P-440 Equity in reproductive health: A systematic review of factors influencing higher maternal mortality among Black Women in the United Kingdom
Authors: Onanuga S , Grace B , Saraki T , Dhanjal M , Pinder R 
Published: June 2023

Abstract

Study question
What factors influence maternal mortality (MM) among women of black origin in the UK?

Summary answer
There are multiple biomedical and systemic factors affecting black maternal mortality including late antenatal booking, poor communication, pregnancy complications and medical comorbidities.

What is known already
One of the key factors impacting global equity in reproductive health is maternal mortality. A maternal death is defined as a death occurring during pregnancy, childbirth or within six weeks postnatally. Black women in the United Kingdom (UK) are over three times more likely to suffer a maternal death than white women. In the UK, the maternal mortality ratio is 10.9 women per 100,000. This has significant implication for fertility and reproductive health equity. There is currently no systematic review of the factors contributing to maternal mortality in black women in the UK.

Study design, size, duration
A systematic literature review was conducted searching Medline, Embase, Global Health, Maternity and Infant Care, and Web of Science databases from their conception till September 2022. Only papers in English language covering a study period from 1970-2018 were included in this study. All peer-reviewed manuscripts irrespective of language or study design were reviewed. The reviews were conducted according to Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines.

Participants/materials, setting, methods
Participants were black women with experiences of maternal care in the UK. Peer-reviewed articles that presented original data which investigated influences primarily on MM in UK women of black descent and, factors that may increase MM risk were included. Papers which included black women without delineating them from other groups of women were excluded. The methodological quality of the studies was assessed using Critical Appraisal Skills Programme and National Institutes of Health checklists.

Main results and the role of chance
A total of 14 studies were included. Biomedical and systemic factors increase black MM risk at the individual, provider (healthcare professionals (HCPs)) and system (the National Health Service) level. Commonly cited biomedical factors including increased risk of pregnancy complications and increased prevalence of medical comorbidities. Systemic factors included late antenatal booking and communication barriers between black women and HCPs.
Qualitative findings from black women and HCPs centred on a theme of ‘deficit’ including mutual trust, basic maternity care and individualised care. Black women’s negative experiences in previous pregnancies often impacted trust levels and subsequently affected receptiveness to messages from HCPs. Regarding deficits in basic maternity care needs, black women spoke on the contrast in their care between the antenatal and postnatal period, viewing their postnatal care more negatively.
However, it is difficult to gauge the full influence of these factors without increased investigation into the other systemic and structural factors that affect black MM including institutional racial biases, stereotypes and microaggressions.

Limitations, reasons for caution
An important limitation was the exclusion of grey literature given the relatively limited evidence base for the proposed research question. However, inclusion may have increased the validity of the conclusions. A further limitation is the studies included tended to lack differentiation between nationality and ethnicity when identifying black women.

Wider implications of the findings
This review is the first to synthesise the literature on factors that influence black MM in the UK. The multiplicity of factors identified highlights the need to incorporate lived-experiences of black women, improve the cultural competence of HCPs, improve fertility and reproductive health care for black women and reduce MM.

Trial registration number
N/A