MBRRACE-UK sets out key recommendations for improving the care of recent migrant women with language barriers whose babies have died

Published on Thursday, 12 December 2024 Post

The MBRRACE-UK collaboration, which is co-led by the TIMMS group at the University of Leicester and Oxford Population Health's National Perinatal Epidemiology Unit, has today published the results of a confidential enquiry into the care of recent migrant women with language barriers who have experienced a stillbirth or neonatal death.

Like many other high-income countries, the UK has seen a steady increase in migration. By 2022, 14% of the UK's population was born abroad and 4% are asylum seekers or refugees. This trend is also evident in maternity services. In 2022, nearly one in three live births in England and Wales were to women born outside of the UK. UK maternity services need to address the unique needs of migrant women, particularly those who may face additional obstacles to accessing care due to language barriers.

This enquiry looked at the care of 25 women who had arrived in the UK less than two years prior to giving birth and had a preferred language other than English, whose babies died before, during, and shortly after birth. The aim of this enquiry was to review the quality of care and identify lessons to improve the care and outcomes for recently arrived migrant women facing language barriers, and their babies.

The care the babies and their mothers received was compared with care outlined by national guidelines for best practice, assessed by a group of clinical experts.

Key findings:

• One in 25 (4%) mother-baby pairs received care that was rated as 'good' with no improvements identified. 68% received care where improvements would have had an impact on the outcome. 28% received care where improvements would not have had an impact on the outcome;
• 96% of the women had a documented need for an interpreter but 73% of documented contacts with healthcare services took place without a professional interpreter from either an in-person interpreter or professional telephone interpreters. Half of the contacts took place without any interpreter;
• Language barriers significantly impacted recently arrived migrant women's access to maternity services, with challenges persisting from initially contacting maternity care providers through postnatal, bereavement, and follow-up care;
• Citizenship was not routinely or accurately recorded for all women and there was variation in the recording of social risk factors. Lack of coordination among healthcare providers led to missed opportunities for optimal care, particularly for women with existing risk factors, resulting in missed follow-up appointments and referrals.

The report has set out a series of key recommendations for clinicians and healthcare providers to address these findings and improve the care of recent migrant mothers who require language support and their babies. The recommendations centre around ensuring that the number of women who require language support is recorded systematically and using this information to implement quality improvement measures, ensuring that services support women in navigating the care system, supporting research to understand barriers and facilitators to maternity care, and developing provision for multiple routes of access to maternity care. The report advocates for piloting an initial assessment appointment for

migrant women of childbearing age to discuss their reproductive healthcare needs and provide information on the services that are available to them.

The report continues to recommend that healthcare providers ask all women about their nationality, ethnicity and language needs, and provide translated information and interpreters at every appointment if required.

Dr Ian Gallimore, Project Manager for MBRRACE-UK, said:

To improve maternity and neonatal outcomes for recently arrived migrant women who do not speak English, it is crucial to enhance the availability of professional interpreting services and targeted advocacy. The continued relevance of the recommendations from the previous perinatal confidential enquiry and the additional recommendations highlighted by this enquiry provide substantial support for improving access to maternity care.

The confidential enquiry report is published on the TIMMS website.

The Perinatal Mortality Review Tool (PMRT) collaboration has today published their sixth set of findings and recommendations for hospitals and care providers who carry out reviews of the care received by babies who died in pregnancy from 22 weeks' gestation onwards or died within 28 days of being born (perinatal deaths).