Antenatal Support – Tackling Cultural Exclusion

Key Messages

In England and Wales, infant mortality rates differ significantly between ethnic groups.

The evidence suggests early antenatal consultation helps reduce avoidable infant death and poor infant (and maternal) health.

Encouraging women from vulnerable ethnic groups to attend antenatal sessions is an important part of the strategy to reduce infant mortality and improve infant health.

The Issue

The Minik Kardes Project in London seeks to improve the health of women from Turkish, Kurdish and Turkish Cypriot backgrounds. Women from these backgrounds often experience social isolation, domestic violence, mental health issues, unemployment, low income and a lack of confidence in parenting skills. However, they often do not receive the support they need from the system.

In the case of migrant women, this might partly be because they have precarious immigration status and do not want to make themselves known to the authorities or because they fear being charged for support.

Another common issue in relation to these women’s health is cultural differences between the women and the health care providers. The Minik Kardes Project gathered qualitative and quantitative data during antenatal sessions and 1 to 1 interviews with previous antenatal service users in order to understand these cultural barriers and evaluate a culturally sensitive approach to the provision of antenatal care.

Cultural Contexts

The study found a number of barriers to accessing services:

  • Linguistic barriers which can inhibit women from accessing antenatal education and diagnostic facilities, imperative in ensuring antenatal well-being – even though health services are obliged to providing interpreters.
  • Complex problems such as domestic violence.
  • Cultural constraints preventing women from attending classes (religious beliefs, family scripts and gender roles).
  • Mainstream NHS antenatal programmes not being flexible enough to meet the needs of participants with diverse backgrounds who might even have their own (often positive) ways of understanding and responding to pregnancy and childbirth.

Cultural and ethnic barriers create a gap between the women and health care providers. Despite known high ratios of domestic violence in the targeted group, disclosure rates are low. Women experiencing domestic violence during their pregnancy often do not have the confidence to disclose it or find the assessment process insufficient to help make informed decisions.

Similarly, postnatal depression within the target community is high, but may be ignored and unacknowledged as seeking help from mental health organisations can be perceived as an embarrassment.

Policy Implications

Given the vulnerabilities uncovered by the study, it could be anticipated that the women’s experience would be relevant to policy areas including:

  • Health inequalities
  • Perinatal mental health
  • Maternal stress and foetal brain development
  • Breastfeeding

NICE guidance on “service provision for pregnant women with complex social factors” recognises that “Pregnant women who are recent migrants… or have difficulty reading or speaking English, may not make full use of antenatal care services”. It recommends using a variety of means to communicate with women, and that health professionals should undertake training in the specific needs of women in these groups.

Despite the NICE guidance, several NHS Trusts are replacing face-to-face antenatal classes with “virtual classes” delivered on-line. Furthermore, there are at least nine areas in England, and one in Wales, where NHS antenatal classes have been cut or “temporarily suspended”.

The NICE guidance also recommends that women who experience domestic abuse should be supported in their use of antenatal care services by making available information and support tailored to women, and providing more flexible appointments.

Similarly, the Minik Kardes study recommends that all health staff receive domestic violence awareness training and that every single pregnant woman receive information on domestic violence. The study further recommends that antenatal sessions should be delivered in partnership with culturally sensitive community organisations and carried out in the mother-tongue of the women involved.

Links for further reading

  1. Bozkurt, D. (2015) Turkish Speaking Women’s Feedback on NHS Antenatal Services Minik Kardes Children’s Centre, London.
  2. Childhood mortality in England and Wales: 2015, Office for National Statistics, 2017.