Midwives understand that when working with women during pregnancy, we can ill afford to look at simply the clinical situation in front of us.
One of our latest ilearn modules on the Social Determinants of Health looks at how health is socially-graded. That is to say: the clinical situation presented to us is the culmination of a life lived in a particular place at a particular time. Midwives have always been public health practitioners – we are at the frontline of creating a smoke free world, of tackling obesity – but as country demographics change so too we must keep learning and adapting to best help each unique individual we meet.
We know the price vulnerable migrant women pay for inequality in health outcomes in the UK. A quarter of maternal deaths between 2011 and 2013 were of women born outside the UK; 43% of these women were not UK citizens. Successive inquiries into maternal deaths have identified recent migrants, refugees and asylum seekers, and women who have difficulty reading or speaking English being more susceptible to pregnancy-related deaths than other women. Deprivation and vulnerability is a marker for increased risk of maternal and death and still birth, and being non-UK born and a recent migrant is one of many factors that contribute to deprivation and vulnerability.
The latest Surveillance of Maternal Deaths in the UK by the NPEU has stressed to all of us who work with pregnant women that we must view her health holistically. Quite simply, her life is at stake:
“Women from vulnerable populations still have a disproportionate risk of dying prematurely, possibly as a result of the multiple health and social challenges they face. This report provides a number of examples of ‘tunnel vision’ in our clinical thinking - increasing evidence of clinical subspecialisation and an inability to view the woman in a holistic manner and provide for her needs appropriately and effectively … The clear message to us all, whether doctor, midwife, nurse, manager, allied health or social care professional, service planner or policymaker, must be that we need to practice and embed the patient centred care that we all preach. This means providing the kind of care that takes into account the entirety of the woman’s health and social needs before, during and after pregnancy.”
Every day midwives and MSWs meet women with insecure immigration status, in temporary or unsafe accommodation, with few rights and few ways of exercising them. What I’m hearing from RCM members is that being at the forefront of these issues can be daunting and overwhelming. They want to give impartial, clear advice to women and they want women to be confident and be able to take control of their health. But there are many barriers for women to reach their potential and barriers to midwives getting the information they need to help.
That’s why the launch of this new Vulnerable Migrant Women’s Network for midwives and others is so valuable. Finally, a one-stop shop for information and a network of other health and social professionals to chat to, learn from, and share best practice. This platform joins our others – Maternal Mental Health and the Bereavement Care Network – which also work on the principle that by gathering the best of what we know in one place, we will do the best by the women we care for.
I’m encouraging all midwives to use this resource to help them rise to their advocacy role, and empower them to empower the women they care for. Getting advice and information will allow midwives to see the woman in her context, to understand how her health can be bettered by improvements outside the health sector. It will help stop that ‘tunnel vision’ that impairs our clinical judgement and broaden our horizons. Ultimately, it will help save women’s lives.