Access To Maternal Care Research Articles

Assessing maternity care access: impacts on cesarean sections and dystocia

BackgroundAs South Korea grapples with a declining birthrate, maternity care accessibility has become challenging. This study examines the association with labour intervention and pregnancy complication, specifically focusing on C-section and dystocia in maternity disparities.MethodsData from the South Korean NHIS-NID was used to analyze 1,437,186 women with childbirths between 2010 and 2015. The research defines 50 specific districts as Obstetrically Underserved Areas produced by the Ministry of Health and Welfare in 2011. C-Section were assessed through using medical procedure and DRG codes, while dystocia was defined using ICD-10 code. Logistic regression analysis was used to examine the significance of the association.ResultsAmong the population residing in underserved areas, 42,873 out of a total of 1,437,186 individuals were identified. For nationwide cases, the odds ratios (ORs) for C-Section were 1.11 (95% CI: 1.08–1.13) and dystocia were 1.07 (95% CI: 1.05–1.09). In relatively accessible urban areas, the ORs for C-Section and dystocia, based on whether they were obstetrically underserved areas, were 1.16 (95% CI: 1.13–1.18) and 1.10 (95% CI: 1.08–1.19), respectively.ConclusionPoor accessibility to maternity care facilities is closely linked to high-risk pregnancies, including an increased incidence of dystocia and a higher rate of C-sections. Insufficient access to maternity care not only raises the risk of serious pregnancy complications. Consequently, there is a pressing need for multi-faceted efforts to bridge this disparity.

Barriers and facilitators of access to maternity care for African-born women living in Australia: a meta-synthesis of qualitative evidence

BackgroundAdverse perinatal health outcomes are notably high among African-born women living in Australia. This problem is partly attributed to their lower engagement in maternity care services as compared to Australian-born women. Various barriers might limit African-born women’s access to and use of services; however, these barriers are not well documented. Therefore, this review aimed to synthesise current qualitative evidence on barriers and facilitators of access to maternity care for African-born women living in Australia.MethodsThe search was conducted in MEDLINE, CINAHL, Embase, PsychInfo, and Maternity and Infant Care databases on 16 April 2023. All articles retrieved were meticulously screened for eligibility by two independent reviewers with any disagreements resolved through discussion. The quality of the included articles was evaluated using the Mixed Methods Appraisal Tool. Studies were screened in Covidence and analysed in NVivo. The findings were organised and presented using Levesque’s framework of healthcare access.ResultsOut of 558 identified papers, 11 studies comprising a total of 472 participants met the eligibility criteria. The review highlighted provider-side barriers such as shortage of information, unmet cultural needs, long waiting times, low engagement of women in care, discrimination, and lack of continuity of care. User-side barriers identified include communication issues, difficulty navigating the health system, and lack of trustful relationships with healthcare providers. In contrast, the review pinpointed provider-side facilitators including positive staff attitudes, service availability, and the proximity of facilities to residential homes, while user-side facilitators such as cultural assimilation and feeling valued by healthcare providers were noted.ConclusionsThis review identified barriers and facilitators of access to maternity care for African-born women living in Australia. Empirical evidence that would inform potential changes to policy and practice to address African-born women’s unique health needs was highlighted. Designing and implementing a culturally safe service delivery model could remove the identified access barriers and improve African-born women’s engagement in maternity care. Moreover, reinforcing factors associated with positive healthcare experiences is essential for improving maternity care access for this priority population.Systematic review registrationPROSPERO CRD42023405458.

Family physicians provide maternity care in and around the maternity care shortage areas, particularly rural.

