Understanding the relationship between social determinants of health and maternal mortality

A new Scientific Impact Paper (SIP) has been published today which aims to inform those involved in the care of pregnant women in the UK about the relationship between social determinants of health and the risk of maternal death.

Understanding the Relationship Between Social Determinants of Health and Maternal Mortality was commissioned by the RCOG, with research led by Leeds Beckett University in collaboration with the University of Sheffield and the University of Oxford.

A number of recommendations have been made in the SIP including:

• Understanding it is the vulnerable, minoritised and disadvantaged women in society that have an increased risk of maternal death. These women are often living in an entangled web of complex inequalities that is beyond their control, which impacts on the care they receive and the outcomes of that care.
• Strategies and care pathways need to be identified and put in place to improve their situation. These women have been let down in the way that our maternity and reproductive health services are currently delivered.
• We need to find a better way of recording social determinant data. The current way of doing this is inadequate and not fit for purpose, and it doesn’t provide us with enough information to really understand how the complex circumstances of the woman impacts on her maternal outcomes.
• The research shows current models of care are still failing pregnant women who have lived in adverse social circumstances prior to, during and after pregnancy. Maternal outcomes are particularly poor for socially disadvantaged women affected by pre-existing physical or mental health problems; those who misuse substances; those who have a lower level of education; those who are overweight, undernourished or poorly sheltered; and those who are at increased risk due to the threat of abusive and unsupportive partners, families and peers.

The recommendations are aimed at helping prevent disadvantaged and vulnerable women dying during and after pregnancy.

Professor Georgina Jones, Professor of Health Psychology in the School of Social Sciences at Leeds Beckett University and lead author of the SIP, said:

“I hope our findings play an important role in reinforcing the message that more needs to be done to improve access to better care and support for those living in adverse and complex social situations.

“The pandemic has raised public awareness about the ways in which health inequalities can adversely affect health outcomes. This is the message at the heart of our paper as well. We are highlighting that adverse social determinants of health affect maternal clinical outcomes, leading to an increased risk of maternal mortality and morbidity. Despite the provision of free reproductive and maternity services, the women who need the most care, because they are at highest risk, often have the poorest access to care and this needs to change. I hope the extensive recommendations that we have made in this SIP will help facilitate this change more quickly.”

Dr Edward Morris, President of the RCOG said:

"This paper further sheds light on the stark reality that poverty, racism and discrimination can affect women throughout their lives and ultimately lead to devastating maternal outcomes.

“These disparities are something we as healthcare leaders have a duty to address.

“All women should have equal access to high-quality antenatal care and support, regardless of their background. Particularly vulnerable pregnant women in the UK such as migrant women who face a myriad of barriers including accessing information in their language, concerns over their immigration status and affording to travel to appointments.

“The RCOG’s Race Equality Taskforce was set up to prioritise women and their babies, and to tackle the inequalities that exist. It is vital that research looks at disparities for Black, Asian, and minority ethnic women across the health systems to better understand existing inequalities, symptoms and causes in the UK. Ultimately, a better understanding of this complex and multi-dimensional issue will help determine robust solutions to combat persisting health disparities in the NHS.”

ENDS

For media enquiries, please contact the RCOG press office on +44 (0)7740 175342 or email pressoffice@rcog.org.uk

Notes to editor

To read the full SIP visit: https://www.rcog.org.uk/sip67