Role of Midwifery Continuity of Care in Reducing Health Inequalities
Condition: Health Knowledge, Attitudes, Practice; Social Determinants; Public Health; Pregnancy Related
Study type: Observational

Summary: 
      The impact of living in a deprived area has far reaching consequences on maternal and infant
      health. Studies in England show women living in deprived areas have some of the poorest
      experiences of care, poor birth outcomes and are 50% more likely to die of pregnancy related
      complications than women in the least deprived neighbourhoods. Life expectancy has also
      stalled for women living in the most deprived areas and the global COVID-19 pandemic has
      further amplified existing health inequalities.

      The Social Determinants of Health (SDH) are the conditions in which people are born, grow,
      work, live, and age, and are mostly responsible for health inequities - the unfair and
      avoidable differences in health seen within and between populations. Evidence shows taking
      action on the SDH alongside Midwifery Continuity of Care (MCC) models, improves birth
      outcomes and reduces health inequalities. How midwives working in MCC models in areas of high
      deprivation address the SDH as part of their public health and prevention role is currently
      not clear. There is also a lack of qualitative evidence exploring the SDH from the
      perspectives of women themselves.

      Drawing on Constructivist Grounded Theory methods, this research will take place in a
      low-income setting in England. Through the use of semi-structured interviews with women and
      midwives working in an NHS MCC model, the study will generate theory to help explain how and
      indeed whether midwives take action to address the SDH as part of their public health role.
      The study also seeks to understand the SDH impacting upon women's lives and what mechanisms
      exist to support or obstruct engagement with the SDH. Examining these domains will contribute
      to the evidence base about the impact of MCC and the public health and prevention strategy in
      NHS maternity services.
    


Intervention name(s): Interviews only.
Intervention type(s): Other
Intervention description(s): Interviews will be conducted with childbearing women and midwives.
Observational model: Case-Only
Time perspective: Other
Sampling method: Non-Probability Sample
Study population: 
        -  Childbearing women - Women who receive their care from one of the MCC caseloading
             teams. In the context of this study the term 'childbearing woman' is defined as any
             woman of childbearing age over the age of 16 years who is currently pregnant or up to
             five years post childbirth;

          -  Midwives - Midwives working in the study setting or have worked in one of the MCC
             caseloading teams. Also, midwives at the study site who have managerial and leadership
             oversight of the MCC teams.
      
Keywords: Midwifery Continuity of Care; Social Determinants of Health; Childbearing women; Health inequalities/inequities; Constructivist Grounded Theory; Qualitative research