Undergraduate Major Project

Inequalities in Maternal health in the UK

Research report on: A Literature Review and
Recommendations for Health and Social Care Services in the UK

Module Code: MOD008036

Student Number: 1947528

Word counts: 4000

Date of submission: 12/12/2023

ii
 Inequalities in Maternal Health: A Literature Review and

Recommendations for Health and Social Care Services in the UK

Research Question: What are the factors contributing to inequalities

in maternal health and how can health and social care services in

the UK respond to these?

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 ABSTRACT

A major problem in the United Kingdom is the disparity in maternal health care that impacts both

moms and their newborns. To try and understand the complex causes of these health disparities,

this study combines information from eleven sources that were published between 2009 and

2022. Findings show that several variables, including but not limited to gender, sexual

orientation, race/ethnicity, class, and religion, significantly impact maternal and baby health. It

further emphasizes that thorough record-keeping and extensive data gathering are critical for

identifying and resolving these inequalities.

On the other hand, this study highlights important gaps in our knowledge of maternal health

disparities and offers crucial insights into the topic. It implies that a multidisciplinary strategy

involving disciplines such as anthropology and social science is necessary to fill these gaps

through thorough qualitative research. More research into the socioeconomic determinants of

maternal health is also urgently required.

There needs to be a multifaceted approach if the UK is serious about reducing maternal health

inequities. Included in this approach should be the following: community involvement, systemic

improvements in healthcare systems, improved data gathering methods, increased support for

interdisciplinary research collaborations, and the promotion of culturally sensitive healthcare

practices. It is crucial to comprehend how socioeconomic status and racial/ethnic diversity

impact maternal health outcomes. More importantly, it is critical to investigate the long-term

effects of these inequalities on families. An problem of social justice and equity, improving

maternal health outcomes ultimately calls for systemic changes to healthcare policy and practice.

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Contents
ABSTRACT................................................................................................................................................ii
Section One.................................................................................................................................................2
Introduction.............................................................................................................................................2
Aims and Objectives................................................................................................................................2
Background to the Study.........................................................................................................................2
Key Terms................................................................................................................................................2
Literature Search Strategy.......................................................................................................................3
Section Two:................................................................................................................................................4
Literature Review Findings.....................................................................................................................4
Section Three:............................................................................................................................................13
Critique of the Findings.........................................................................................................................13
Section Four..............................................................................................................................................16
Discussion.............................................................................................................................................16
Research Gaps and Opportunities..........................................................................................................17
Conclusion.............................................................................................................................................18
Recommendations for Further Research Directions...........................................................................19
Concluding Remarks.............................................................................................................................19
Reference list.............................................................................................................................................21
Overview of the Literature Review........................................................................................................24

1
Section One

Introduction

Identifying the many factors that contribute to the health disparities that mothers in the United

Kingdom endure is the objective of this study project. In order to address the maternal health

disparities that exist among non-white British women (HOWELL and AHMED, 2019), the

purpose of this study is to investigate the reasons behind the higher prevalence of adverse

pregnancy and delivery outcomes among this demographic.

Aims and Objectives

The primary objective is to study and comprehend the fundamental causes of disparities in

maternal health outcomes in the United Kingdom, with a particular emphasis on women of color

and white women (Limb, 2021). Health and social care providers can also benefit from the

study's practical suggestions for filling these gaps. The research study is focused to to explore the

reasons behind maternal health disparities. In addition to this, the study is also targeting to

understand the inequalities and their causes via the literature review

Background to the Study

Maternal health disparities are a significant problem in the United Kingdom's public health

system. In several aspects of maternal health, women who are not white in the United Kingdom

face larger risks than white women in the same country (Bracke, 2021). One of the numerous bad

outcomes that can result from the threats is an increase in the rates of maternal death and serious

illnesses (Anekwe, 2020). Other negative consequences include difficulties in obtaining adequate

maternity care and being satisfied with the treatment that one receives.

