Aim
This review aimed to identify existing policy interventions designed to tackle ethnic health inequalities in maternal and neonatal health in England. The literature was mapped using a conceptual framework that incorporates maternal and neonatal patient pathways and identify areas amenable to intervention.
Key findings:
This review highlights the paucity of evidence on interventions aimed at reducing ethnic health inequalities in maternal and neonatal outcomes. The longstanding unexplained and unjustified racial disparities of Black, Asian and minority ethnic pregnant women, mothers, and babies require urgent attention. This review provides the evidence base for key actions in achieving equity for these population groups.
- Interventions published were not done so in a systematic approach in the quality of reporting and evaluation varied across the studies therefore making it difficult to compare and evaluate effectiveness at scale.
- Lack of detailed policy to tackle ethnic health inequalities.
- Ethnicity is not often recorded accurately.
- Interventions at organisational level targeting structural and institutionalised processes which perpetuate racism and ethnic inequalities are lacking.
- Limited specific interventions for Black African, Black Caribbean, Roma and Gypsy and mixed ethnic groups, migrants and refugees and asylum seekers
- Lack of population health-based interventions.
Recommendations:
For policy and practice
- An interactive portal on the NHS Improvement Maternity Transformation website for relevant teams and organisations to register their interventions from the feasibility/ pilot stage using an appropriate framework is urgently required to capture what is ongoing across different parts of the country. This will avoid duplication of efforts and allow examples of good practice to be spread across the entire maternal and neonatal health system
- Intervention reporting should follow the appropriate checklist (such as the TIDier framework) for improved quality of reporting. This will improve evidence-based policymaking and commissioning of services
- Evaluation of local interventions should be built into the design (such as adequate data recording), and targets should be specific, measurable, achievable, realistic, and time-bound.
- A consensus on baseline measures of risk factors for inequalities in adverse perinatal outcomes as agreed by the Maternal Medicine Networks should be adopted when designing and evaluating interventions. This will permit clear evidence of the effectiveness of interventions in the reduction of ethnic health inequalities if these data are collected and measured at baseline and during the evaluation of interventions.
- Detailed policy analysis is urgently required to ensure a specific policy targeted at reducing ethnic health inequalities is co-developed and rolled out to all stakeholders
- Ethnicity recording in health records should be improved and consistent.
For research
- Investment in research to reduce ethnic health inequalities in maternal and neonatal health is urgently required. Complex interventions that incorporate a patient’s socioeconomic context are urgently needed to move the focus away from the patient and towards the community where they live and the institutions they navigate in accessing care.
- Researchers seeking to address improvements in maternal and neonatal outcomes should conduct health inequality impact assessments.
- Researchers should be encouraged to publish negative findings of interventions.
- Interventions aimed at reducing ethnic health inequalities should clearly state this in the aims and objectives of the evaluation. When designing and evaluating interventions that may impact ethnic health inequalities, baseline data on ethnic health inequalities should be collected. This will permit clear evidence of the effectiveness of interventions in the reduction of ethnic health inequalities. Beyond the reduction of ethnic health inequalities, it is also important to assess if interventions do not worsen ethnic inequalities if any exist at baseline
- Taking an implementation science perspective could be valuable to bridge the “know-do gap” i.e. the gap between what we know through research and what is implemented. Implementation science aims to bridge this gap by getting evidencebased findings out into practice promptly.
- Interventions targeting institutional and interpersonal racism at the organisational level are urgently needed. Using Hassen and colleagues’ conceptual framework for strategies in developing and implementing anti-racism interventions, a multi-level, long-term approach going beyond one-off cultural competency training with buy-in from senior leadership with evaluation embedded is the first step.
- Co-production of interventions and research with women from ethnic minority groups, in particular Black African and Black Caribbean, Roma and Gypsy ethnic groups who are underrepresented in targeted interventions are required. These can include the adaption of known effective interventions such as the culturally adapted CBT for postnatal depression for South Asian women if feasibility results are replicated in the recently concluded multisite trial.
- Detailed policy analysis is urgently required to ensure a specific policy targeted at reducing ethnic health inequalities is co-developed and rolled out to all stakeholders.
- Where the data permits, disaggregated ethnic groups should be adopted using the 2021 ONS census classifications to understand if only certain ethnic groups benefit from evaluated interventions.
- Improving ethnicity reporting where the data permits with the use of appropriate language (such as the NHS Race and Health Observatory language principles) is needed for future studies to appreciate the different social and complex needs of these groups.
- Adjustment for appropriate confounding variables in quantitative research is vital to ensure robust findings.
- Evaluation of national policy-driven interventions from regions beyond London is needed to improve the generalisability of the findings to different populations.
- The recent ‘Family Hubs’ which will target 75 local authorities with high levels of deprivation can serve as a platform for population level interventions to improve preconception health by addressing structural level barriers such as access to services.1 It also provides a platform for linking up local maternity systems and the integrated care systems to target specific population needs.
