Access to and engagement with healthcare services among women with Children’s Social Care involvement during the perinatal period who subsequently died: a confidential enquiry

Introduction: In the last decade, UK maternal death surveillance data have shown that among the women who died during pregnancy and the year after birth (the perinatal period), the proportion of women with Children's Social Care (CSC) involvement nearly doubled. Parental non-engagement in the context of CSC involvement has been described as a particular professional concern. Objective: To explore organisational and system barriers when accessing and engaging with healthcare services experienced by women with CSC involvement who subsequently died during the perinatal period. Methods: MBRRACE-UK national surveillance data were used to identify women who died during or in the year after pregnancy in the UK between 2014 and 2021 and who had CSC involvement. A confidential enquiry of healthcare records of a random sample of women with CSC involvement during pregnancy or in the year after the end of pregnancy and who subsequently died (n=47) was undertaken to explore barriers to care. Results: We identified four themes to describe the barriers faced by women with CSC involvement when accessing and engaging with healthcare services in the perinatal period: (1) burden of care, (2) disruption of care, (3) follow-up of non-attendance and (4) bias in care. Our findings highlighted the additional challenges that women had to contend with, while already facing multiple adversities in their daily lives. Conclusion: Our confidential enquiry found that the existing narrative of non-engagement among women with CSC involvement is unfounded for most women. Care for women with CSC involvement needs to be made trauma-informed, accessible and minimally disruptive.