rights of Black and Minority Ethnic Women Experiencing Domestic Violence in Northern Ireland

This report examines the support sought by and provided to Black and Minority Ethnic (BME) women, including immigrant women, in the context of domestic violence in Northern Ireland. It was undertaken as a scoping study and forms part of a submission to the UN Committee on the Elimination of Discrimination Against Women (CEDAW).Northern Ireland has experienced an increase in migration, particularly from the European Economic Area with the most recent census showing an increase in the ‘non-national’ population over the past ten years - from 1.8% (2001) to 4.5% (2011). This figure, although increasing, is an under-representation of the proportion of those residing in Northern Ireland who form part of the BME population as it does not include those who hold British or Irish nationality.The findings reveal the challenges faced by BME women such as isolation, language barriers, unfamiliarity with laws and services, and institutional racism. These factors act as barriers in the help-seeking process and increase women’s vulnerability to domestic violence. Some of the most compelling findings are the ways in which immigration law and policy and the benefits system fail to address the needs of immigrant women who experience domestic violence in Northern Ireland. The report highlights the failings in terms of the UK’s human rights obligations and makes a number of recommendations to CEDAW as part of its periodic examination in July 2013. Following its publication, the CEDAW Committee requested the UK government to address, in particular, the report’s findings in relation to the application of the ‘domestic violence’ rule.

Perinatal mental health services for black and ethnic minority women in prison

Objective: To provide a synthesis of published research concerning the perinatal mental health needs of black and minority ethnic (BME) women in prison. Methods: This integrative review utilised a narrative overview design to explore available literature. Results: The search strategy identified 13 relevant papers. Out of these, six met the inclusion criteria. The results found that imprisoned women are more likely to be from a BME background. As a group, pregnant women in prison present a vulnerable obstetric risk. In addition to the universal obstacles, BME women face further challenges of overcoming ethno-cultural barriers when trying to access appropriate perinatal mental health care while in prison. Clinical implications: BME imprisoned pregnant women are clearly a high-risk obstetric group, and their numbers are increasing. Deciphering and meeting the unique perinatal mental health needs of this group of women presents a challenge to both the health-care and prison systems. Becoming aware and sensitive to these needs is the first step towards policy makers and service providers addressing them. This research will add to the limited academic field on the perinatal mental health needs of BME women in prison. These findings demonstrate that more research and attention needs to be paid to this highly vulnerable group of women.

The impact of the detection and diagnosis of breast cancer in black and Asian women

Purpose – Given the high number of women diagnosed with breast cancer each year, the aim of this paper is to identify any culturally specific concerns of black and Asian women diagnosed with breast cancer. Design/methodology/approach – This study was designed as a qualitative study. Using focus groups and follow-up interviews participants were able to express their attitudes, beliefs and feelings around breast cancer detection and diagnosis. The focus groups replicated a social gathering rather than a formalised research interview and thus participants were able to freely express their views and agree or disagree with other focus group participants. Findings – Breast cancer is not well known within the black and minority ethnic (BME) communities and women are unlikely to regularly check their breasts. BME women are less likely to attend breast cancer screening and may ignore mammogram appointments. Young BME women do not perceive themselves as “at risk” of breast cancer. Fear of having cancer in the family and social taboos meant there are cases of BME women not discussing their diagnosis outside immediate family. Research limitations/implications – Although it is anticipated that the findings will be generalisable to BME women throughout the UK it must be recognised that this was a study of 33 BME breast cancer patients in nine London Trusts. Interviewees were only with women who came forward and had gone through treatment, which by definition did not include those “hidden” within their communities. As a qualitative study the aim was to identify a broad range of experiences rather than to represent these experiences numerically, further large-scale research may be appropriate. Practical implications – The development of specifically designed BME patient care may be informed by this research. Originality/value – This paper identifies the need for culturally specific care of BME women during the detection and diagnosis of breast cancer.