This study examined demographic, practice, and area-level characteristics associated with family physicians' (FP) provision of maternity care. Using the American Board of Family Medicine Certification examination application survey data, we investigated the relationship between FPs' maternity care service provision and (1) demographic (gender, years in practice, race/ethnicity), (2) practice characteristics (size, ownership, rurality), and (3) county-level factors (percentage of reproductive-age women, the number of obstetrician-gynecologists (OBGYNs) and certified nurse midwives (CNMs) per 100,000 reproductive-age women). We performed summary statistics and multivariate logistic regression analyses. Of the 59,903 FPs in the sample, 7.5% provided maternity care. FPs practicing in rural were 2.5 times more likely to provide maternity care than those practicing in urban areas. FPs in academic (odds ratio [OR] 4.6, 95% confidence interval [CI] 4.1-5.1) and safety-net settings (OR 1.9, 1.7-2.1) had greater odds of providing maternity care. FPs in the bottom quintile with no or fewer OBGYNs and CNMs had a higher likelihood of maternity care provision (OR 2.1, 1.8-2.3) than those in the top quintile, with more OBGYNs and CNMs. FPs in high-needs areas, such as rural and safety net settings, and areas with fewer CNMs or OBGYNs are more likely to provide maternity care, demonstrating the importance of FPs in meeting the needs of women with limited maternity care access. Our study findings highlight the importance of considering the contributions of FPs to maternity care as the organizations prioritize resource allocation to areas of highest need.

Hospitals Are Closing in Tennessee: Investigating the Effect of Closures on Contraceptive Access and Short-Interval Birth [ID 2683524

INTRODUCTION: Access to maternity care (MC) and providers are important factors for contraception access and health outcomes for pregnant-capable individuals. After a series of hospital closures in Tennessee in the last decade, this study investigated the relationship between maternal county of residence and short-interval birth (SIB) rates statewide. METHODS: Tennessee birth certificate data for 2015–2020 from the Tennessee Department of Health was coded using March of Dimes 2022 definitions of access to MC overall, a hospital with obstetric (OB) care or birth center, and an OB provider (per 10k births) based on maternal county of residence. Short-interval birth was defined as birth interval 6–23 months. Nulliparous births and those with missing last living birth interval were excluded. Analysis was completed in SPSS 29.0, and Pearson χ2 tests compared SIB proportions between MC access groups. RESULTS: Overall, 269,908 births were analyzed. Of these, 78.1% maternal counties of residence had full MC access, 13.9% had low access, and 8.0% resided in a MC desert. Short-interval births were highest (24.4%; CI, 23.8–25.0) in MC deserts followed by areas with full access (23.7%; CI, 23.5–23.9) and low access (22.4%; CI, 22.0–22.8) (P<.001). Those with no access to an OB provider had highest rates of SIB (24.3%: CI, 23.7–24.8) compared to other categories (P<.001). CONCLUSION: Lacking access to maternity care likely corresponds with lacking access to contraception and higher rates of SIB in Tennessee. Prenatal and postpartum contraception counseling are important components of care for all individuals but especially those without acceptable access to OB providers and hospitals.

Do Rates of Obtaining Desired IPP LARC Differ by Maternal Care Access Levels and Demographics? [ID 2683528

INTRODUCTION: This analysis aimed to determine whether rates of obtaining desired immediate postpartum long-acting reversible contraception (IPP LARC) differed by maternity care access level or maternal demographic characteristics to identify gaps in practice, specific to health equity among Tennessee Medicaid recipients. METHODS: Data were obtained from deliveries March 2018 to December 2022 at our institution. Only deliveries insured by TennCare Medicaid were included in the analysis. Maternal care access level was defined by March of Dimes 2022 designations based on location of maternal residence. Variables included contraception counseling, desired and obtained contraception type, late/limited prenatal care designation, and demographics including race, ethnicity, age, gravida, and maternity care access level. RESULTS: Of the 10,623 publicly insured deliveries from March 2018 to December 2022, 2,251 patients desired IPP LARC, and 84.5% obtained it. Among those who did not (15.5%), 4.9% lived in a designated maternity care desert (MCD); 15.6% had late, limited, or no prenatal care; 21.7% were Hispanic; and 14.2% were Black, non-Hispanic. There were no statistically significant differences in IPP LARC obtainment between maternal care access levels or the other maternal demographics considered. CONCLUSION: When individuals are unable to obtain their desired contraceptive option immediately following delivery, assessing factors that may prevent access, including systemic barriers and potential bias, should be important in the organization. Bias may be identified as gaps in rates of obtainment stratified by maternal characteristics. Although we do not currently see statistically significant differences in rates of obtaining desired IPP LARC based on maternal characteristics, ongoing assessment will continue.