2
Literature Search Strategy The purpose of this literature review is to establish the basis for the

remaining sections of the study, which will delve deeper into the variables that cause disparities

in maternal health and propose remedies within the health and social care services of the United

Kingdom. This review was carried out with the assistance of academic databases such as

PubMed, Elsveir, Science Direct, and Google Scholar, in addition to papers from the relevant

government agencies. In order to take into account more recent events, the research concentrated

on scholarly articles and reports that were published between the years 2009 and 2022. The most

commonly searched terms were "inequalities in maternal health," "disparities in healthcare,"

"social determinants of health," in addition to "healthcare system in the United Kingdom."

Inclusion Criteria:

 Research paper between 2009-2022 dealing with Maternal health disparities across the

world

 Research papers focusing on maternal health issues/problems and their causes

Exclusion Criteria:

 Research papers not falling btw targeted timeline (2009-2022)

 Research papers dealing with health inequalities and disparities but have no focus on

maternal health issues

 Articles focused on postpartum care, studies not related to maternal health, articles

published before 2012, studies with data from outside the UK.

3
Key Terms
 Maternal Health Inequalities: The disparities in health outcomes, experiences, and

access to care for mothers, influenced by their race, socioeconomic status, or

geographical location.

 Non-White British Women: Refers to women in the UK who are not of white British

descent, including Black, Asian, and minority ethnic (BAME) groups.

 Health and Social Care Services: Encompasses all aspects of prenatal, maternity,

postnatal, and perinatal care provided by the UK's health and social care systems.

Health care & Social care services

Non-White British Women

Maternal Health Inequalities

Ethnic Inequalities

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Section Two:

Literature Review Findings

This part will provide an overview of the findings derived from 10 carefully chosen

sources. It will summarize the objectives, principal findings, methodologies, conclusions,

and their pertinence to the research aims and objectives of the literature review.

1. Jardine, J. Et al (2021). Adverse pregnancy outcomes attributable to

socioeconomic and ethnic inequalities in England: A national cohort study.

Aims: To quantify the magnitude of socioeconomic and ethnic inequalities in adverse

pregnancy outcomes in England.

Methods: Data from 132 NHS hospitals in England, covering singleton births between 24

and 42 weeks of gestation, were analyzed. The study excluded terminations of pregnancy and

focused on stillbirth, preterm birth, and fetal growth restriction (FGR), comparing outcomes

across socioeconomic and ethnic groups. Factors like smoking, BMI, and other maternal

risks were adjusted for in the analysis.

Main Findings: According to the findings of the study, women who belong to minority

ethnic groups and socioeconomically deprived groups, particularly Black and South Asian

women, had a higher likelihood of experiencing stillbirth, premature birth, and FGR.

Inequalities in socioeconomic status were responsible for a sizeable fraction of these

unfavorable outcomes, with the risks being largest in the most disadvantaged groups..

Conclusion: The socioeconomic and ethnic gaps that exist in England have a substantial

impact on the unfavorable outcomes of pregnancy, particularly among women of African and

5
South Asian descent who live in disadvantaged areas. The entire population as well as certain

minority groups that are at risk should be the primary focus of preventative measures.

2. Fernandez Turienzo, C., Newburn, M., Agyepong, A., Buabeng, R., Dignam, A.,

Abe, C., Bedward, L., Rayment-Jones, H., Silverio, S.A., Easter, A. and Carson,

L.E., 2021. Addressing inequities in maternal health among women living in

communities of social disadvantage and ethnic diversity. BMC Public Health, 21,

pp.1-5.

Aim: This study focuses on understanding the heightened risks and challenges faced by

socioeconomically disadvantaged and ethnic minority groups during the COVID-19 crisis,

specifically regarding maternal health.

Methods: In order to analyze the extent to which the COVID-19 pandemic has exacerbated

pre-existing vulnerabilities, socio-economic and structural disadvantages, as well as

discrimination against populations that are socially disadvantaged and ethnically diverse,

researchers and community organizations undertook analyses. At the focus of the study were

a number of different issues, such as access, involvement, and quality of care; racism,

discrimination, and trust; interaction with community stakeholders; and the influence of

greater social and economic inequities.

Main Findings: The findings of this study underline the fact that the COVID-19 pandemic

has exacerbated the existing disparities that are harming childbearing women, particularly

those who are coping with mental illness and who reside in places that are socially deprived

and have a diverse ethnic population. Among the most important problems that have been

6
noted are difficulties in gaining access to healthcare, racism in the system, and trust deficits,

as well as the requirement for increased interaction with community interested parties.

