The impact of COVID-19 on service provision and maternal and neonatal outcomes: through the lens of inequalities Royal College of Obstetricians and Gynaecologists

There are significant inequalities in maternity care and outcomes in England. Black women are five times and Asian women are three times more likely to die than white women during pregnancy, birth and the postpartum period. 

During the COVID-19 pandemic, there were substantial shifts in the way that maternity care was delivered. This research project looked at how these changes affected inequalities of outcomes and care for women and babies of different ethnicities across England. 

The researchers used routinely collected data and showed that adverse perinatal outcomes with a focus on pre-term birth decreased during the first lockdown, however, the inequality gap remained unchanged. This highlights that even when outcomes improve, there is a need for focused interventions to ensure equity in outcomes. 

The research also identified NHS trusts (‘positive deviant’ trusts) that had demonstrated a substantial reduction in adverse maternal and perinatal outcomes, and where changes in practice during the pandemic narrowed existing gaps in outcomes between women from different ethnic groups. 

Discussions with staff and user representatives from these positive deviant trusts highlighted that the teams at these trusts had high levels of proactivity, specialist knowledge and had better communication with pregnant women through flexible telephone appointments. Staff also described increased multidisciplinary team working and an increase in staffing expertise in the first lockdown, as staff were redeployed from elective services that had been paused. This surplus in senior staff was used productively to help assess risk or provide broader support to teams. 

In subsequent waves of the pandemic, it was highlighted that staffing became a challenge, possibly due to increasing sickness and burnout. This is also reflected in the research, which showed that the initial reduction in inequalities stopped further on into the pandemic.

Research has shown that a higher percentage of women from ethnic minority groups have complex pregnancies. The positive deviant trusts responded better to complex pregnancies at the start of the pandemic, thus demonstrating that given proactivity and the right resources, health care inequalities can be reduced.

Findings from the project have been widely disseminated, including via events, meetings and conferences, and peer-reviewed publications.

Contact

For more information about this project, please contact Stamatina Iliodromiti, Professor of Obstetrics and Gynaecology, Queen Mary University of London.