Intended for healthcare professionals

Rapid response to:

Practice Guidelines

Ectopic pregnancy and miscarriage: summary of NICE guidance

BMJ 2012; 345 doi: https://doi.org/10.1136/bmj.e8136 (Published 12 December 2012) Cite this as: BMJ 2012;345:e8136

Rapid Response:

Re: Ectopic pregnancy and miscarriage: summary of NICE guidance

As Newbatt and colleagues identity, women from minority ethnic groups account for half of maternal deaths from ectopic pregnancy in the UK. Most if not all of these deaths are avoidable. More difficult to quantify is the significant number of women who suffer severe maternal morbidity and emotional distress as a result of ectopic pregnancy and other complications in early pregnancy. Tailoring maternity and primary care systems to address the needs of minority ethnic groups, including women of refugee backgrounds, is critical to saving mothers lives and ‘closing the gap’ in maternal health outcomes.

Two challenges identified by Newbatt and colleagues are women accessing care late, and communication difficulties between families and care providers. We are currently undertaking research with Afghan families (both women and men) of refugee background living in Melbourne, Australia exploring their experiences of having a baby in new country. Afghan men and women consistently identify lack of information in an easily understandable and accessible format as a barrier to help seeking and decision-making. Reasons for late attendance at antenatal care include not being aware of available services, and being unfamiliar with the concept and purpose of pregnancy care. Poor literacy in their own language and limited health literacy have multi-faceted impacts on knowing what to expect in pregnancy, what to expect from care, and when and how to access help. Most Afghan women and men reported accessing health information from family and friends, even if this meant contacting family members that remained overseas.

Very few Afghan women had interpreting support in pregnancy with reliance on husbands as interpreters. Afghan men traditionally play little part in their partner’s pregnancy care. However, in the absence of female relatives to accompany women to appointments, the likelihood that their English is a little better than that of their wives, and often as the providers of transport, men often attended antenatal care appointments. Whilst there were also reports of positive encounters with professional interpreters, women reported a reluctance to trust interpreters who spoke a different dialect to their own, were male, or likely to be known within the community. Confidentiality and the maintenance of dignity are important to all women, but especially important in the context of the refugee experience. What women want is for care providers to show interest in them and their family, including their cultural and religious practices; to be given information in a format that they can understand; and encouragement and opportunity to ask questions.

The NICE guidance on the management of early pregnancy loss is but a first step in tackling health inequalities. Listening and learning from the experiences of marginalised women and their families, those who rarely have a voice in the health system, is the next. Acting to overcome the specific barriers to supporting women through pregnancy care requires a skilled, culturally competent work force together with a health system that has capacity to address the specific support and information needs of culturally and linguistically diverse communities. Unless care is responsive to culture, communication challenges and social complexity, pregnancy outcomes for women from minority ethnic groups will see little improvement.

Dr Jane Yelland
Research Fellow
Healthy Mothers Healthy Families Research Group
Murdoch Childrens Research Institute
Victoria, Australia

Dr Elisha Riggs
Senior Research Officer
Healthy Mothers Healthy Families Research Group
Murdoch Childrens Research Institute
Victoria, Australia

Mr Josef Szwarc
Manager
Research & Policy
Victorian Foundation for Survivors of Torture
Victoria, Australia

Ms Fatema Fouladi
Bicultural Community Researcher
Healthy Mothers Healthy Families Research Group
Murdoch Childrens Research Institute
Victoria, Australia

A/Prof Stephanie Brown
Group Leader & Principal Research Fellow
Healthy Mothers Healthy Families Research Group
Murdoch Childrens Research Institute
Victoria, Australia

Competing interests: No competing interests

20 December 2012
Jane S Yelland
Research Fellow
Elisha Riggs, Josef Szwarc, Fatema Fouladi, Stephanie Brown
Murdoch Childrens Research Institute
Royal Children's Hospital, Flemington Road, Parkville 3052 Victoria, Australia