Ethnic minority women's experience of maternity services in England

Objectives. Provision for ethnic minority groups has been acknowledged as integral to good maternity care in England and ethnicity has been highlighted as an indicator of both poorer clinical outcomes and poorer experiences. Improving outcomes and services is dependent on understanding women's interaction with both service delivery and provision. The aim of this study was to explore Black and minority ethnic (BME) women's experiences of contemporary maternity care in England. Design. A UK-wide survey which investigated core aspects of maternity care sought the views of BME women about their experiences. A random sample of women were selected by the Office for National Statistics from birth registration in England and invited to complete a questionnaire three months after the birth. In a secondary analysis, text responses to open-ended questions about their maternity care were analysed using thematic analysis. Results. Sixty per cent of the 368 women who self-identified as BME responded with open text. Themes that emerged related to ‘feeling cared for,’ with subthemes of ‘expectations of care’ and ‘policies, rules and organisational pressures’; ‘staff attitudes and communication’ with sub-themes of ‘please believe me,’ ‘hospital as a safe place,’ ‘choices denied’ and ‘being sensitive and supportive would help,’ and ‘ethnicity and culture’ with sub-themes of ‘stereotyping’ and ‘improving the quality of care.’ Conclusion. The findings highlight issues affecting the quality of maternity care that BME women in England receive. Many issues are not unique to BME women; however, the findings reflect some seemingly enduring issues and coherence with other wider international findings, particularly in relation to post-natal care and staff attitudes. Actually being cared for and supported across their child-bearing experience are needs that women themselves identified as critical for care providers to recognise and respond to. The failures of care provision described should inform the development of services.

Can managed care networks improve perinatal mental healthcare for Black and minority ethnic (BME) women?

PurposePerinatal mental illness is an important public health issue. Conditions such as postnatal depression increase mothers' risk of suicide and can herald onset of recurrent and chronic mental health problems. Maternal mental illness can also adversely impact the cognitive, physical, and psychological health and development of children. In light of known psychosocial risks, there is concern that fewer than expected women from black and minority ethnic (BME) backgrounds access care and treatment. This paper aims to address this issue.Design/methodology/approachResponding to persistent reports of patchy service provision across the UK more generally and particular concerns about potentially unmet needs among BME women, mixed‐method research was undertaken between September 2009 and March 2010. Using survey questionnaires and telephone interviews, the study sought to explore professional stakeholders' perspectives on current perinatal mental health provision and the extent to which it meets the needs of BME women. Findings from the study were intended to inform policy and plans to improve provision by establishing managed care networks (MCNs) for perinatal mental healthcare.FindingsIn total, 45 questionnaires were returned from the national survey. One‐third of respondents (n=14) consented to follow‐up telephone interviews. There was evidence of multi‐agency working among the 27 professional groups which respondents reported as being directly involved in delivering perinatal mental healthcare across the country. However, there was also evidence of disjuncture and poor communication – particularly between statutory and voluntary sectors and NHS primary and secondary care. Some respondents had difficulty defining “BME” or identifying the women to whom the acronym might be applied. They also questioned the validity of providing “BME‐specific” services. Instead, they endorsed more ethnically “inclusive models” of provision and “signposting” women to appropriate “community” services.Practical implicationsTaken together, these findings suggests that whilst there might be a theoretical argument for perinatal mental health MCNs, considerable effort is required if policy‐makers' aspirations for more “joined‐up” services capable of meeting the needs of all women are to be fully realised. Furthermore, current proposals for public sector reform coupled with reduction in voluntary sector provision is likely to disproportionately affect women from BME and other marginalised communities as they provide significant amounts of “below the radar” care and support.Originality/valueThis paper is of particular relevance to policy makers and practitioners. Findings suggest that women from BME backgrounds might be particularly vulnerable to perinatal mental illness. Contraction of voluntary sector provision increases the likelihood that the needs of BME women will remain unmet with deleterious consequences for their health and wellbeing of their families. This has potentially serious public health implications. MCNs/clinical networks have the potential to reduce inequalities by providing more “joined up” care for all women. However, the evidence base for levels of need and appropriate service response to perinatal mental illness among BME women is weak. Further research is required to bridge the evidence gap and to evaluate the impact of health and social care reform on vulnerable groups.

