Pregnancy and maternity in the UK Armed Forces: an ecosocial perspective

Abstract Background Recent UK reports highlight failings in maternity care, with disparities linked to social determinants. However, little is known about the maternity outcomes of active-duty service women (ADSW) in the UK Armed Forces (UKAF). Pregnant ADSW navigate fragmented care pathways across Defence and National Health Service (NHS) providers often becoming ‘invisible’ within systems. Neither organisation has examined how structural factors influence their maternity outcomes. This paper applied ecosocial theory to conceptualise how social, environmental and institutional determinants influence pregnancy and maternity outcomes in the UKAF. Methods Ecosocial theory was used to examine how patterns of health and disease are shaped by environmental, psychological and occupational factors in perinatal ADSW lives. Using core constructs-including embodiment, pathways of exposure and accountability-a conceptual model was developed and tailored to the UKAF context. The model draws on a critical synthesis of UKAF research and empirical evidence, alongside a broader review of peer-reviewed literature on military health, occupational culture and maternity care. Results The model highlights intersecting pathways through which military structures and institutional culture may influence maternity outcomes. Embodiment explains how ADSW may internalise stressors such as geographic isolation, fragmented care and minority stress. The construct of accountability reveals gaps in responsibility and knowledge production between Defence and NHS systems. This framework identifies possible systemic drivers of health inequities and epistemic invisibility in UK military maternity care. Conclusions Ecosocial theory offers a novel lens to understand how institutional and structural conditions shape maternity outcomes in the UKAF. This theoretical contribution highlights the need for targeted empirical research involving perinatal ADSW in the UKAF. Key messages • There is a critical need to expand research into pregnancy and maternity within the UK Armed Forces. • Applying ecosocial theory highlights how institutional structures, gendered environments and cultural norms shape perinatal health.