Complex social factors in pregnancy - a Scottish health needs assessment

ISSUE: Health inequalities begin prior to conception. In the UK, babies born to women living in the most deprived areas are twice as likely to be stillborn compared to babies from the least deprived areas. Maternity services have a vital role in tackling health inequalities during the antenatal period but are not always equipped to optimally achieve this. DESCRIPTION: A health needs assessment (HNA) of pregnant women experiencing complex social factors (CSFs) was undertaken in NHS Lothian. The objectives were to describe the epidemiology of CSF in pregnancy, identify the needs arising from these, map the services available, and understand the experiences of staff and pregnant women. The HNA reviewed data from >42,000 maternity records between 2016-2020, engaged with midwives through focus groups and questionnaires, and undertook focus groups with women who had recently used antenatal services. RESULTS: Between 2016-2020, socio-economic deprivation was the most common CSF at booking (17%), followed by domestic abuse (4%), living in temporary accommodation (4%) and teenage pregnancy (4%). Other CSFs included problem substance use, difficulty reading/speaking English and involvement in the justice system. Midwives highlighted that CSFs could affect anyone at anytime, were often multiple and overlapping, and required additional time and partnership working to support. Whilst excellent models of care existed, there was geographical inequity in the quantity and quality of support available. Conversations with women emphasised the importance of continuity of care and described how a single point of contact through a trusted practitioner helped them access the range of services required. LESSONS: The HNA made 15 recommendations on how maternity services could better support CSFs. These related to developing better data systems to understand CSFs, increasing staff support, designing flexible care models, and strengthening multi-agency working. KEY MESSAGES: • The HNA has raised awareness of the range of CSFs encountered by pregnant women and their links to short- and long-term health inequalities for women and their babies. • The HNA is being used by maternity services to improve CSF support by using routine health data, allocating resources in a way that is proportionate to need and strengthening multi-agency working.