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Inequalities in Infant Mortality work programme - barriers to the early initiation of antenatal care by BME women

Principal investigator
Jennifer Hollowell (NPEU (Former member))
Sandy Oliver (Eppi-Centre, London), Josephine Kavanagh (Eppi-Centre, London), Peter Brocklehurst (NPEU), Ron Gray (NPEU (Former member)), Jenny Kurinczuk (NPEU)
Antenatal care, Socioeconomic and ethnic inequalities
Department of Health
Start year
End year
NPEU Contact
Rachel Rowe


This study followed-on from an earlier systematic review of the effectiveness of interventions to increase the early initiation of antenatal care by disadvantaged and vulnerable women,conducted as part of the Inequalities in Infant Mortality project.

The aims of this mixed-methods review were:

  • to identify and describe the barriers to and facilitators of early initiation of antenatal care in socially disadvantaged and vulnerable women in the UK; and
  • to explore the extent to which interventions identified in a related effectiveness review address these.

The study involved a synthesis of the relevant UK qualitative literature to identify the barriers to and facilitators of early initiation of antenatal care in socially disadvantaged and vulnerable women; and a cross-study synthesis to identify the extent to which the interventions identified in the earlier NPEU effectiveness review address barriers and facilitators relevant to disadvantaged and vulnerable women in the UK.

The main focus of the review was on Black and Minority Ethnic (BME) women.

Key findings

The findings suggest that:

  • There is a need to actively promote the existence, purpose and benefit of continuous antenatal care in a culturally appropriate way to the populations most at risk of late booking.
  • The complexity of the system does not facilitate early presentation for continuous antenatal care, especially by BME women who are unfamiliar with such a system and women with limited English. Healthcare staff in contact with pregnant BME women, particularly recent migrants and women who do not have English as their first language, need to be more aware of the need to proactively provide information to women in a way that women can understand.
  • BME women, who lack English as their first language or are recent migrants, may not fully or adequately understand information and advice provided during GP or other consultations and may be reluctant or unable to seek information that they need. The involvement of lay or professional advocates, or the adoption of an advocacy role by existing staff, might improve the quality and effectiveness of communication.
  • There is a need for GP and maternity services to consider how best to accommodate BME women's cultural preferences for female healthcare staff and to be aware that women may lack the confidence an assertiveness to request such services if they are not actively offered.
  • Women's experiences suggest a lack of cultural sensitivity/competence on the part of service providers
  • Women who are asylum seekers, and in some cases refugees, face additional barriers, some of which might be better addressed through national initiatives and policies.
  • Many of the 'promising' approaches identified would require further development and testing before they could be implemented and/or evaluated in the NHS.