26 Jan 2022

There remains a five-fold difference in maternal mortality rates among women from Black African/Caribbean ethnic backgrounds and almost two-fold difference among women from South Asian (particularly Pakistanis and Bangladeshis) ethnic backgrounds compared to White women (Knight et al, 2019). These inequalities have only been exacerbated by the Covid-19 pandemic and therefore we will potentially see worsening inequalities in maternal health for years to come.

Why this research is needed

There is evidence that the prevalence of maternal mortality, morbidity and co-morbidity is not being reduced and risk factors such as deprivation and racism play a large part in this. Long-term conditions (LTCs) such as poor mental health, diabetes and heart disease are risk factors for developing further LTCs and managing these well is key to prevent the development of multiple long-term conditions (mLTCs). It is well known that age increases the chance of being affected by mLTCs, but people that live in deprived areas, lower socio-economic groups and Black and minority ethnic groups are more likely to be affected earlier in their lives than their white counterparts.

In South East London the accumulation of multiple long-term conditions is both more prevalent and starts earlier in life among its ethnic minority groups, who also experience discrimination and inequalities throughout their lives. Racial discrimination is associated with high rates of common mental health conditions, particularly in the city’s Black ethnic groups, and poor mental health is associated with mLTCs such as diabetes and hypertension. This study therefore focuses on the postnatal period to explore the experience of mental health conditions among Black Caribbean and Black African women in Lambeth, and through life history interviews places these experiences in the context of the lifecourse to interrogate the interconnections between health, racism and other factors.

 

Study aims

The aim of the study is to understand how multiple inequalities over the lifecourse shape postnatal mental health and the accumulation of mLTCs among Black Caribbean and Black African women in Lambeth.

Objectives:

1.To interrogate how has racism and racialisation have shaped women’s experience of health and healthcare over their lives.

2. To explore how the experience of inequalities inform how women experience current postnatal mental health conditions, multimorbidity and related healthcare.

3. To use the understanding of life histories and of the key transitional life stage of parenthood to inform the development of early interventions to prevent the transition to mLTC.

How the research will be carried out

The research team will use qualitative life history interviews with up to 40 Black Caribbean and Black African women who have had a baby within a year of the interview, to explore how racism and racialisation have shaped women’s relationship with the health and other social services, how this affects their experience of mental health and care during the postnatal period, and what can be done during this life-stage to prevent the accumulation of ill-health and disadvantage.

Women living in areas of deprivation, who have greater vulnerability to mLTC, will be recruited for interviews rather than focusing solely on recruiting women who have a diagnosis of a ‘mental health disorder’. These women will be recruited through community midwifery teams at Guy’s and St Thomas’ NHS Foundation Trust and through community-based organisations.

How patients and the public are involved in the research

Patients and the public informed the development of the research proposal; the topic and study design was discussed with an informal advisory group which included members of a perinatal mental health charity based in south London, health Visitors, and local public health professionals.

A formal  patient and public involvement and engagment (PPIE) group meeting will be held three times over the course of the research. There will also be a feedback forum, to which people from wider networks will be invited.

Other stakeholders will be invited to reflect the purporse of the research including the ARC’s maternity and perinatal mental health PPIE group. Andrew Eyres, strategic director for Integrated Health and Care at Lambeth Council and Dr Di Aitken, governing body GP clinical lead and lead in Lambeth on equalities and on quality/clinical effectiveness have agreed to form part of the PPI group. In addition, the research team have connections with maternity and postnatal health charities such as Melodies for Mums and 5XMore.

Potential benefits of the project

This research will be used to inform the development of intervention strategies that engage with the underlying causes of mLTC disparities; to support women from a very early stage to prevent the accumulation of ill health and disadvantage. For example, it will identify particular risks that could be used to identify vulnerable women in primary health care records for early management within the health and social care services. Beyond the health service the research may identify supportive informal care practices in communities which could be built upon e.g. in faith groups – or specific issues at specific life stages that could be supported e.g. financial help with transport costs to attend appointments.

More broadly, the research will contribute to the evidence base on the prevention of the intergenerational cycles of health disparities nationally and the research team will produce summaries relevant to Public Health in Lambeth and Southwark and via bodies such as the new NHS Race & Health Observatory and the NHS England Policy team on inequalities.

The research is funded by King’s Health Partners and Guy’s and St Thomas’ Charity. It was adopted by ARC South London in January 2022 and will be completed by July 2023.