Conclusion: In order to effectively address health disparities, it is not sufficient to focus

solely on biological reasons. In order to effectively address societal and structural racism as

well as overall disadvantage, it is essential to implement public health initiatives that are

comprehensive, integrative, and long-term. In order to effectively enhance health outcomes

for vulnerable populations, such measures ought to be created and put into action in

collaboration with the communities in the surrounding neighborhood.

3. " Aquino, M.R.J.V., Edge, D. and Smith, D.M., 2015. Pregnancy as an ideal time

for intervention to address the complex needs of black and minority ethnic women:

Views of British midwives. Midwifery, 31(3), pp.373-379.

Aims: To explore midwives' experiences in providing care to Black and Minority Ethnic

(BME) women in the UK, focusing on their perspectives on maternal health inequalities and

the impact on service delivery.

Methods: Twenty semi-structured interviews with qualified midwives were conducted in an

NHS Trust in North West England. Data were transcribed and analyzed thematically using a

specific topic guide.

Findings: The study revealed three primary themes: language barriers impeding

communication with non-English speaking women, mismatched expectations of maternity

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care between midwives and women, and the need for inter-agency collaboration to address

complex needs beyond traditional maternity care.

Conclusions: Despite their best efforts, midwives encounter obstacles that threaten their

ability to offer equitable care, which may contribute to inequities in service delivery. Among

the most important advances are the recognition of pregnancy as a crucial period for holistic

health care, the enhancement of education for both Black and Minority Ethnic women and

midwives, and the development of access to interpretation services. In order to effectively

address these problems, the study recommends developing a collaborative approach to

maternity care.

4. " Montgomery, E., De Backer, K., Easter, A., Magee, L.A., Sandall, J. and

Silverio, S.A., 2023. Navigating uncertainty alone: A grounded theory analysis of

women's psycho-social experiences of pregnancy and childbirth during the COVID-

19 pandemic in London. Women and Birth, 36(1), pp.e106-e117.

Aim: To examine the psycho-social experiences of women who received maternity care and

gave birth in South London during the first COVID-19 lockdown.

Methods: Twenty-three women participated in semi-structured interviews conducted

virtually. The data were recorded, transcribed, and analyzed manually using Classical

Grounded Theory Analysis, including line-by-line coding, focused coding, development of

super-categories and themes, and theory generation.

Findings: Six emergent themes were identified, organized into three dyadic pairs: (1) Lack

of relational care versus good practice persistence during the pandemic, (2) Denial of the

embodied experience of pregnancy and birth versus efforts to ensure safety, and (3)

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Disconnection from support networks versus the importance of the family unit at home.

These themes collectively formed the theory of 'Navigating uncertainty alone'.

Conclusion: The study reveals that women's experiences of pregnancy and childbirth during

the pandemic were a mix of positive and negative aspects. Challenges like lack of relational

care and isolation from support networks were somewhat balanced by good medical

practices, safety efforts by staff, and the increased significance of the family unit. The

overarching experience was marked by a heightened sense of uncertainty and the need to

navigate maternity care independently during the pandemic.

5. " Womersley, K., Ripullone, K. and Hirst, J.E. (2021). Tackling inequality in

maternal health: Beyond the postpartum. Future Healthcare Journal, [online] 8(1),

pp.31–35. doi:https://doi.org/10.7861/fhj.2020-0275.

Aim: To tackle the overlooked aspect of postpartum care in medical systems, focusing on its

enduring effects on the health of women, particularly those from underprivileged and ethnic

minority backgrounds.

Methodology: A critical analysis combining existing studies and health policy assessments.

Main Findings: Underlines the prolonged health consequences of conditions related to

pregnancy, disparities in maternal healthcare, differences in resource allocation, and the

necessity for a fundamental change in healthcare practices and policies.

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Conclusion: A group of individuals who advocate for a collaborative approach among

medical specialties, proactive health screenings, increased educational initiatives,

collaborative work across specialties, and targeted research in order to reduce health

disparities. It is essential for comprehending the deficiencies in postpartum care.

