Inequalities in maternity services in West Birmingham

An investigation by Healthwatch Birmingham into maternity services in West Birmingham reveals some of the barriers encountered by Black African and Black Caribbean women during antenatal care, labour and birth, and postnatal care.

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26 women from Black African and Black Caribbean backgrounds told us about variability and inequality in maternity services in West Birmingham. These experiences included:

• Lack of continuity of carer leading to anxiety and inability to discuss issues such as mental health.
• Failure to be referred to midwives by their GP, which delayed screening and scans.
• Poor staff attitudes and behaviour.
• Lack of access to interpreters or translators.
• Not feeling they had real choice around where to give birth, and what type of birth to have.

Positive feedback included:

• Good communication and information about services and how to access support in between appointments.
• High quality of antenatal classes.
• Staff that support women with compassion and empathy.

Women also told us about changes they would like to see to maternity services in West Birmingham, such as:

• Better access to information and improving the information shared with women.
• Ensuring continuity of carer for all women.
• Taking action to address structural and interpersonal discrimination, bias and racism.
• Improving support for women with underlying conditions or comorbidities and other concerns.
• Making maternity care personal and individualised.

In response to our findings, Sandwell and West Birmingham Hospitals NHS Trust (SWBH) have committed to improvements including:

• Enhancing its interpreting service.
• Extensive community engagement and training voluntary sector organisations to support families’ access to maternity services.
• Ensuring that the Trust’s workforce is equipped to provide culturally competent care.

Commenting on the findings, report author Dr. Chipiliro Kalebe-Nyamongo (Policy and Research Manager at Healthwatch Birmingham) said:

‘The importance of effective communication and care centred around individual needs is a consistent message from the women who bravely shared their experiences with us. It is essential that services both explain every stage of the maternity care journey and listen to the concerns of all women in their care. This includes tackling language barriers through ensuring access to interpreters if necessary, as well as ensuring that all women are treated with equal respect.

It is also deeply worrying that many women had experienced discrimination from staff. Addressing these issues through improved staff training must be a top priority for SWBH, and Healthwatch Birmingham will be holding the Trust accountable for delivering significant change.

We must remember that problems with maternity services affect not just the women using them. People from Black African and Black Caribbean backgrounds face significant health inequalities, and barriers to accessing good maternity care means these inequalities can begin before children are even born.’