This week’s blog is our first in a series that will look at different aspects of maternity inequalities and comes from Dalvir Kandola, Consultant Midwife- Lead for Inclusivity, University Hospitals of Leicester. This blog looks at the issue of maternity inequality through the lens of a professional role with a remit for driving equality and inclusivity.
Maternity services in England have been under scrutiny for not providing equitable care to all women and birthing people (Birthrights 2022, FiveXMore 2020, MBRRACE 2023). As a Consultant Midwife- Lead for Inclusivity, I lead and support the local maternity workforce in realising their full potential and capability in supporting birthing people and their families, working closely with the key stakeholders to develop a maternity service that is responsive and inclusive to the needs of those who use it. Within my role, I work proactively along with other colleagues in embedding the requirements of national maternity and neonatal strategies and priorities such as the NHS England Three Year Delivery Plan for Maternity and Neonatal Services (NHS England 2023) and the Equity and Equality Guidance for Local Maternity Systems (NHS England 2021).
My role is key within Leicester, Leicestershire and Rutland as the population within this area of England is unique. Leicester is one of the first cities where White ethnicity is no longer majority of the population (Office for National Statistics 2021) and therefore Leicester is known as a ‘super-diverse city’ (Spencer 2012.)
So, what does ‘inclusivity’ really mean? Well, it can be argued that it means nothing, because it means everything. This can make it really challenging as to where to focus efforts. Whilst there has been a large drive to reduce the inequity gap in relation to outcomes for certain ethnic groups, equality, diversity and inclusion (EDI) is much broader than ethnicity alone. There also needs to be acknowledgement of outcomes of other population groups such as the LGBTQ+ community and people with neuro-diverse needs.
My biggest frustration is that there is ‘too much talk and not enough action’ around the topic of inclusion. My passion lies with making tangible change with measurable outcomes. When implementing change, it is important to have a balance of short- and long-term goals. This has several benefits. Short term goals achieve quick results, maintains momentum and motivation. Long term goals are useful for strategic decisions and make take months, or even years to achieve. Examples of short term goals I have achieved since commencing post in January 2024 has included ensuring our maternity records to ensure there is a dedicated space next to ‘name’ for ‘preferred pronouns’, therefore normalising this conversation and supporting personalised care. I have also led on Race Equality Week in Maternity, engaging staff in 5-minute activities surrounding microaggressions. Furthermore, I have developed an EDI champion forum, staff within maternity and student midwives at two local universities join together to support the Inclusivity agenda and support dissemination of the work we are doing as many of the members are from under-represented communities themselves. Longer term, I am working to secure funding to support cultural safety training within our maternity department. This will take time to establish and to ensure that all staff within maternity have attended the training. I am also working on a 15-month programme with the Race Health Observatory in a quality improvement project to address perinatal mental illness within the Black and Asian populations.
My role demonstrates how varied a midwife’s job can be and is crucial to ensuring there is oversight of the actions being taken across this large organisation in addressing inequalities in healthcare.
To find out more, follow me: @Dalvir_Kandola
Additional resources:
- Perinatal health outcomes of women from Gypsy, Roma and Traveller communities: A systematic review – PubMed (nih.gov)
- Trans Pregnancy Survey (dxfy8lrzbpywr.cloudfront.net)
- Learning and Action Network (LAN) – NHS – Race and Health Observatory (nhsrho.org)
References:
Birthrights (2022) Systemic racism, not broken bodies [pdf] https://www.birthrights.org.uk/wp-content/uploads/2022/05/Birthrights-inquiry-systemic-racism_exec-summary_May-22-web.pdf
FiveXMore (2022) About the campaign [online] https://themotherhoodgroup.org/
MBRRACE (2023) Saving Lives, Improving Mothers’ Care. Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2019-21 [pdf] https://www.npeu.ox.ac.uk/assets/downloads/mbrrace-uk/reports/maternal-report-2023/MBRRACE-UK_Maternal_Compiled_Report_2023.pdf
NHS England (2021) Equity and Equality Guidance for local maternity systems [pdf] Equity and equality: Guidance for local maternity systems (england.nhs.uk)
NHS England (2023) Three year delivery plan for maternity and neonatal services [pdf] NHS England » Three year delivery plan for maternity and neonatal services
Office for National Statistics (2021) Census 2021. How life has changed in Leicester: Census 2021 (ons.gov.uk)
Spencer, S (2021) Super-diversity and the City Super-diversity and the City | COMPAS (ox.ac.uk)