6. " Knight, M., Kurinczuk, J.J., Spark, P. and Brocklehurst, P. (2009). Inequalities

in maternal health: national cohort study of ethnic variation in severe maternal

morbidities. BMJ, [online] 338(mar03 2), pp.b542–b542

Aims: To examine the differences in severe maternal morbidity rates among various

ethnic groups in the United Kingdom.

Main Findings: In non-white women, there has been a notable increase in the prevalence

of significant maternal health problems, with a particularly elevated risk in women of

African and Caribbean descent.

Methods: Employed a nationwide cohort analysis utilizing data from the UK Obstetric

Surveillance System (UKOSS).

Conclusions: A higher prevalence of severe maternal morbidity in non-white women

highlights the necessity for customized maternity services and enhanced healthcare

accessibility. Important for comprehending the inequalities in severe maternal morbidity.

10
 7. " Bracke, S. (2021). Action to reduce maternal health inequalities. [online] BMJ

Sexual & Reproductive Health blog.

Aim: To explore the discrepancies in maternal health among ethnic minority groups in

England and Wales and suggest policy changes.

Methodology: Involved analyzing data regarding maternal mortality, health disparities, and

possible influencing factors.

Main Findings: Points out racism as a key cause of health inequalities and underscores the

uneven access to healthcare services and provision.

Conclusion: Recommends setting clear goals to lessen maternal mortality differences,

implementing systemic solutions, and tackling widespread issues that lead to health

disparities. Important for recognizing the impact of systemic elements on maternal health

disparities.

8. Hamal, M., Dieleman, M., De Brouwere, V. and de Cock Buning, T. (2020). Social

determinants of maternal health: a scoping review of factors influencing maternal

mortality and maternal health service use in India

Aims: To pinpoint social elements influencing maternal mortality and morbidity.

Main Findings: Determined that racial or ethnic background, socioeconomic status, and

healthcare accessibility are crucial factors impacting maternal health.

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Methods: Conducted a comprehensive scoping review of existing research on social

determinants.

Conclusions: Emphasizes the importance of addressing social determinants to mitigate

disparities in maternal health. Crucial for comprehending the global factors affecting

maternal health outcomes.

9. Crowe, 2022. Factors Contributing to Maternal Health Inequalities for Women Who

Are Not White British in the UK"

Aim: Investigating midwives' views on the root causes of ethnic differences in maternity

healthcare.

Methodology: Implemented a methodical review of existing literature and extracted insights

from qualitative research.

Findings: Midwives identified three primary factors influencing healthcare inequities:

interpersonal challenges, practical hurdles, and a sense of divisiveness

Conclusion: Suggests more in-depth exploration into the role of subconscious prejudices and

stresses the necessity for a comprehensive national approach and enhanced record-keeping to

tackle these inequities. This study is significant for comprehending healthcare professionals'

viewpoints on disparities in maternal health.

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 10. Kronenfeld, J.J. (2010). The Impact of Demographics on Health and Health

Care: Race, Ethnicity and Other Social Factors.

Aims: To conduct a succinct review of literature focusing on gender, women's health

issues, and various social determinants.

Main Findings: The review indicates that women with lower skill levels in Central,

Northern, and Western European countries exhibit a greater ability to utilize healthcare

facilities compared to women possessing higher educational qualifications.

Methods: The approach involves a comprehensive literature review.

Conclusions: The findings of this literature review highlight a unique trend in healthcare

utilization across Central, Northern, and Western Europe, where women with lower skill

levels demonstrate greater engagement with healthcare services than their more educated

counterparts. This suggests the need for further research to understand the underlying

factors influencing this pattern, including socio-economic, cultural, and policy-related

aspects. Additionally, these insights call for a reevaluation of healthcare accessibility and

outreach strategies, ensuring they are effectively tailored to meet the diverse needs of

women across different educational and skill backgrounds.