Examining the quality of care across the continuum of maternal care (antenatal, perinatal and postnatal care) under the expanded free maternity policy (Linda Mama Policy) in Kenya: a mixed-methods study

BackgroundKenya still faces the challenge of mothers and neonates dying from preventable pregnancy-related complications. The free maternity policy (FMP), implemented in 2013 and expanded in 2017 (Linda Mama Policy (LMP)),...

Disparities in Maternal Health Visits Between Rural and Urban Communities in the United States, 2016-2018.

The objective was to estimate the rural-urban differences in the receipt of prepregnancy, prenatal, and postpartum services. The authors conducted a cross-sectional data analysis using data from the Pregnancy Risk Assessment and Monitoring System from 2016 to 2018 to analyze rural-urban differences in the receipt of medical visits and care content delivery during the prepregnancy year, as well as the prenatal and postpartum periods among birthing people in the US, using survey-weighted multivariable logistic regression models. Rural-dwelling birthing people were significantly less likely to attend a medical visit in the prepregnancy year or postpartum period, even when controlled for sociodemographic and clinical characteristics. Compared to their urban counterparts, they were also less likely to receive comprehensive screening and counseling in the prepregnancy and postpartum maternity phases. Efforts to ameliorate rural-urban differences in maternal care access and quality should explicitly adopt multilevel, systemic approaches to policy and program implementation and evaluation. Policymakers and practitioners should consider telehealth as a potential complementary tool to minimize gaps in quality of care which disproportionately impact rural-dwelling birthing people.

Utilization of Antenatal Care Services Within the Context of COVID-19, Security Challenges, and an Unstable Healthcare System at Primary Health Care Centers.

Utilizing antenatal care (ANC) is vital for maternal and neonatal well-being, especially in low-resource settings with healthcare challenges. Identifying factors impacting antenatal care this context, t of current situation in Sudan is crucial for developing strategies to improve maternal care. This study explores ANC utilization amidst COVID-19, security issues, and healthcare instability in primary health care centers in a resource-constrained environment, aiming to enhance maternal care access and quality. This is a mixed-methods study. Quantitative data were collected through a retrospective analysis of ANC attendance records before and during the pandemic. Demographic variables were analyzed for their association with ANC utilization. In-depth interviews were conducted to collect qualitative data from pregnant women and healthcare providers. These interviews focused on capturing the experiences, perceptions, and obstacles associated with antenatal care services during the pandemic and within the healthcare system challenges. Preliminary quantitative analysis revealed a significant decline in ANC utilization during the pandemic. Fear of COVID-19 infection, disrupted transportation, and resource constraints have emerged as significant barriers to ANC attendance. The qualitative findings highlighted the impact of security challenges on healthcare access and the adaptation strategies employed, including mobile ANC clinics and telehealth consultations. This study illuminates the intricate landscape of ANC utilization in the face of a pandemic, security instability, and healthcare system vulnerability. Policymakers and stakeholders should collaborate to strengthen healthcare systems and ensure the continued provision of essential maternal health services during challenging times.

366 Investigating the impact maternity care access and social vulnerability on short-interval birth in Tennessee

366 Investigating the impact maternity care access and social vulnerability on short-interval birth in Tennessee

Dual Barriers: Examining Digital Access and Travel Burdens to Hospital Maternity Care Access in the United States, 2020.

