Background to the study

Delayed or reduced used of perinatal care services such as antenatal care, such as vaccinations during pregnancy results in poorer outcomes for both mother and baby. Research shows that pregnant women from underserved groups (minority ethnic backgrounds, socio-economically disadvantaged areas, young mothers, and those with complex social lives) are less likely to use perinatal care. These groups are also at higher risk of poorer outcomes and complications in pregnancy.

The decision to seek and actively engage in care is a complex phenomenon, dependent not simply on the availability of knowledge, but rather on various social, cultural, and contextual factors, for example, trust in healthcare providers, narratives in social media. With rapid reconfiguration of services and mixed messaging, the Covid-19 pandemic has made it even harder for women from these underserved groups to navigate the complex NHS care structure, and to receive care.       



Pregnant woman stomach

Project aims

The aim of the project is to understand how a health system shock such as the Covid-19 pandemic impacts women seeking care, demonstrated by pregnant women from underserved groups in a diverse, inner-city population of south London. The specific objectives are:

  1. Use routinely-collected clinical data to quantify differences in delayed or reduced care seeking behaviour between different underserved groups;
  2. Explore how broader lifecourse social and environmental factors influence differences in care seeking behaviour of pregnant women during a health system shock;
  3. To understand women’s embeddedness and engagement with health systems and social structures, and to contribute to policy development to improve care seeking behaviour.

How this research will be carried out?

This project will use a mixed methods design and will comprise the following components:

1. A systematic literature review to consolidate and synthesise existing literature on care-seeking behaviour, specifically facilitators and barriers to women identifying themselves as viable candidates to seek care.

2. Quantitative analysis using the eLIXIR, Born in South London database to investigate comparative rates of use between different groups, in pre- during- and para-pandemic periods. The database contains linked, routinely collected maternal and neonatal health records, primary care data, and socio-demographic information from women giving birth at two acute NHS hospitals in south London and is representative of the local population.

3. Qualitative exploration using participatory appraisal activities and in-depth interviews to elaborate on statistical findings. In this component, the project aims to explore in detail, women's experiences with seeking care, nuanced social and cultural factors that impact their decision making, and changes that needs to be made to increase uptake and use.

How will patients and the public be involved?

This project will benefit from strong links to the project specific patient and public involvement and engagement (PPIE) groups of the eLIXIR study and the ARC South London adopted RESILIENT study, both of which comprises women from underserved groups who have given birth in south London, have lived experience of accessing complex care during pregnancy, and are passionate about supporting research in maternal health inequalities. The project will be presented to these groups at regular intervals to help guide the research process and ensure relevance of the methods and results. Additionally, selected patients and the public will be involved in co-production of research in the qualitative component of this project, through participatory appraisal methods.

Potential benefits of the study

The findings of this project will be used to better target interventions and to develop a more patient-centred and culturally-competent service, for pregnant women from underserved groups who we know are at risk of poorer health outcomes, and thereby reduce the health inequality gap. By actively engaging with the community, this project hopes to critically examine and shift the narrative on social and racial inequality in healthcare and help us to envision a better future for maternity services in a diverse inner-city population.

This project is funded by Tisha Dasgupta’s Doctoral training grant from the Economic and Social Science Research Council and the London Interdisciplinary Social Science Doctoral Training Partnership [ES/P00703/1]. It was adopted by ARC South London in February 2023 and will be completed by September 2028.