These ten studies cover maternal health disparities in the UK and worldwide, focusing on women

of colour. These studies support earlier research: Socioeconomic and ethnic disparities affect

minority populations' pregnancy difficulties such stillbirth, early delivery, and fetal growth

limitation. The COVID-19 epidemic has highlighted structural racism, limited healthcare access,

and the necessity for community action to address these issues. Midwives confront various

hurdles in treating Black and Minority Ethnic women equally, including language barriers and

13
misplaced expectations. The report also emphasizes the need for comprehensive postpartum

treatment that considers pregnancy's long-term health impacts. Due to their higher incidence of

severe maternal morbidity, non-white women need more healthcare and specialized maternity

therapies. The studies emphasize the importance of social determinants in maternal health and

the need for systemic and individual remedies to disparities and integrated public health

programs.

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Section Three:

Critique of the Findings

This section critically assesses the strengths and limitations of the sources used in the literature

study, examining the research methodologies to evaluate the reliability and credibility of the

findings.

1. Jardine et al. (2021):

 Strengths: Utilizes a large dataset from NMPA with a robust cohort design,

quantifying the impact of racial and socioeconomic factors on adverse pregnancy

outcomes.

 Limitations: Reliance on retrospective data may not capture all relevant factors

influencing adverse outcomes. Associations identified might not fully reveal the

underlying qualitative elements

2. Fernandez Turienzo et al. (2021):

 Strengths: Engages with communities directly, offering unique insights into

maternal health disparities and strategies to address them.

 Limitations: The non-traditional methodology may limit generalizability, and the

online engagement approach could introduce selection bias due to unequal online

access.

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3. Aquino et al. (2015):

 Strengths: Offers valuable qualitative insights through interviews with midwives,

specifically targeting a relevant professional group. Systematic thematic analysis

enriches the understanding of maternity care challenges for BME women.

 Weaknesses: Geographic limitations and a small sample size (20 ) may impact

generalizability. The absence of direct input from BME women omits critical

perspectives for fully grasping maternity care disparities.

4. Hamal et al. (2020):

 Strengths: Compiles diverse literature to comprehensively understand social

determinants in maternal health in India.

 Limitations: As a scoping review, it doesn’t contribute new data but relies on

existing studies, with the included studies’ quality potentially affecting the

reliability of findings.

5. Knight et al. (2009):

 Strengths: Employs a substantial national cohort design using UKOSS,

effectively capturing racial group differences in severe maternal morbidity.

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  Limitations: Potential underreporting of severe morbidity cases could skew the

true extent of disparities, with limited exploration of qualitative factors behind

these disparities.

6. Crowe (2022):

 Strengths: Employs a systematic literature review methodology, synthesizing qualitative

findings from various studies to understand midwives' perspectives on maternal health

inequities.

 Limitations: Relies on the quality and depth of source studies for synthesis and

predominantly reflects midwives' viewpoints, possibly excluding perspectives of other

healthcare professionals or the women themselves.

7. Womersley, Ripullone, and Hirst (2021):

 Strengths: Provides insightful commentary on the often-neglected postpartum

period, reviewing existing studies and highlighting policy implications.

 Limitations: Lacks original data or formal research methods, primarily

summarizing existing research rather than generating new findings.

8. Bracke (2021):

 Strengths: Critically analyzes data on maternal health disparities, emphasizing

racism's role and suggesting policy interventions.

 Limitations: While data-driven, it doesn’t present new research findings, and the

practical effectiveness of its recommendations remains untested.

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9. Kronenfeld (2010):

 Strengths: The study's strengths lie in its innovative focus on a relatively

underexplored aspect of healthcare utilization, emphasizing how skill level and

education impact women's access to healthcare services in specific European

regions. This regional focus is particularly beneficial for targeted policy-making

and healthcare strategies. Additionally, the research contributes significantly to

the discourse on gender and health, particularly concerning social determinants of

health. The use of a literature review methodology ensures a comprehensive and

rigorous analysis of existing research, grounding the conclusions in a solid body

of evidence.

 Limitations: However, the study's reliance on existing literature as its sole source

of data presents limitations. The scope and depth of its findings are inherently tied

to the range and quality of the research reviewed, potentially missing out on

relevant studies or newer data. The absence of primary data collection may also

limit the exploration of new perspectives or nuanced aspects not covered in the

existing literature. While the focus on educational backgrounds provides valuable

insights, it might inadvertently overshadow other critical factors like cultural or

economic barriers. Moreover, the study's regional focus, while beneficial for

specificity, restricts the applicability of its findings to other geographic areas,

limiting the generalizability of its conclusions

10. Montgomery et al.,(2023):

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  Strengths: its timely and relevant exploration of the impact of the COVID-19

pandemic on maternity care, a crucial issue during a significant public health

crisis. This focus provides valuable insights into an urgent healthcare concern.

