Experiences of seeking and receiving maternity care during a health-system shock: a qualitative study with women and partners in the UK with a focus on marginalised groups

Introduction Health-system shocks, such as the COVID-19 pandemic, significantly disrupted routine maternity care. This study explored the lived experiences of accessing maternity care during such a shock, with a focus on marginalised populations and those with social or medical complexity. Methods Semi-structured interviews (n=55) were conducted with 40 women and 15 partners across the UK who accessed maternity care during the pandemic. Data were analysed using Template Analysis, guided by an extended Candidacy framework, which explores how healthcare eligibility is negotiated between individuals and health systems. Results At the individual level, limited information and disrupted relationships made it harder for individuals to assert their claim to candidacy, when seeking care. At the system level, services became harder to use due to new barriers associated with virtual care delivery and restrictions on partners. Judgements were made by professionals on cultural differences, birth plans and women’s opinions being disrespected. At the joint individual-system level, navigating the system was harder due to ever-changing restrictions. Service users resisted offers of care that did not align with their needs. Local conditions such as media messaging and heavy strain on the National Health Service workforce further exacerbated negative experiences of care. These barriers were exacerbated for those belonging to marginalised groups. Conclusions Barriers to seeking maternity care during health-system shocks are layered across individual, system and joint levels, and disproportionately affect those facing social or medical disadvantage. Responsive policies and service designs must address these intersecting challenges to improve equity in access and care during future disruptions.