With the increases in nationwide hospital maternity unit closures, there is a greater need for telehealth services for the supervision, evaluation, and management of prenatal and postpartum care. However, challenges in digital access persist. We examined associations between driving time to hospital maternity units and digital access to understand whether augmenting digital access and telehealth services might help mitigate travel burdens to maternity care. This cross-sectional study used 2020 American Hospital Association Annual Survey data for hospital maternity unit locations and 2020 American Community Survey five-year ZIP Code Tabulation Area (ZCTA)-level estimates of household digital access to telecommunication technology and broadband. We calculated driving times of the fastest route from population-weighted ZCTA centroids to the nearest hospital maternity unit. Rural-urban stratified generalized median regression models were conducted to examine differences in ZCTA-level proportions of household lacking digital access equipment (any digital device, smartphones, tablet), and lacking broadband subscriptions by spatial accessibility to maternity units. In 2020, 2,905 (16.6%) urban and 3,394 (39.5%) rural ZCTAs in the United States were located >30 minutes from the nearest hospital maternity units. Regardless of rurality, these communities farther away from a maternity unit had disproportionally lower broadband and device accessibility. Although urban communities have greater digital access to technology and broadband subscriptions compared to rural communities, disparities in the percentage of households with access to digital devices were more pronounced within urban areas, particularly between those with and without close proximity to a hospital maternity unit. Communities where nearest hospital maternity units were >30 minutes away had higher poverty and uninsurance rates than those with <15-minute access. Socioeconomically disadvantaged communities face significant barriers to maternity care access, both with substantial travel burdens and inadequate digital access. To optimize maternity care access, ongoing efforts (e.g., Affordable Connectivity Program introduced in the 2021 Infrastructure Act), should bridge the gaps in digital access and target communities with substantial travel burdens to care and limited digital access.

Exploring the impact of COVID-19 on reported maternal and neonatal complications and access to maternal health care in five government health facilities in Blantyre, Malawi.

There is a dearth of studies assessing the effects of SARS-CoV-2 on the healthcare system and access to care, especially in lower- and middle-income countries such as Malawi. We aimed to assess the impacts of COVID-19 on reported maternal and neonatal complications as well as potential changes in maternal care access to care among five primary care health facilities in Blantyre, Malawi. This retrospective cohort study assessed maternal and neonatal register data from five participating health centers in Blantyre, Malawi using the Malawi District Health Information Software 2 (DHIS2) to compare outcomes from 15 months before COVID-19 emerged, defined as the pre-Covid period (January 2019 -March 2020) with nine months after COVID-19 (April 2020 -December 2020). There was a significant decrease in reported use of vacuum extraction, which went from <0.01%in the pre-COVID period to 0% in the COVID period (p = 0.01). The proportion of births reporting fetal distress almost tripled from 0.46% to 1.36% (p = 0.001) during the COVID-19 period. Additionally, reported anticonvulsant use significantly increased from 0.01% to 1.2% (p<0.01), and antibiotic use significantly increased from 0.45% to 1.6% (p = 0.01). Asphyxia was the only significant neonatal complication variable reported, increasing from 2.80% to 3.45% (p = 0.01). Our findings suggest that significant outcomes were mainly due to the indirect effects of COVID-19 rather than the virus itself. Based on our findings and the contextual qualitative interviews with two Malawian expert midwives, we concluded that mothers may have been affected more due to understaffing and shortage of skilled personnel in the study health facilities. Therefore, the development of highly skilled health workers may contribute to better outcomes, along with adequate staffing and a streamlined referral process.

