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| Distribution across the strata of maternal age, ethnicity and IMD by the other characteristics. a Distribution of ethnicity according to maternal age. b Distribution of IMD quintile by maternal age, with IMD 1 representing the most deprived quintile. c Distribution of ethnicity by IMD quintile.
Source publication
Women of reproductive age are a group of particular concern with regards to vaccine uptake, related to their unique considerations of menstruation, fertility, and pregnancy. To obtain vaccine uptake data specific to this group, we obtained vaccine surveillance data from the Office for National Statistics, linked with COVID-19 vaccination status fro...
Context in source publication
Context 1
... 4a-c demonstrates graphically that among women of reproductive age (regardless of vaccination), across strata of each of age, ethnicity, and IMD, any two of these three characteristics were not evenly distributed across the third. This was particularly true for ethnicity across IMD quintiles (Fig. 4c). When the independent impact on any vaccination uptake (i.e., at least one dose) vs. no vaccination, of each of age, ethnicity, and IMD were considered in multivariable analyses, adjusting for vaccination programme week, any vaccine uptake of at least one dose was most likely in women aged 40-49 years and those in IMD centile 5, and ...
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Citations
... Outcome disparities are not due simply to biological or social health factors inherited by ethnic minority women, but also to poor quality and unsafe care, and sometimes, mismanagement [2,3]. These disparities were magnified during the pandemic, as the SARS-CoV-2 virus disproportionately affected those in Black, Asian, and Minority Ethnic groups [7], who were also less likely have been vaccinated against COVID-19 [8][9][10]. ...
Background
Persistent, high rates of maternal mortality amongst ethnic minorities is one of the UK’s starkest examples of racial disparity. With greater risks of adverse outcomes during maternity care, ethnic minority women are subjected to embedded, structural and systemic discrimination throughout the healthcare service.
Methods
Fourteen semi-structured interviews were undertaken with minority ethnic women who had recent experience of UK maternity care. Data pertaining to ethnicity and race were subject to iterative, inductive coding, and constant comparison through Grounded Theory Analysis to test a previously established theory: The ‘Imperfect Mosaic’.
Analysis & findings
A related theory emerged, comprising four themes: ‘Stopping Short of Agentic Birth’; ‘Silenced and Stigmatised through Tick-Box Care’; ‘Anticipating Discrimination and the Need for Advocacy’; and ‘Navigating Cultural Differences’. The new theory: Inside the ‘Imperfect Mosaic’, demonstrates experiences of those who received maternity care which directly mirrors experiences of those who provide care, as seen in the previous theory we set-out to test. However, the current theory is based on more traditional and familiar notions of racial discrimination, rather than the nuanced, subtleties of socio-demographic-based micro-aggressions experienced by healthcare professionals.
Conclusions
Our findings suggest the need for the following actions: Prioritisation of bodily autonomy and agency in perinatal physical and mental healthcare; expand awareness of social and cultural issues (i.e., moral injury; cultural safety) within the NHS; and undertake diversity training and support, and follow-up of translation of the training into practice, across (maternal) health services.
Maternity care is a core service provision of any healthcare system, delivering care for women and birthing people, and their wider family units. During the SARS-CoV-2 pandemic, much of maternity care service provision was reconfigured with the aim of continuing care provision which could not otherwise be re-scheduled or delayed, but in-line with infection control measures instituted through social and physical distancing. The RESILIENT Study was designed to investigate the impact of the COVID-19 pandemic and pandemic-related reconfigurations to maternity care service delivery. It is particularly concerned with the experiences of minority ethnic groups and those with social or medical complexity. One of our specific objectives was to investigate the experiences of maternity care during the pandemic from the perspective of women and birthing people; fathers, partners, and non-gestational parents; healthcare professionals; and policy makers through the use of in-depth interviews. We will analyse data on virtual care, self-monitoring, and vaccination (each using thematic framework analysis); care-seeking and care experience (using template analysis); and on building an ethical future of maternity care (using grounded theory analysis). This is the focus of this protocol. Our findings about the experiences of care receipt, provision, and planning during the pandemic will complement existing literature and our impact will be broad, on: individual patients, NHS maternity providers, NHS policies, and wider society.
