Project20: Maternity care mechanisms that improve (or exacerbate) health inequalities. A realist evaluation.

Rayment-Jones, H; Harris, J; Harden, A; Turienzo, CF; Sandall, J

Project20: Maternity care mechanisms that improve (or exacerbate) health inequalities. A realist evaluation.

Rayment-Jones, H Harris, J Harden, A Turienzo, CF Sandall, J

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Publisher:: Elsevier BV
Publication Type:: Journal Article
Citation:: Women Birth, 2022, pp. S1871-5192(22)00352-3
Issue Date:: 2022-11-25

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Field	Value	Language
dc.contributor.author	Rayment-Jones, H
dc.contributor.author	Harris, J
dc.contributor.author	Harden, A
dc.contributor.author	Turienzo, CF
dc.contributor.author	Sandall, J https://orcid.org/0000-0003-2000-743X
dc.date.accessioned	2023-02-21T22:13:05Z
dc.date.available	2022-11-14
dc.date.available	2023-02-21T22:13:05Z
dc.date.issued	2022-11-25
dc.identifier.citation	Women Birth, 2022, pp. S1871-5192(22)00352-3
dc.identifier.issn	1871-5192
dc.identifier.issn	1878-1799
dc.identifier.uri	http://hdl.handle.net/10453/166295
dc.description.abstract	BACKGROUND: Women with low socioeconomic status and social risk factors are at a disproportionate risk of poor birth outcomes and experiences of maternity care. Specialist models of maternity care that offer continuity are known to improve outcomes but underlying mechanisms are not well understood. AIM: To evaluate two UK specialist models of care that provide continuity to women with social risk factors and identify specific mechanisms that reduce, or exacerbate, health inequalities. METHODS: Realist informed interviews were undertaken throughout pregnancy and the postnatal period with 20 women with social risk factors who experienced a specialist model of care. FINDINGS: Experiences of stigma, discrimination and paternalistic care were reported when women were not in the presence of a known midwife during care episodes. Practical and emotional support, and evidence-based information offered by a known midwife improved disclosure of social risk factors, eased perceptions of surveillance and enabled active participation. Continuity of care offered reduced women's anxiety, enabled the development of a supportive network and improved women's ability to seek timely help. Women described how specialist model midwives knew their medical and social history and how this improved safety. Care set in the community by a team of six known midwives appeared to enhance these benefits. CONCLUSION: The identification of specific maternity care mechanisms supports current policy initiatives to scale up continuity models and will be useful in future evaluation of services for marginalised groups. However, the specialist models of care cannot overcome all inequalities without improvements in the maternity system as a whole.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	Elsevier BV
dc.relation.ispartof	Women Birth
dc.relation.isbasedon	10.1016/j.wombi.2022.11.006
dc.rights	info:eu-repo/semantics/openAccess
dc.subject	11 Medical and Health Sciences
dc.subject.classification	Obstetrics & Reproductive Medicine
dc.title	Project20: Maternity care mechanisms that improve (or exacerbate) health inequalities. A realist evaluation.
dc.type	Journal Article
utslib.location.activity	Netherlands
utslib.for	11 Medical and Health Sciences
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/Midwifery
utslib.copyright.status	open_access	*
dc.date.updated	2023-02-21T22:13:03Z
pubs.publication-status	Published online

Abstract:

BACKGROUND: Women with low socioeconomic status and social risk factors are at a disproportionate risk of poor birth outcomes and experiences of maternity care. Specialist models of maternity care that offer continuity are known to improve outcomes but underlying mechanisms are not well understood. AIM: To evaluate two UK specialist models of care that provide continuity to women with social risk factors and identify specific mechanisms that reduce, or exacerbate, health inequalities. METHODS: Realist informed interviews were undertaken throughout pregnancy and the postnatal period with 20 women with social risk factors who experienced a specialist model of care. FINDINGS: Experiences of stigma, discrimination and paternalistic care were reported when women were not in the presence of a known midwife during care episodes. Practical and emotional support, and evidence-based information offered by a known midwife improved disclosure of social risk factors, eased perceptions of surveillance and enabled active participation. Continuity of care offered reduced women's anxiety, enabled the development of a supportive network and improved women's ability to seek timely help. Women described how specialist model midwives knew their medical and social history and how this improved safety. Care set in the community by a team of six known midwives appeared to enhance these benefits. CONCLUSION: The identification of specific maternity care mechanisms supports current policy initiatives to scale up continuity models and will be useful in future evaluation of services for marginalised groups. However, the specialist models of care cannot overcome all inequalities without improvements in the maternity system as a whole.

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http://hdl.handle.net/10453/166295