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Title: Perinatal mortality in Pakistani, Bangladeshi and White British mothers, in Luton
Author: Garcia, Rebecca
ISNI:       0000 0004 7229 9259
Awarding Body: University of Bedfordshire
Current Institution: University of Bedfordshire
Date of Award: 2017
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Addressing modifiable factors in perinatal mortality is a key priority for commissioners and service providers, aiming to improve birth outcomes and reduce preventable deaths (Department of Health, 2016; National Maternity Review, 2016). Luton, a town with a plural population, experiences higher rates of perinatal mortality than the national average (CDOP, 2015). Figures show an ethnic variation; Pakistani and Bangladeshi mothers experience higher rates of perinatal mortality in England compared with White British mothers, and the reasons for this are unclear. Much of the existing literature approaches the problem by examining individual risk factors quantitatively or exploring South Asian women’s experiences qualitatively. There is little research considering how Pakistani, Bangladeshi and White British women’s health beliefs impact on their health behaviour through the maternity care pathway, in Luton, and how this might contribute to perinatal mortality. This study takes an intersectional approach, using a convergent mixed-methods research design, reviewing retrospective secondary data (2008-2013) from the Luton and Dunstable Hospital NHS Foundation Trust’s Circona Maternity information System, to identify risk factors for perinatal mortality in Luton. Additionally, focus groups were conducted with lay women (aged over 16, living in LU1-LU4, who had experienced a live birth, at 37 weeks of gestation in the previous 6-24 months), and face-to-face interviews were held with bereaved mothers (aged over 16, who suffered an infant bereavement in the preceding 6-24 months, living in LU1-LU4). Health care professionals working on the maternity care pathway also took part in focus groups or interviews, providing their views on the service needs of Pakistani, Bangladeshi and White British women. The results/findings showed that risk factors varied according to ethnicity. Pakistani mothers had a greatest number of risk factors i.e. birthweight, diabetes, gestational diabetes, BMI < 18kg/m2, parity two, three and four and later booking (> 12 weeks). Deprivation featured in 81% of all deaths in 2014. The findings with the mothers revealed mostly similarities among women, regardless of their ethnicity; the majority of women wanted more pregnancy-related information, especially in respect of stillbirth and adverse outcomes. Similarly, bereaved mothers regardless of their ethnicity also reported mostly similarities, which included experiencing intuition when things were not right with the pregnancy. A few differences according to ethnicity were also identified, which focused on cultural or religious needs, such as cultural therapies (mostly dietary restrictions) undertaken by Pakistani and Bangladeshi women. The intersectional approach allowed simultaneous and aggregated factors (i.e. heritable, socio-economic status, structural factors and health beliefs and health behaviours) to be exposed; staff believed Pakistani and Bangladeshi women were not proactive in seeking pregnancy-related information, relying on verbal information and staff assumed mothers were literate and understood health messages. The intersected findings also revealed that few women took folic acid preconception, and many women co-slept with their baby. This study contributes new knowledge to the understanding of how Pakistani, Bangladeshi and White British women’s health beliefs influence their health behaviour, and contributes to perinatal mortality in Luton.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: maternity ; ethnic minorities