Ethnic differences in women's worries about labour and birth

Objective. To describe the worries experienced by pregnant Black and Minority Ethnic (BME) women about labour and birth and compare their experience to that of White women. Design. Data were collected in England in a survey of experience of maternity care. A random sample of 4800 women selected from birth registration records and questionnaires were mailed at three months postpartum. A total of 2960 (63%) completed a checklist of common worries about labour and birth. For 2765 there were complete data on ethnicity and all potential confounders. Chi2 tests and logistic regression models were used to investigate the associations of ethnicity with worries about labour. Unadjusted and adjusted models were run for each worry outcome. Adjustment was made for age, education, parity, relationship status and area deprivation (Index of Multiple Deprivation, IMD). Results. Overall, the pattern of worries was similar, however, larger proportions of BME women worried about almost all the aspects of labour and birth investigated, including pain, uncertainty about labour onset and duration, possible medical interventions and embarrassment. After adjustment for age, education, relationship status, parity and socioeconomic position, the higher odds of worry in the BME group were most marked in relation to pain and discomfort, not knowing how long labour would take, embarrassment and having more worries overall. Further adjustment for factors likely to affect women's worries, namely depression, being admitted to hospital during the pregnancy, or having experienced medical problems in a previous pregnancy did not alter these findings. Conclusion. Compared with White women, twice as many ethnic minority women worried about pain and discomfort, not knowing how long labour would take and about embarrassment during labour and birth. Additional research is needed to understand these concerns and how they might be ameliorated by the health professionals working directly with women and any services changes needed to improve the quality of maternity care. Implications for practice include improved information-giving and support in providing the individualised care that women need.

Perinatal mental health care for black and minority ethnic (BME) women: a scoping review of provision in England

The purpose of this study was to explore providers' and commissioners' perceptions of the extent to which services currently meet the perinatal mental health needs of black and minority ethnic (BME) women. A mixed method study involving a national survey and in‐depth interviews was undertaken in response to reports of patchy service provision and particular concerns about potentially unmet needs among BME women. Findings indicate that the surprising number of professional groups (n=27) involved in delivering perinatal mental health care were predominantly located in secondary care. Perceptions of the validity of ‘BME‐specific’ services were equivocal. Service delivery for minority women tended to focus on language and translation; which might facilitate assessment and physical (though not psychological) care but would do little to address women's cultural needs.

Antenatal services for ethnic minority women in South Tyneside

Black and Minority Ethnic (BME) women are identified as being a disadvantaged group, often prevented from accessing adequate antenatal care due to various barriers. This audit aimed to assess provision of antenatal services for BME women at South Tyneside District Hospital (STDH) and identify potential areas of change, to improve quality and accessibility of care. The audit retrospectively reviewed 60 sets of case notes of BME women booked between January and June 2007. Results showed that only 23.5% of women who needed an interpreter received one. All English-speaking women were given written information about antenatal care but documentation was absent regarding whether or not non English-speaking women had received information in their native languages. 82.4% of women had booked their pregnancies by 12 weeks gestation. It concluded that an adequate service is provided for BME women at STDH, although amendments could be made, with regards to the provision of interpreters and documentation of individual needs.

‘Human costs’ of breast cancer among non-English speaking BME women

This article describes a qualitative exploratory research study aimed at determining how non-English speaking black and minority ethnic (BME) women with breast cancer access information about cancer and healthcare services. The research, which is in its early stages of investigation, indicates that despite the fact that all patients find it difficult to access information about cancer, BME women face a number of difficult challenges. These include accessing appropriate information, as well as dealing with culturally specific (often negative) attitudes about breast cancer. A key finding in the research relates to uncertaintly, particularly about breast cancer, how to access information about the disease and how to access healthcare services.