Rural and Urban Differences in Insurance Coverage at Prepregnancy, Birth, and Postpartum

To measure insurance coverage at prepregnancy, birth, and postpartum, and insurance coverage continuity across these periods among rural and urban U.S. residents. We performed a pooled, cross-sectional analysis of survey data from 154,992 postpartum individuals in 43 states and two jurisdictions that participated in the 2016-2019 PRAMS (Pregnancy Risk Assessment Monitoring System). We calculated unadjusted estimates of insurance coverage (Medicaid, commercial, or uninsured) during three periods (prepregnancy, birth, and postpartum), as well as insurance continuity across these periods among rural and urban U.S. residents. We conducted subgroup analyses to compare uninsurance rates among rural and urban residents by sociodemographic and clinical characteristics. We used logistic regression models to generate adjusted odds ratios (aORs) for each comparison. Rural residents experienced greater odds of uninsurance in each period and continuous uninsurance across all three periods, compared with their urban counterparts. Uninsurance was higher among rural residents compared with urban residents during prepregnancy (15.4% vs 12.1%; aOR 1.19, 95% CI 1.11-1.28], at birth (4.6% vs 2.8%; aOR 1.60, 95% CI 1.41-1.82), and postpartum (12.7% vs 9.8%, aOR 1.27, 95% CI 1.17-1.38]. In each period, rural residents who were non-Hispanic White, married, and with intended pregnancies experienced greater adjusted odds of uninsurance compared with their urban counterparts. Rural-urban differences in uninsurance persisted across both Medicaid expansion and non-expansion states, and among those with varying levels of education and income. Rural inequities in perinatal coverage were experienced by Hispanic, English-speaking, and Indigenous individuals during prepregnancy and at birth. Perinatal uninsurance disproportionately affects rural residents, compared with urban residents, in the 43 states examined. Differential insurance coverage may have important implications for addressing rural-urban inequities in maternity care access and maternal health.

Decolonising the Midwifery Curriculum

Decolonising the midwifery curriculum means to understand the historical and political effects of colonialism on healthcare, and how those accessing maternity care can still be disadvantaged by it today. Decolonising the midwifery curriculum is readdressing the imbalance in Eurocentric content that reinforce Western dominance, ensuring that taught content represents all cultures and fosters a sense of shared understanding and cultural humility. It is a process that asks us to challenge ourselves and institutional power imbalances that perpetrate harmful bias towards ethnicity, class, gender and able-bodism, to produce midwives who are better equipped to provide culturally-safe and inclusive care.

Providing Accessible Healthcare for Autistic Women

Narratives by autistic women regard their maternity-care experiences with feelings such as being isolated, neglected, stigmatised and judged. They feel hospital environments overload their senses which causes barriers to accessing maternity care. I have spent some time researching and creating a series of support plans to invite conversations between autistic women and maternity staff to create accessible, meaningful healthcare encounters. The aim of this article is to provide some ideas for care adjustments so that future narratives overflow with positive encounters.

Midwives’ experiences caring for asylum-seeking women in the UK: a systematic review

Background/Aims Asylum-seeking women face higher rates of maternal and neonatal mortality as a result of multiple barriers to accessing maternity care. Midwives are currently experiencing short staffing and high rates of burnout. Complex cases can add additional workload and stress. There is an evidence gap concerning midwives’ experiences of caring for asylum-seeking women in the UK. This study's aim was to examine the existing literature on this topic and consider the findings against the current realities of working within the NHS maternity system. Methods Literature was screened using the Critical Appraisal Skills Programme qualitative article checklist and the preferred reporting items for systematic reviews and meta-analyses flow diagram. Eight studies were included and analysed for thematic similarities. Results The results of the systematic review were categorised into three themes: racism and resentment, structural difficulties and systematic problems. Conclusions Midwives lacked the time to appropriately care for asylum-seeking women. A lack of time and resources may negatively impact midwives’ attitudes towards asylum-seeking women.

Perceptions and experiences of maternity care workers during COVID-19 pandemic in Lagos State, Nigeria; a qualitative study.

