Making maternity care sustainable and equitable

The Centre for Sustainable Healthcare is collaborating with the Royal College of Obstetricians & Gynaecologists, the Royal College of Midwives and the Sustainable Healthcare Coalition on an innovative SBRI funded project to develop quality improvement interventions that will improve the social and environmental sustainability of maternity care. But why is making maternity care more sustainable and equitable important? How will reducing carbon and increasing sustainable initiatives improve maternity care?

Maternity care – sometimes called antenatal care or pregnancy care – is a large umbrella term that encompasses the wide range of clinical, medical and social interventions that accompany pregnancy and childbirth.

How does global warming affect maternity care?

The impact of global warming not only on maternity care services but the health and wellbeing of the parent and the child is well documented. With increasing heatwaves, adverse weather events, air pollution and more all having significant negative effects.

Research into climate change and the potential effects on maternal and pregnancy outcomes has identified a clear link between negative maternal and pregnancy outcomes and a lack of food, safe drinking water and proper sanitation caused by climate-induced migration; increased frequency of extreme weather events; changing patterns of disease and morbidity, especially with emerging tropical diseases such as Zika; and direct heat exposure through climate change. It is clear that the consequences of climate change for pregnant women and the unborn child can be substantial.

The lack of sustainability in maternity care

Despite the fact maternity care is highlighted as one of the key clinical challenges in the Core20Plus5 equity strategy – an NHS England approach to reduce health inequalities at a national and system level – there is still a lack of focus on maternity care in discussions around increasing sustainable models of care, and there are still huge inequities in care delivery and experience.

The NHS itself has taken great strides to reduce its carbon footprint, dropping emissions by 30% since 2010, exceeding its commitments under the climate change act, but despite this, still has a long way to go. The carbon footprint of all healthcare in general is high, accounting for 4.4% of all emissions globally, but maternity care itself is a significant sector within that. The maternity care pathway is often high volume, caesarean sections alone, for example, are one of the most common surgeries carried out across the NHS. Entonox – a pain-relieving gas mixture administered during childbirth – accounts for two-thirds of nitrous oxide emissions. Despite this clear data there has been no comprehensive carbon footprinting of maternity services.

Using sustainability to engage people in tackling inequity in maternity care

It is clear that inequity in healthcare is a key barrier to achieving the EU’s 2030 Agenda for Sustainable Development and the Sustainable Development Goals (SDGs), and the inequity in women’s maternal health is a significant issue. According to the MBRRACE statistics, between 2019 and 2021 – the latest statistics available at the time of writing and statistically unchanged from the 2018 to 2019 period – women of Black ethnic backgrounds were four times more likely than white women to die in childbirth, and Asian women were almost twice as likely. This is compounded by socio-economic factors, with women living in the most economically deprived areas having a maternal mortality rate two-and-a-half times higher than women living in the least deprived areas.

One of the biggest disparities of maternity provision is in continuity of care. Seeing the same midwife and developing a supportive, trusting relationship between the service user and the caregiver is widely known to bring about better outcomes for both mother and baby, so much so that the NHS Long Term Plan sees continuity of care as a priority and states that 75% of women from Black, Asian and other ethnic minorities and women from the most deprived areas should receive continuity of care by 2024. Unfortunately this target has never come close to being met, thanks in large part to reported causes such as suboptimal staffing levels, which is just one of the many reasons that inequity in maternity care needs to be tackled as a matter of urgency.

But how exactly will making maternity care more sustainable help to reduce inequity of care? This is just one of the key questions this project aims to answer.

Taking collective action to deliver low carbon, equitable maternity care

To tackle inequity and the lack of sustainability in maternity care, a long term, multidisciplinary approach is needed. Alongside SBRI Healthcare, the Centre for Sustainable Healthcare is collaborating with the Royal College of Obstetricians and Gynaecologists, the Royal College of Midwives and the Sustainable Healthcare Coalition to deliver the project “Taking collective action to deliver low carbon, equitable maternity care”.

But more than that, this study aims to engage expert advisors from obstetrics and midwifery as well as a panel organised by the RCOG of those with lived experiences of maternity care and their advocates. This year-long project aims to engage the multi-disciplinary maternity community through studying the various maternity care pathways, highlighting carbon and health inequity hotspots, supporting maternity teams to run QI projects to tackle these hotspots, and bringing the whole community together to discuss how the findings can influence future maternity care.

The project includes;

Mapping the maternity pathways to identify carbon and inequity hotspots.
Agreeing target areas where changes could affect carbon and equity at the same time.
A Green Maternity Challenge where maternity teams from across the UK co-design Sustainability in Quality Improvement (SusQI) projects with our lived-experience group to test changes in situ.
Events to feed back the learning to the maternity community including industry partners.

How is the Centre for Sustainable Healthcare helping to reduce carbon and inequity in maternity care?

In collaboration with our partners and wider members of the multidisciplinary professions, the Centre for Sustainable Healthcare will manage the year long project as well as bringing our carbon footprinting and practical SusQI expertise to help ensure the project delivers its potential benefits. We will help align net zero and equity actions with clinical and patient priorities in an effort to ultimately improve patient outcomes and experiences, and reduce health inequities.

Service-user and clinical engagement will increase understanding of maternity sustainability and equity hotspots, and increase engagement with both in practice, and by modelling cross-disciplinary working and service-user involvement we will promote a culture of integration, team working and co-design on the ground and improve the experience of maternity service users.

Environmental, social and economic benefits will be quantified at project level and scaled to national level providing robust measurement, and industry partners will be aware of target areas for innovation, and clinical guidance, education and national quality work can embed net zero and equity from the learning and outputs of this project.

But equally as important, we are showcasing the power of community action, and already we are confirming that the maternity community is full of energy, determination, ideas and strong networks and this positivity is driving the project forward and helping to grow the Women’s Health Sustainability Network, bringing increased knowledge and action on delivering high value, sustainable, equitable care

How can you help make maternity care more sustainable?

Join our Women’s Health Sustainability Network and make your voice count. This new and growing online hub will be our primary forum for the project and members run monthly events and share up to date research and sustainability news.

Attend our events to find out what hotspots we’ve identified.

If you are involved in the maternity community in a professional capacity, put in a team application to be part of the Green Maternity Challenge.

Through this project, we will show that maternity care can be more sustainable and more equitable, and by working in collaboration with each other, health professionals and service users can work toward more environmentally sustainable changes during pregnancy, birth and postpartum which helps to reduce the carbon footprint having a baby brings. Through this, we will demonstrate the real importance of making maternity care more sustainable, which is helping improve service user outcomes as well as the environment.

This work was commissioned and funded by SBRI Healthcare. SBRI Healthcare is an Accelerated Access Collaborative (AAC) initiative, in partnership with the Health Innovation Network. The views expressed in the publication are those of the author(s) and not necessarily those of SBRI Healthcare or its stakeholders.