MIDIRS Midwifery Digest Hot Topic: Why are some voices not heard? Exploring how maternity care can be improved for women with limited English
By Joanne Cull et al on 21 June 2022
There is a robust body of evidence, accumulated over the decades, which shows that limited English proficiency is a key factor associated with poorer maternal and neonatal outcomes. Our work as midwives and researchers has led us to believe that this is a complex, multi-dimensional issue, which we will explore in this article.
We discuss challenges of interpreter use by clinicians and with current interpreting service provision. We propose a range of solutions to improve care for this group of women. Finally, we argue that language must be viewed as an independent variable in research, as it is often conflated with, or hidden by, wider discussions of ethnicity and migration status.
We hope this article will illuminate the challenges of providing high-quality care for women with limited English proficiency and set out a clear road map for reducing the continued inequity.
Language as a key determinant of maternal health
The Confidential Enquiry into Maternal and Child Health (CEMACH) report Why mothers die 2000-2002 noted that ‘there is a particular risk for women…who have little or no command of the English language’ (Lewis 2004:251). Nearly two decades later, these findings were mirrored by the most recent MBRRACE-UK report and the Health Secretary Investigation Branch (HSIB) report into intrapartum stillbirth during the COVID-19 pandemic (Knight et al 2021, HSIB 2021).
Women with limited English proficiency face a range of challenges to access timely, high-quality maternity care: for example, initiation of routine maternity care can be delayed as women might find it difficult to book appointments and understand referral pathways, and telephone triage services often rely on the ability to speak English (Cardwell & Wainwright 2018, McKnight et al 2019). Without accurate communication with maternity care professionals during consultations, there is a risk that vital information will be missed and that informed consent cannot be achieved (Birthrights & Birth Companions 2019, Bridle et al 2021).
Cull J, Anwar N, Brooks E et al. MIDIRS Midwifery Digest, vol 32, no 2, June 2022, pp 142-146
Original article ©MIDIRS 2022
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