ealth inequality audit: improving access to maternity services for reduced fetal movements
Background
UK Stillbirth rates increased from 3.9 per 1000 births in 2020 to 4.2 in 2021
Health inequity contributes to stillbirth rates
Black African women from the most deprived areas have the highest stillbirth rate of 8 per 1000 births
Other risk factors include deprivation, Afro-Caribbean or Indian ethnicity even after adjustment for other socioeconomic factors
43% of stillbirths in the covid pandemic occurred in women with a first language other than English
West Yorkshire had the highest stillbirth rate in the UK in 20215
Reduced fetal movements (RFM) is associated with stillbirth even in low-risk women with only one episode.
Audit Aim
To identify groups of service users who are less likely to present with reduced fetal movements to Leeds Teaching Hospitals, to identify the target group of local interventions to prevent avoidable stillbirths.
Methods
Data extracted from digital maternity records from 1st of January 2019 – 31st December 2022
Patients with miscarriage or termination excluded.
Multiple logistic regression used to examine effect of demographic variables on likelihood of presenting with RFM
Results
32006 total attendances for RFM made by 15401 individual service users
Outcomes associated with lower likelihood of presenting with RFM (table 1):
Black African
Any Other White Background
English is not first language
Older age at booking
Increasing parity
No association with index of multiple deprivation (IMD) decile (table 1)
Increased likelihood of presenting with RFM amongst service users of Indian Asian, mixed White and Asian, and other Asian ethnicity (table 1)
Discussion
Findings are consistent with other published research on predictors for presentation with RFM 7,8
Focus groups are currently underway to understand service users' perspective
Physiological differences in ethnicity is not a recognised factor that reduces maternal awareness of fetal movements9
Unknown reasons for non-presentation with RFM may be exacerbated by racism within maternity services for service users of Black African ethnicity 10,11,12
Migrant service users face many structural and cultural barriers to care, including language and other competing needs 13
Research needed to understand maternity outcomes of service users “of any other white background”
6. Strengths & Limitations
Strengths of this audit include large audit population over long time period, examining outcomes not yet explored in this group of service users, and better understanding of target groups for interventions to widen healthcare access.
Ethnicity is a poor measure of race and cultural background, and patients may have been misclassified. Other confounding factors may account for the results. Digital maternity records may contain inaccuracies in demographic data.
