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Deprived women 60% less likely to have any antenatal care

Maternal public health education should better target poorer women

Louise Prime

Thursday, 18 September 2014

Antenatal health care professionals and services in the UK should focus much more on socioeconomically deprived women because they are far less likely than better-off women to have any maternity care, as well as more likely to have negative pregnancy outcomes, say researchers from Oxford University.

To try to find out why socially disadvantaged women in the UK tend to have poorer maternal health outcomes, they compared how a sample of 5,332 women from different socioeconomic groups experienced and used maternity care in England, as well as comparing outcomes, and their study* is published in BJOG: An International Journal of Obstetrics and Gynaecology.

They found that women in the most deprived group (quintile 5) were 60% less likely than women in the least deprived group (quintile 1) to have received any antenatal care at all. For each quintile decrease in a woman’s socioeconomic position, there was a 25% reduction in her chance of having had any antenatal care; a 15% rise in her likelihood of having an unplanned than a planned caesarean section; a 15% drop in her chances of having a routine postnatal check up; a 4% higher risk of having an antenatal hospital admission; a 4% higher risk of caesarean birth; and a 7% increase in her risk of being transferred during labour.

More deprived women were also more likely to say that during antenatal care and labour they’d not been treated respectfully, or spoken to in a way they could understand, by doctors and midwives.

The study’s authors concluded: “This analysis suggests the need for a focusing of professionals and services towards pregnant women from lower socio-economic groups and more targeted maternal public health education towards socially disadvantaged women.”

One of the co-authors, Professor Marian Knight, from the National Perinatal Epidemiology Unit at the University of Oxford, said strategies would have to be carefully planned and developed to address the possible reasons for these differences in healthcare delivery and outcomes. She said: “The findings from our analysis suggest that several factors may collectively contribute towards poorer maternal outcomes amongst women from the lowest socioeconomic groups. These include unplanned pregnancy, no antenatal care or late engagement with antenatal services, transfer during labour, higher caesarean section rates and poorer communication with healthcare professionals.”

Parents’ charity NCT called for prioritisation of better care for those women who need it most. Its senior policy adviser Rosemary Dodds commented: “It’s extremely worrying to find that some of the most vulnerable women were more likely to find they couldn’t see a health professional as early as they wanted in their pregnancy or felt they were not treated with respect.

“Maternity services are under pressure with increasing birth rates and limited resources. However providing high quality antenatal care is crucial for expectant mothers. It can help them to cope better emotionally and may identify problems which could be treated. Improving continuity of carer for the most vulnerable women should be a priority to improve outcomes for mothers and babies.”

* Anthea Lindquist, et al. Experiences, utilisation and outcomes of maternity care in England among women from different socioeconomic groups: Findings from the 2010 National Maternity Survey. BJOG 2014; doi:10.1111/1471-0528.13059

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