BackgroundThe COVID-19 (coronavirus disease 2019) pandemic challenges provision and access to essential maternity care in low-resilience health systems. The aim of this study was to explore maternity healthcare workers’ experiences of, and perceptions about providing maternity care during the COVID-19 outbreak in Lagos State, Nigeria.MethodsThis qualitative study conducted individual, remote, semi-structured interviews with midwives and traditional birth attendants (TBAs). Eligible participants spoke English, and provided maternity care during COVID-19 in Lagos, Nigeria. Participants were recruited via purposive and snowball sampling, from primary health facilities in seven Local Government Areas of Lagos State. Interview transcripts were analysed thematically following the framework method.ResultsSixteen midwives (n = 11) and TBAs (n = 5) were interviewed from March to April 2021. Two overarching themes were identified from the data. ‘Maternity care workers’ willingness and ability to work during the COVID-19 pandemic’ outlined negative influences (fear and uncertainty, risk of infection, burnout, transport difficulties), and positive influences (professional duty, faith, family and employer support). Suggestions to improve ability to work included adequate protective equipment, training, financial support, and workplace flexibility. ‘Perceived impact of COVID-19 on women’s access and uptake of maternity care’ highlighted reduced access and uptake of antenatal and immunisation services by women. Challenges included overstretched health services, movement and cost barriers, and community fear of health facilities. Participants reported delayed healthcare seeking and unattended home births. Midwives and TBAs identified a need for community outreach to raise awareness for women to safely access maternity services. Participants highlighted the responsibility of the government to improve staff welfare, and to implement public health campaigns.ConclusionsDespite disruption to maternity care access and delivery due to COVID-19, midwives and TBAs in Lagos remained committed to their role in caring for women and babies. Nevertheless, participants highlighted issues of understaffing and mistrust in Lagos’ underfunded maternity care system. Our findings suggest that future resilience during outbreaks depends on equipping maternity care workers with adequate working conditions and training, to rebuild public trust and improve access to maternity care.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12913-022-08009-y.

Qualitative research on maternal care access among Arabic-speaking refugee women in the USA: study protocol

BackgroundRefugees tend to have greater health needs and pre-existing medical conditions due to poor living conditions, lack of health services, exposure to a variety of risk factors, and a high...

Experiences of accessing maternity care in the UK: Perspectives from Somali migrant women in Leicester

INTRODUCTIONMigrant women born in Somalia often have poorer pregnancy outcomes. Access to care around pregnancy is vital to improve outcomes. The views and experiences of Somali migrant women accessing maternity care in the UK have not been extensively explored. This study therefore explores and describes these with regard to accessing maternity care in the UK, with the hope of gaining a better understanding of perceptions and factors that influence their access to care around pregnancy.METHODSA qualitative approach was used to investigate the views and experiences of women born in Somalia who had migrated to Leicester. Data collected were transcribed and analyzed using a constant comparison method. The software package Nvivo 10 was used to organize themes, and verbatim quotes were used to support their interpretation.RESULTSMain finings included: 1) positive attitudes of community midwives and availability lead to positive and meaningful experiences; 2) language difficulties and ineffective communication are barriers to effective access; 3) lack of cultural awareness and preconceived ideas by some hospital caregivers makes them unsupportive and insensitive; 4) need for continuity of care and the provision of resources are needed to build important trusting relationships with care providers; and 5) personal, community and religious factors impact access to care.CONCLUSIONSThe results highlight a number of important potential barriers to accessing care around pregnancy for migrant women born in Somalia and how these could be addressed to improve pregnancy outcomes.

