Identifying barriers to maternal care in mothers from black, minority ethnic and refugee communities in Islington

Maternal death rate in the UK has risen sharply and reached levels above those observed in the previous 20 years. Between 2020 and 2022 there were 13.41 deaths for every 100,000 maternity cases compared to 8.79 deaths per 100,000 cases in 2017–19 (1) . In conjunction with this, maternal mortality rates show significant disparities: women from black ethnic backgrounds have a three times higher risk of dying as mothers than white women (2) . The maternal death rate for women in the most deprived areas is twice that of those residing in the least deprived areas (3) emphasising the need for ongoing efforts to close these gaps. Located in Islington, Manor Gardens is a unique charity committed to improving maternal health by offering essential support services to expectant women. Their programmes include providing pre and postnatal care, mental health assistance, nutrition guidance, and access to health care professionals. The aim of this study was to combine quantitative analysis of the charity’s maternity information system with qualitative interviews to evaluate the maternity services provided by the charity. Specifically, the study sought to assess service utilisation, explore user experiences and perceptions of their maternity care experiences. Ethical approval was obtained from the London Metropolitan University to analyse the data from the charity’s maternity information system. We included women who used their services from 2019 to 2023. In addition to this, eight opportunistic face -to- face interviews were undertaken and thematically analysed to understand the impact of cultural and socioeconomic factors on their maternity care experience. We identified 256 women had accessed the charity’s services of whom 70 were included in our report due to incomplete data. Forty-nine percent (n = 34) of women were identified as having minority ethnicities, 35% as other and 16% as white. Forty-six percent (n = 32) did not speak English or had basic English. Social isolation, domestic abuse, seeking asylum, unsuitable housing and not having a bank account were among the barriers which prevented access to healthcare. Only 19% confirmed they had registered with a GP. The thematic analysis identified the following themes: Migration and Settlement Experience, Cultural Barriers, Healthcare Experience, Maternity Care and Postpartum Challenges and Support Systems. The interviews revealed the experiences of mothers, marked by social isolation, language and cultural barriers impacting understanding of healthcare procedures, struggles following childbirth magnified by impoverished living standards. These highlight the importance of effective support systems and culturally sensitive health care. Our findings suggest that by supporting maternal health, Manor Gardens Charity has the potential to identify barriers which can adversely impact the lives of many women and their families within a deprived community.