The Strategic Framework for Women's Enterprise: BME women at the margins

PurposeUntil May 2003, there was no coherent national strategic approach to the development of women's enterprise in the UK although for decades researchers and support groups have been calling for a distinctive approach to supporting women business owners due to their different business ownership profiles such as different motivations for entering business ownership, reduced access to resources, particularly finance and longer incubation periods. Historically, a piecemeal approach has dominated the policy landscape with regard to small business development as well as female entrepreneurship. As part of the effort to provide a more coherent national strategic approach to women's enterprise policy, the government launched the Strategic Framework for Women's Enterprise (SFWE) in 2003, an umbrella document from which all initiatives to support female entrepreneurship acquire their momentum. The paper seeks to explore the SFWE.Design/methodology/approachTaking an intersectional approach, this paper explores the SFWE seeking to examine its provisions and how these relate to black and minority ethnic (BME) women in the light of the multiplicity of their experiences in terms of gender, ethnicity and class.FindingsThe paper concludes that the SFWE approaches the issue of BME women's entrepreneurship as a sub‐set of female entrepreneurship and therefore assumes that they will benefit from all gender‐based policies. The document treats women as a homogenous group and the acknowledgement of the diversity of female entrepreneurs, particularly BME women's experiences, is not reflected in the action priorities relating to business support provision, access to finance, childcare and caring responsibilities and transition from benefits to self‐employment.Research limitations/implicationsThe paper shows that there is a need for further research into the experiences of BME women in business in order to address their peculiar needs brought about by the intersectionality of ethnicity, “race”, gender and class in their lived experiences and to support this with policy provisions that are relevant to their needs. The recurrent problem is whether to concentrate on making mainstream business support provision and initiatives responsive to the needs of BME women or to define issues and develop independent initiatives that cater for these needs.Originality/valueThe main contribution of this paper is its focus on a significant but under researched group of women business owners in the context of an evidence‐based policy approach to entrepreneurship support and highlights the need for a more focused approach to their specific needs if the entrepreneurial potential of all women is to be harnessed.

Identification of an ultrasonic attenuation heterogeneity in myocardium

maternal health inequalities exist across the world. In the United Kingdom, whilst there are variations within and between groups, Black and Minority Ethnic (BME) women tend to have worse maternal health outcomes than White British women. However, there is limited information about BME women׳s experience of maternity services. Midwives are central to the provision of safe maternity care but little is known about their perceptions of ethnically-based inequalities in maternal healthcare. Therefore, this study explored a cohort of midwives׳ experiences of providing care for BME women, focussing on their views on the relationship between maternal health inequalities and service delivery.using a specifically-designed topic guide, 20 semi-structured interviews were conducted with qualified midwives in one National Health Service (NHS) Trust in the North West of England over a two-month period. Data were subsequently transcribed and thematically analysed.three main and seven sub-themes were identified. Firstly, ‘language’ summarised difficulties midwives experienced in engaging with women whose English was limited. Secondly, ‘expectations of maternity care’ outlined the mismatch between midwives and women׳s expectations of maternity care. Finally, ‘complex needs extending beyond maternity care’ highlighted the necessity of inter-agency working to address women׳s care holistically when their needs transcend the scope of maternity services.Midwives׳ accounts indicated that they strive to provide equitable care but encountered numerous barriers in doing so. Paradoxically, this might contribute to inequalities in service delivery. In midwives׳ view, unrestricted access to interpretation and translation services is essential for provision of effective, holistic maternity care. Participants also advocated education for both women and midwives. For the former, this would improve BME women׳s understanding of health and care systems, potentially leading to more realistic expectations. Improving midwives׳ cultural competence would better equip them to respond to the needs of an ethnically diverse population. Finally, midwives highlighted that many minority women׳s complex care needs were identified during pregnancy. Hence, they regarded pregnancy as an ideal time for interventions to improve the health of women and their families and, as such, antenatal care cannot be treated as an isolated event. According to midwives in this study, delivering safe, effective maternity services in the 21st century requires greater collaboration with the women they care for and other health and care agencies (including independent sector providers).