How to Improve Equity and Sustainability in Maternity Care: Key Target Areas

Maternity services are among the NHS’s most crucial and high-volume services, with over 673,000 births in the UK in 2022. Despite the scale of these services, significant inequalities persist. In the UK, Black women are four times more likely to die during pregnancy or childbirth compared to white women, and Asian women face twice the risk. Women from the most deprived areas are also more likely to experience stillbirths compared to those from the least deprived areas.

To address these disparities and promote sustainable practices, the Centre for Sustainable Healthcare (CSH) has partnered with the Royal College of Obstetricians and Gynaecologists (RCOG), the Royal College of Midwives (RCM), and the Sustainable Healthcare Coalition (SHC) in an SBRI-funded project, "Taking Collective Action to Deliver Low Carbon, Equitable Maternity Care."

The project’s lived experience group has collaborated with data on carbon and equity hotspots and identified seven target areas where significant improvements can be made.

Target Areas

Target Areas for Equitable and Sustainable Maternity Care

  1. Valuing People’s Time: Streamlining Maternity Services

Time is a valuable resource in maternity care, yet inefficiencies often lead to delays, wasted appointments, and unnecessary hospital stays. Streamlining these services not only benefits women and their families but also reduces the environmental impact of healthcare.

Examples: Improving discharge processes, consolidating appointments into a single visit, and offering virtual consultations can minimise unnecessary travel and reduce carbon emissions associated with maternity care.

Environmental Impact: By optimising these processes, the NHS can lower its carbon footprint while enhancing the patient experience.

  1. Supporting Informed Choices in Maternity Care

Empowering women with the information they need to make informed decisions is crucial for equitable maternity care. Providing comprehensive, accessible, and culturally relevant information helps women choose options that align with their personal values and sustainability goals.

Examples: Facilitating access to local voluntary services, ensuring the availability of translation services, and offering clear guidance on sustainable choices, such as opting for reusable nappies or sustainable baby products.

Environmental Impact: Informed choices lead to more efficient use of resources, reducing waste and carbon emissions in maternity care.

  1.  Improving Pelvic Health and Continence Care Post-Childbirth

Pelvic health issues, including incontinence, are common after childbirth and can significantly affect a woman's quality of life. By focusing on pelvic health, we can prevent long-term issues that require ongoing treatment, which has both health and environmental benefits.

Examples: Promoting antenatal pelvic health guidance, enhancing perineal tear care, and improving access to specialist services can mitigate these issues early on.

Environmental Impact: Reducing the need for long-term continence products decreases waste and the overall carbon footprint associated with ongoing care.

  1. Enhancing Access and Experience for Marginalised Groups

Health inequalities persist in maternity care, especially for Black, Asian, and young mothers, as well as those from deprived areas. By focusing resources on these underserved populations, we can improve maternity outcomes and create a more equitable healthcare system.

Examples: Tailoring antenatal care programmes, providing culturally sensitive care, and enhancing support for women in deprived areas can make a significant difference.

Environmental Impact: Improved health outcomes reduce the need for resource-intensive healthcare interventions, thereby lowering carbon emissions.

  1. Streamlining Care for Complex Pregnancies

Complex pregnancies often require additional care, which can be inefficient and resource-intensive. Enhancing systems to manage these pregnancies more effectively can improve outcomes and reduce unnecessary strain on the healthcare system.

Examples: Implementing better hypertension management pathways, utilising remote monitoring technologies, and improving care coordination among healthcare providers.

Environmental Impact: Reducing unnecessary appointments and hospital stays for complex pregnancies lowers the NHS’s environmental impact.

  1. Supporting Breastfeeding and Infant Feeding Choices

Breastfeeding provides numerous health benefits, but many women who wish to breastfeed lack adequate support. Enhancing breastfeeding support systems can improve health outcomes and reduce the environmental impact of formula feeding.

Examples: Establishing peer support groups, offering culturally relevant nutritional advice, and increasing access to lactation consultants.

Environmental Impact: Successful breastfeeding reduces reliance on formula feeding, which involves significant production, packaging, and transportation costs, contributing to carbon emissions.

  1. Listening to Women and Birthing People in Maternity Care

Personalised care is more effective when women and birthing people are actively involved in decision-making. Co-designing services with patients ensures that maternity care is responsive to their needs and values, including sustainability concerns.

Examples: Offering more choice in birth settings, incorporating patient feedback into service design, and working with third-sector organisations to provide community-based care.

Environmental Impact: Community-based, personalised care options typically have a lower environmental impact compared to traditional hospital-based services

Ready to Make a Difference?

We believe that by focusing on Quality Improvement and service redesign projects around these target areas, maternity care can become more equitable and sustainable. These target areas overlap, and many projects will address several simultaneously. For all improvement work, the outcome and experience of the people using the services are key—particularly for those underserved by the status quo.

" I am thrilled to be leading on this work as co-Vice Chair of the RCOG Women’s Network. Having been involved in a range of projects across maternity and pelvic floor health, I can really see the need for more work and innovation in sustainable maternity care. The research is clear, pregnant women,   people and infants are some of the most vulnerable to the effects of climate change and we know that climate change and healthcare inequalities are linked." - Emma Crookes, RCOG Women’s Network co-Vice Chair and Chair of the Lived Experience Group for the Taking collective action to deliver low carbon, equitable maternity care project
You can learn more from the lived experience chair, Emma, here.

  • Join our Women’s Health Network—an online community committed to tackling the environmental impact of women's health by sharing knowledge, ideas, and examples of good practice.
  • Apply for support to deliver a maternity improvement project as part of the Green Maternity Challenge 2024. Applications close 20th September 2024.

 

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