Rob Howard (Consultant in Public Health, Leicester City Council) and Dr Ruw Abeyratne (Director of Health Equality and Inclusion – University Hospitals of Leicester NHS Trust) will provide a verbal update on the progress being made to tackle inequalities in maternal mortality faced by Black and Asian women in the City.
Minutes:
Rob Howard (Consultant in Public Health, Leicester City Council) and Dr Ruw Abeyratne (Director of Health Equality and Inclusion – University Hospitals of Leicester NHS Trust) provided a verbal update on the progress being made to tackle inequalities in maternal mortality faced by Black and Asian women in the City.
It was reported that:-
· There was a Task and Finish Group to look at what was available and what could be done to improve it.
· Rob Howard came out of MBRRACE-UK report on research into perinatal morbidity and at deaths in ethnicity. Although the numbers were relatively small the rates for women of black origin was 4 times higher than white women, of Asian origin twice as high and women of mixed heritage were three times higher.
· Further work had been undertaken to categorise issues around attitudes, language, being dismissive of concerns and knowledge or lack of knowledge/assumptions about pain levels for ethnic women. There needed to be better coding for data and more community based work.
· UHL had undertaken a lot of work on the development of culture in the care process. Focus Groups had bene held to address the concerns and problems that were not understood and care of health and wellbeing in the challenging environment staff worked in. There was a need to recognise cultural competency and sensitivity to women and their families. There were recurrent themes about trust and not being listened to and practitioners needed to change how these concerned were respond to. There was a need to move from listening to concerns viewpoints towards showing practitioners had learned from what people had said. Languages were a challenge and how this was utilised as a tool for care and allowed to be a barrier. It was important to make applications acceptable to women and their families. Collecting local data was essential and even though the numbers were a small a dashboard in development.
Members of the Board commented that:-
· Ethnicity could independently affect mortality and morbidity. There was a need to change the determinations which were malleable. Understanding the mortality in countries of origin and what could be learned from those countries to improve the situation was important. We should not be insular when looking at the norms. For example The advice in Japan was that it was acceptable for parents to sleep with children until they were 7 years old and the advice in the UK was that parents should not sleep with babies as this increased the risk of them dying. This was not the experience found in Japan and evidence suggested that other issues such as the use of drugs and alcohol were more important contributory factors.
· Work from this initiative could be applicable to other service areas.
· It should be recognised that there was a need for individual change as well as a collective change. Further consideration should be given to what counts as ‘black community’ as those of Afro Caribbean, Somali or Nigerian origins all had different complex issues. There was an opportunity to identify if there was a particular group of origin that was more disadvantaged. Change would not occur quickly because of the practice of women sharing comments with each other and if they have a bad experience that would be shared. That would have to be addressed and measures taken to avoid that and to reassure others that not everyone had bad experiences.
· Issues around cultural norms is critical to Leicester due to it being a pluralistic city and identifying what is the norm for Leicester. Measures that worked elsewhere would not necessarily work in Leicester.
· There was a difference between people of African and Caribbean origin and rates of mortality in those countries and the relationship between those countries and here. If there was a marked increase in the UK was this due to genetic or other issues.
· If ethnicity was an issue, even if adjusted for deprivation, if it was not physiological then was it equity and equality? Looking at other western European countries such as France, Germany or Sweden to see if they have similar issues. If they don’t, why not as they had a similar history of diversity in immigration.
In response, officers stated that:-
· There was not data relating to women who come to the UK compared to data for women who were born and raised in this country. Mortality and morbidity factors happened before conception so there was plenty that could be influenced to address those issues.
· The shared experiences across communities were not just maternity but involved all experiences and the role of partners, fathers and the and support from the community added extra levels of complexity.
· The questions asked by Board members were the same as those being asked by officers and whilst the answers were not yet there was work that could be done to improve the knowledge and data in these areas.
The Chair commented that this was an ongoing piece of work with different strands and a short update would be helpful at the next meeting. An update on the preliminary feedback on engagement sessions could follow to a future meeting. This work could be used for other departments across all NHS organisations and the partnership coming together to help each other. The council had good data and an award-winning team for producing it and this could be shared so it could influence all other aspects of health.
AGREED:- That officers be thanked for the update and were asked to submit further updates as the project progressed.