Othering of Forced Migrant Women in Maternal Care. Becoming a Mother – Being constructed as Other: Results of a qualitative study in Germany

Abstract Refugee women are legally entitled to all necessary medical services related to pregnancy - including medical check-ups, childbirth costs, and midwifery assistance. However, studies indicate that they face structural barriers to maternal care access and are at greater risk of having poor pregnancy outcomes. This study aimed to explore the role of attributions of Otherness and practices of Othering in maternal care and the consequences for the quality of maternal care for forced migrant women in Germany. Qualitative semi-structured problem-centered interviews were conducted in three regions. The study sample includes 64 health care professionals (social workers, midwives, gynecologists) as well as 15 forced migrant women who recently gave birth to a child. Interviews were analyzed via framework analysis to identify perceptions, attitudes, and contextual conditions of providing maternal care to female refugees and to examine their experiences in the German maternity health care system. Most professionals showed an implicit, rarely questioned notion of an ostensible center of motherhood and parenthood. The qualitative results show how forced migrant women are constructed as other to this presupposed center of mothers. The practice of Othering occurs individually by health care professionals as well as structurally by the German asylum system and health care system. Both exclusionary and benevolent processes of Othering come into play. The effects of those attributions of Otherness are described from the perception of refugee new mothers concerning their pathways, resources, and obstacles in maternal care. Opportunities to achieve adequate maternal care for mothers and parents constructed as others from an ostensible and rarely questioned center of motherhood and parenthood are presented and discussed. To face diversity in maternal care, the notion of the center needs to be critically discussed as well as different aspects of consequences of Othering.

Access to and interventions to improve maternity care services for immigrant women: a narrative synthesis systematic review

BackgroundIn 2016, over one-quarter of births in the UK (28.2%) were to foreign-born women. Maternal and perinatal mortality are disproportionately higher among some immigrants depending on country of origin, indicating the presence of deficits in their care pathways and birth outcomes.ObjectivesOur objective was to undertake a systematic review and narrative synthesis of empirical research that focused on access and interventions to improve maternity care for immigrant women, including qualitative, quantitative and mixed-methods studies.Review methodsAn information scientist designed the literature database search strategies (limited to retrieve literature published from 1990 to 2018). All retrieved citations (45,954) were independently screened by two or more team members using a screening tool. We searched grey literature reported in related databases and websites. We contacted stakeholders with subject expertise. In this review we define an immigrant as a person who relocates to the destination country for a minimum of 1 year, with the goal of permanent residence.ResultsWe identified 40 studies for inclusion. Immigrant women tended to book and access antenatal care later than the recommended first 10 weeks of pregnancy. Primary factors included limited English-language skills, lack of awareness of availability of the services, lack of understanding of the purpose of antenatal appointments, immigration status and income barriers. Immigrant women had mixed perceptions regarding how health-care professionals (HCPs) had delivered maternity care services. Those with positive perceptions felt that HCPs were caring, confidential and openly communicative. Those with negative views perceived HCPs as rude, discriminatory or insensitive to their cultural and social needs; these women therefore avoided accessing maternity care. We found very few interventions that had focused on improving maternity care for these women and the effectiveness of these interventions has not been rigorously evaluated.LimitationsOur review findings are limited by the available research evidence related to our review questions. There may be many aspects of immigrant women’s experiences that we have not addressed. For example, few studies exist for perinatal mental health in immigrant women from Eastern European countries (in the review period). Many studies included both immigrant and non-immigrant women.ConclusionsAvailable evidence suggests that the experiences of immigrant women in accessing and using maternity care services in the UK are mixed; however, women largely had poor experiences. Contributing factors included a lack of language support, cultural insensitivity, discrimination and poor relationships between immigrant women and HCPs. Furthermore, a lack of knowledge of legal entitlements and guidelines on the provision of welfare support and maternity care to immigrants compounds this.Future workStudies are required on the development of interventions and rigorous scientific evaluation of these interventions. Development and evaluation of online antenatal education resources in multiple languages. Development and appraisal of education packages for HCPs focused on the provision of culturally safe practice for the UK’s diverse population. The NHS in the UK has a hugely diverse workforce with a vast untapped linguistic resource; strategies could be developed to harness this resource.Study registrationThis study is registered as PROSPERO CRD42015023605.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 8, No. 14. See the NIHR Journals Library website for further project information.