Ethnic and social inequalities in women's experience of maternity care in England: results of a national survey

Abstract

Summary Objective To examine ethnic and social inequalities in women's experience of maternity care in England. Design A 2007 national survey of women (16 years or over) about their experience of maternity care. Multiple logistic regression analysis, controlling for several maternal characteristics, was used to examine inequalities by ethnicity, partner status and education. Setting Sample of records of 149 NHS acute trusts and two primary care trusts (PCTs) providing maternity services in England. Results A total of 26,325 women responded to the survey (response rate 59%). Ethnic minority women were more likely than White British women to access services late, not have a scan by 20 weeks, and experience complications during pregnancy and birth. They were more likely to initiate breastfeeding and say they were treated with respect and dignity. Single women responded more negatively to almost all questions than women with a husband/partner. They were less likely to access care within 12 weeks of pregnancy (OR 0.45, 95% CI 0.39–0.52), have a scan at 20 weeks (OR 0.49, 95% CI 0.39–0.63), attend NHS antenatal classes (OR 0.56, 95% CI 0.49–0.65), have a postnatal check-up (OR 0.67, 95% CI 0.60–0.75), and initiate breastfeeding (OR 0.57, 95% CI 0.51–0.62), and were more likely to experience complications. Women completing education at 19+ years were more likely to access services early (OR 1.21, 95% CI 1.04–1.40), attend antenatal classes (OR 1.48, 95% CI 1.31–1.67), have a postnatal check-up (OR 1.19, 95% CI 1.07–1.32) and initiate breastfeeding (OR 3.88, 95% CI 3.56–4.22) than those completing education at 16 years or younger, and were less likely to experience complications. Conclusions Ethnic minority women, single mothers, and those with an earlier age at completing education access maternity services late, have poorer outcomes, and report poorer experiences across some – though not all – dimensions of maternity care. Ethnic differences were absent or inconsistent between groups for some aspects of care. We recommend these findings are used by commissioners, trusts and healthcare professionals to inform improvements in maternity services for high-risk groups and reduce inequalities.