Additionally, the methodological rigor is evident in the use of semi-structured

interviews and Classical Grounded Theory Analysis. This approach ensures a

thorough and detailed exploration of the women's experiences, enhancing the

credibility and depth of the findings.

 Limitations: the limited sample size and geographical scope restrict the study's

generalizability. Focusing on 23 women from South London may not reflect the

diverse experiences of women across the UK. Secondly, the study's reliance on

virtual interviews could potentially introduce biases or limit the depth of

interaction, impacting the richness and authenticity of the data collected. This

methodological constraint could influence the study's overall findings and

conclusions.

Section Four

Discussion

This comprehensive review sheds light on pivotal elements contributing to maternal health

disparities:

1. Ethnicity-Related Disparities: Research works (Nair, Kurinczuk, and Knight, 2014;

Knight et al., 2009; Jardine et al., 2021) have consistently highlighted alarming

disparities in maternal mortality and morbidity among non-white British ethnic groups,

19
 especially Black women, emphasizing the significant impact of ethnicity on maternal

health outcomes.

2. Influence of Social Determinants: The complex relationship between social

determinants such as socioeconomic status, healthcare accessibility, and ethnicity (Hamal

et al., 2020; Jardine et al., 2021) is a major factor in maternal health, pointing to the

profound effect of these elements.

3. Challenges in Healthcare Provision: Studies (Fernandez Turienzo et al., 2021) identify

critical issues within healthcare systems that exacerbate maternal health inequalities,

including inadequate maternity care, discontinuity in care, and representation gaps.

4. Impact of Racism and Bias: Research (Fernandez Turienzo et al., 2021; "Action to

Reduce Maternal Health Inequalities") brings to light the detrimental effects of systemic

racism and discrimination within healthcare settings.

5. Data Collection and Analysis: The need for accurate data and comprehensive

documentation (NMPA, 2019; Jardine et al., 2021) emerges as a key theme, underlining

the importance of data in understanding and addressing health disparities.

Research Gaps and Opportunities

While the reviewed literature provides substantial insights, it also uncovers several research

gaps:

1. Need for Qualitative Insights: There's a conspicuous need for qualitative research to

unearth the deeper factors influencing disparities.

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 2. Call for Interdisciplinary Perspectives: Broadening the research scope to include

disciplines like social sciences could provide a richer, more contextual understanding of

maternal health disparities.

3. Exploring Intersectionality: A more thorough investigation into how different social

determinants intersect and impact maternal health is essential.

Conclusion

Conclusively, the review underlines the complexity of maternal health disparities in the UK,

influenced by a myriad of factors including social determinants, healthcare system challenges,

and ingrained biases. To effectively address these issues, we propose:

1. Emphasis on Culturally Competent Care: Healthcare services must prioritize

culturally sensitive practices and actively address biases and racism.

2. Robust Data Practices: Developing comprehensive data collection and analysis systems

is crucial for ongoing monitoring and improvement.

3. Enhancing Interdisciplinary Collaboration: Encouraging research collaborations

across various academic and professional fields to deepen the understanding of these

disparities.

4. Strengthening Community Involvement: It is of the utmost importance to involve

communities, particularly those groups that are already at a disadvantage, in the process

of identifying problems and developing solutions.

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In summary, effectively mitigating maternal health disparities in the UK requires a multi-faceted,

inclusive approach that acknowledges and addresses the complex interplay of various

contributing factors.

Recommendations for Further Research Directions

Given the dynamic nature of maternal health inequalities in the UK, there are several critical

areas that future research should focus on to deepen our understanding and enhance

interventions:

1. Exploring Intersectionality: It is important for future study to investigate the ways in

which several social determinants, such as ethnicity, socioeconomic level, and

geographical location, interact to influence the outcomes of maternal health situations. As

Agénor (2020) suggests, this intersectional approach has the potential to result in

interventions that are more focused and successful because it acknowledges the

compound nature of the imbalances that exist.

