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Bohren and Bradfield make important points when considering inequality of outcomes in UK maternity care. Progress has been slow, but given the vast improvements we have seen in perinatal mental health in the last few years, we should remain optimistic that - with the right political will and appropriate investment - that improvements can be made.
Much has been made - rightly so - of the inequalities experienced by those of different racial backgrounds in not only the MBRRACE report referred to but also that of the National Child Mortality Database Reports which demonstrate that social, environmental and health differences result in infant vulnerabilities which affect outcomes right into childhood [1,2]
It is very likely that changes within the Department of Health made at the end of the last Government may have made it more challenging to address these inequalities.[3] One hopes that the current Government will begin to address these changes robustly.
There are two further important points to make:
Firstly, within the current context of concern for maternity services overall in the UK, following the Kirkup[3] and Ockenden[4] reports (and the ongoing enquiry in Nottingham), that the opportunity to address inequality should be made alongside other improvements to maternity services (and not get buried by the needs of the majority).
Secondly, the inequality experienced by mothers with associated substance use has so far been overlooked and needs to be addressed. The mention of substance use in pregnancy was completely absent from the recent UK Black report, for example.[5] In the words of Bohren and Bradfield: "Humanisation of care occurs when a person’s priorities and needs are understood and prioritised throughout their care experiences. This typically best occurs through trusting relationships with known care providers who provide continuity of care throughout the perinatal period."
The issue of substance use and pregnancy is much misunderstood by both professionals and the public. These mothers all have 'their own story' to tell, and require understanding, and the right support - not judgement. To do that requires multi-disciplinary, multi agency services that can work together flexibly and well to respond to their needs.
For it is only by actions such as these that we can begin to improve things for the next generation, and 'break the cycle'. Let's start by helping mothers to do this - it's what mothers want, it's what midwives and other healthcare professionals want - and it's what our society needs,
Re: Need to consider mothers with associated substance use when addressing inequality in maternity services
Dear Editor,
Bohren and Bradfield make important points when considering inequality of outcomes in UK maternity care. Progress has been slow, but given the vast improvements we have seen in perinatal mental health in the last few years, we should remain optimistic that - with the right political will and appropriate investment - that improvements can be made.
Much has been made - rightly so - of the inequalities experienced by those of different racial backgrounds in not only the MBRRACE report referred to but also that of the National Child Mortality Database Reports which demonstrate that social, environmental and health differences result in infant vulnerabilities which affect outcomes right into childhood [1,2]
It is very likely that changes within the Department of Health made at the end of the last Government may have made it more challenging to address these inequalities.[3] One hopes that the current Government will begin to address these changes robustly.
There are two further important points to make:
Firstly, within the current context of concern for maternity services overall in the UK, following the Kirkup[3] and Ockenden[4] reports (and the ongoing enquiry in Nottingham), that the opportunity to address inequality should be made alongside other improvements to maternity services (and not get buried by the needs of the majority).
Secondly, the inequality experienced by mothers with associated substance use has so far been overlooked and needs to be addressed. The mention of substance use in pregnancy was completely absent from the recent UK Black report, for example.[5] In the words of Bohren and Bradfield: "Humanisation of care occurs when a person’s priorities and needs are understood and prioritised throughout their care experiences. This typically best occurs through trusting relationships with known care providers who provide continuity of care throughout the perinatal period."
The issue of substance use and pregnancy is much misunderstood by both professionals and the public. These mothers all have 'their own story' to tell, and require understanding, and the right support - not judgement. To do that requires multi-disciplinary, multi agency services that can work together flexibly and well to respond to their needs.
For it is only by actions such as these that we can begin to improve things for the next generation, and 'break the cycle'. Let's start by helping mothers to do this - it's what mothers want, it's what midwives and other healthcare professionals want - and it's what our society needs,
1. https://www.ncmd.info/wp-content/uploads/2023/11/A-thematic-review-of-vu...
2. Odd DE, Stoianova S, Williams T, et al. Race and Ethnicity, Deprivation, and Infant Mortality in England, 2019-2022. JAMA Netw Open. 2024;7(2):e2355403. doi:10.1001/jamanetworkopen.2023.55403
3. Mahase E. OHID: Cuts to disparities office could worsen health inequalities, doctors warn BMJ 2024; 384 :q378 doi:10.1136/bmj.q378
3. https://www.gov.uk/government/publications/maternity-and-neonatal-servic...
4. https://www.gov.uk/government/publications/final-report-of-the-ockenden-...
5. https://www.gov.uk/government/collections/independent-review-of-drugs-by...
Competing interests: No competing interests