Inside the ‘imperfect mosaic’: Minority ethnic women’s qualitative experiences of race and ethnicity during pregnancy, childbirth, and maternity care in the United Kingdom

TY - JOUR

T1 - Inside the ‘imperfect mosaic’

T2 - Minority ethnic women’s qualitative experiences of race and ethnicity during pregnancy, childbirth, and maternity care in the United Kingdom

AU - Silverio, Sergio A.

AU - Varman, Nila

AU - Barry, Zenab

AU - Khazaezadeh, Nina

AU - Rajasingam, Daghni

AU - Magee, Laura

AU - Matthew, Jackie

N1 - Funding Information: This study was funded by The College of Radiographers Industry Partnership Scheme grant awarded to: JM, SAS, & colleagues (reference:-CBRHvaCoRIPS197). Funding Information: Sergio A. Silverio (King’s College London) is in receipt of a Personal Doctoral Fellowship from the National Institute for Health Research Applied Research Collaboration South London [NIHR ARC South London] Capacity Building Theme [ref:- NIHR-INF-2170]. Jacqueline Matthews (King’s College London) is in receipt of a Clinical Doctoral Research Fellowship from the NIHR [ref:- NIHR-300555]. Zenab Barry is supported by the NIHR ARC South London at King’s College Hospital NHS Foundation Trust. The Rep All Women Study was adopted by the NIHR ARC South London Maternity and Perinatal Mental Health Theme. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. All other authors declare they have no competing interests. Publisher Copyright: © 2023, The Author(s).

PY - 2023/12/21

Y1 - 2023/12/21

N2 - Background: Persistent, high rates of maternal mortality amongst ethnic minorities is one of the UK’s starkest examples of racial disparity. With greater risks of adverse outcomes during maternity care, ethnic minority women are subjected to embedded, structural and systemic discrimination throughout the healthcare service.Methods: Fourteen semi-structured interviews were undertaken with minority ethnic women who had recent experience of UK maternity care. Data pertaining to ethnicity and race were subject to iterative, inductive coding, and constant comparison through Grounded Theory Analysis to test a previously established theory: The ‘Imperfect Mosaic’. Analysis & Findings: A related theory emerged, comprising four themes: ‘Stopping Short of Agentic Birth’; ‘Silenced and Stigmatised through Tick-Box Care’; ‘Anticipating Discrimination and the Need for Advocacy’; and ‘Navigating Cultural Differences’. The new theory: Inside the ‘Imperfect Mosaic’, demonstrates experiences of those who received maternity care which directly mirrors experiences of those who provide care, as seen in the previous theory we set-out to test. However, the current theory is based on more traditional and familiar notions of racial discrimination, rather than the nuanced, subtleties of socio-demographic-based micro-aggressions experienced by healthcare professionals. Conclusions: Our findings suggest the need for the following actions: Prioritisation of bodily autonomy and agency in perinatal physical and mental healthcare; expand awareness of social and cultural issues (i.e., moral injury; cultural safety) within the NHS; and undertake diversity training and support, and follow-up of translation of the training into practice, across (maternal) health services.

AB - Background: Persistent, high rates of maternal mortality amongst ethnic minorities is one of the UK’s starkest examples of racial disparity. With greater risks of adverse outcomes during maternity care, ethnic minority women are subjected to embedded, structural and systemic discrimination throughout the healthcare service.Methods: Fourteen semi-structured interviews were undertaken with minority ethnic women who had recent experience of UK maternity care. Data pertaining to ethnicity and race were subject to iterative, inductive coding, and constant comparison through Grounded Theory Analysis to test a previously established theory: The ‘Imperfect Mosaic’. Analysis & Findings: A related theory emerged, comprising four themes: ‘Stopping Short of Agentic Birth’; ‘Silenced and Stigmatised through Tick-Box Care’; ‘Anticipating Discrimination and the Need for Advocacy’; and ‘Navigating Cultural Differences’. The new theory: Inside the ‘Imperfect Mosaic’, demonstrates experiences of those who received maternity care which directly mirrors experiences of those who provide care, as seen in the previous theory we set-out to test. However, the current theory is based on more traditional and familiar notions of racial discrimination, rather than the nuanced, subtleties of socio-demographic-based micro-aggressions experienced by healthcare professionals. Conclusions: Our findings suggest the need for the following actions: Prioritisation of bodily autonomy and agency in perinatal physical and mental healthcare; expand awareness of social and cultural issues (i.e., moral injury; cultural safety) within the NHS; and undertake diversity training and support, and follow-up of translation of the training into practice, across (maternal) health services.

KW - Race

KW - Ethnicity

KW - Equity

KW - Discrimination

KW - Maternity Care

KW - Obstetrics

KW - Midwifery

KW - Qualitative Research

KW - Interviews

KW - Grounded Theory

KW - The NHS

KW - Women

KW - Women's Health

KW - Empowerment

KW - Health Services Research

UR - http://www.scopus.com/inward/record.url?scp=85180170186&partnerID=8YFLogxK

U2 - 10.1186/s12889-023-17505-7

DO - 10.1186/s12889-023-17505-7

M3 - Article

SN - 1471-2458

VL - 23

JO - BMC Public Health

JF - BMC Public Health

IS - 1

M1 - 2555

ER -