2. Understanding Diverse Experiences: It is of the utmost importance to investigate the

experiences and perspectives of women who come from a variety of ethnic backgrounds

in relation to their interactions with healthcare systems. According to Soltani et al.

(2020), research in this area has the potential to uncover vital insights into existing

constraints and chances for improvements, hence providing a more patient-centered

viewpoint on the provision of healthcare.

3. Investigating Long-term Impacts: A greater amount of concentrated study is required

because of the long-term implications that maternal health disparities have on both

mothers and their children. In order to appreciate the broader consequences of these

22
 disparities and to design targeted preventative measures and interventions, it is vital to

conduct studies of this nature, as Fernandez Turienzo et al. (2021) have also noted.

Concluding Remarks

The disparities in maternal health that exist in the United Kingdom constitute a substantial

problem that goes beyond the realm of healthcare and touches upon issues of social justice and

fairness. This article highlights the need of using a holistic and multidimensional approach by

providing guidelines and suggesting future research possibilities. This strategy must to have as

its primary objective not only the reduction of disparities in health outcomes, but also the

guarantee of inclusiveness and equitable access to medical treatment for each and every person.

The adoption of these research paths is a step toward the development of a healthcare system that

is sensitive to the requirements of all women, regardless of their ethnicity, financial status, or

geographic location.

23
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27
Overview of the Literature Review

Source Title Aims Main Findings Methodology Conclusions Relevance to Research

and Authors Objectives

"Inequalities To study Non-white women National cohort Customized Aligns with objectives of

in Maternal ethnic experience higher analysis using UK maternity improving healthcare

Health: variation in rates of severe Obstetric services and services for ethnic

National severe maternal morbidity. Surveillance improved access minority groups.

Cohort maternal System (UKOSS). to care are

Study" - morbidities essential for

Knight et al. in the UK. reducing

(2009) disparities.

"Pregnancy To explore Identified language Semi-structured Advocates for Relates to objectives of

as an Ideal midwives’ barriers, expectation interviews with collaborative enhancing healthcare

Time for experiences mismatches, and the midwives in an maternity care provider education and

28
Intervention" with BME need for inter- NHS Trust. approaches and cultural competence.

- Aquino, women in agency better education

Edge, Smith the UK. collaboration. for both women

(2015) and midwives.

"Social To explore Racial or ethnic Comprehensive Importance of Underscores the role of

Determinants social background, scoping review of addressing social and economic

of Maternal determinants socioeconomic existing research. social factors in maternal health

Health: A influencing status, and determinants to outcomes.

Scoping maternal healthcare reduce maternal

Review in health in accessibility impact health

India" - India. maternal health. disparities.

Hamal et al.

(2020)

29
"Navigating To Mixed experiences, Semi-structured Pregnancy and Provides insights into the

Uncertainty investigate balancing lack of interviews, childbirth additional challenges

Alone" - the psycho- care and isolation analyzed using experiences posed by the pandemic on

Montgomery, social with good practices Grounded Theory. during the maternal health.

De Backer, experiences and family support. pandemic were

Easter, of women complex,

Magee, during the requiring

Sandall, COVID-19 independent

Silverio pandemic in navigation.

(2023) London.

"Factors Investigate Midwives identified Conducted a Recommends Relevant for understanding

Contributing to midwives' practical, cultural, and systematic literature further research healthcare providers'

30
Maternal perceptions of logistical concerns as search and into the impact of perspectives on maternal health

Health factors contributors to health synthesized findings implicit bias and inequalities, aligning with the

Inequalities for contributing to inequalities from qualitative emphasizes the research objective to explore

Women Who ethnic studies need for a national healthcare providers' insights

Are Not White disparities in strategy into maternal health disparities

British in the maternity care

UK" (Crowe,

2022)

31
"Tackling To address Highlights the long- Critical analysis of Advocates for a Emphasizes the

Inequality in the term health effects existing studies collective importance of postpartum

Maternal overlooked of pregnancy- and healthcare approach among care and data-driven policy

Health" - postpartum related conditions policies. medical development.

Womersley, care in and disparities in specialties and

Ripullone, healthcare maternal healthcare. improved data

Hirst (2021) systems. collection.

32
Appendix

33