Project 8: Talking about risk connected to ethnicity in maternity care
Background
Women and babies from Black and Asian communities are more likely to have poor maternity outcomes than White women and babies. There is other work going on to reduce these inequalities. This project focuses on one part of the problem: how we talk to families about risk connected to ethnicity.
The headline statistics about unequal risks have been widely publicised as part of important public campaigns to improve maternity care for Black and Asian families. Health professionals also use statistics connected to ethnicity when talking to individual women. These headline statistics compare the relative risks for broad ethnic groups, at population level. They are often shared without context about the actual (rather than relative) risks, and without discussion about the factors affecting a woman's individual level of risk, which may be low.
An unintended consequence has been to make some Black and Asian women afraid of what will happen to them during maternity care. Some feel pressured into accepting interventions because of their ethnicity. This can cause understandable stress and can reduce women's trust in maternity services. It leads some women to avoid maternity care – which increases the chance of poor outcomes.
Black and Asian women are also more likely to have some health conditions during pregnancy, such as gestational diabetes. They may be offered extra screening and testing, and extra care if they have these conditions. Some women interpret these offers as unfair targeting because of their ethnicity. This can lead to distress and rejection of the screening and testing – which again increases the chance of poor outcomes.
Aims and Objectives
We want health professionals, researchers and campaigners to talk about risk related to ethnicity in ways that are accurate, clear, and support informed choice. This project aims to:
- improve the way information about ethnicity and risk is communicated
- reduce avoidable fear and distress
- improve Black and Asian women's trust and experiences of maternity care
Methods
The project is in two parts:
1. Interviews
- We will interview 30 mothers from Black and Asian communities to understand how information about ethnicity and maternity risks has affected their experiences and decisions.
- We will interview 15 midwives and 15 doctors working in NHS maternity care about their experiences of discussing ethnicity-related risk and offering extra screening and tests.
We will use the evidence from these interviews to inform the development of guidance in the second part of the project.
2. Developing guidance
We will work in partnership with:
- Black and Asian community groups
- campaign organisations
- health professionals.
Together we will produce guidance to help:
- health professionals talk to women about their own individual level of risk in a way that supports informed choice
- researchers, community organisations and campaign groups to use maternity statistics about ethnicity in a clear, accurate and supportive way.
Policy Relevance and Dissemination
The guidance will help to improve the way information about ethnicity and risk is shared with Black and Asian families.
We will also share the findings by:
- publishing them in an academic journal
- producing a briefing for policy makers
- creating an easy-to-read summary for the public.
Team
Principal Investigators: Fiona Alderdice, Jenny McLeish
Wider PRU team: Marian Knight, Allison Felker, Julia Sanders and Jenny Douglas
Contact: jenny.mcleish@npeu.ox.ac.uk
