A mixed method exploration of the impact of Covid-19 on ethnic inequalities in maternal and neonatal outcomes

Abstract Background: Deep inequalities in maternity care and outcomes for women from ethnic minority groups were present before the coronavirus pandemic. During the pandemic, rapid and heterogeneous changes were made to maternity services and care. It is not known what effect these changes have had on maternity outcomes and whether this effect differed across ethnic groups. Identification of changes which may reduce inequality is a national priority. The aim of this project was to identify changes in maternity care which reduced inequalities in maternal and perinatal outcomes during the period of rapid organisational change in the COVID-19 pandemic. Methods: A Women’s Reference Group of public advisors guided the project. Analysis of Hospital Episode Statistics Admitted Patient Care data of 128 NHS Trusts in England identified “positive deviant” healthcare organisations that reduced inequalities in maternity outcomes. Maternal and perinatal composite adverse outcome indicators were used to compare outcomes between White and Minority ethnic groups, before and during the pandemic to identify “positive deviants”. Positive deviant Trusts were identified for qualitative interview, alongside comparators. Senior clinicians, heads of midwifery and representatives of women giving birth were interviewed. Reflexive thematic analysis was employed. Results: We conducted 20 interviews from six positive deviant and four comparator Trusts. Positive deviants reported that necessary shifts in roles led to productive and novel use of expert staff; comparators reported senior staff ‘stepping in’ where needed and no benefits of this. They reported proactivity and quick reactions, increased team working, and rapid implementation of new ideas. Comparators found constant changes overwhelming, and no increase in team working. No specific differences in care processes were identified. Conclusions: Proactivity, flexibility, staffing resource, and increased team working were associated with a reduction in ethnic inequalities in maternal and perinatal outcomes. Hence, harnessing these strengths of high-functioning units proves vital in reducing health inequalities.