Unequal Care: Examining the intersection of multifactorial factors contributing to suboptimal perinatal outcomes: A scoping review and implications for perinatal services in the UK

Background: Maternal and neonatal health inequalities remain prevalent among disadvantaged ethnic minority women in developed economies. Differences in perinatal care and neonatal outcome are influenced by multiple factors related to equality, diversity, and inclusion. In this scoping literature review we examine how these contribute to adverse maternal care and neonatal outcomes in the UK. Methods: We conducted a search of four electronic databases (PubMed, Medline, Embase, and CINAHL) for articles published in English between 2010 and 2022. Using the PICO (Population, Intervention, Comparison, and Outcome) framework, we defined our inclusion and exclusion criteria. Forty-seven papers met the specified inclusion criteria. We undertook a thematic analysis exploring themes and identifying potential areas for research and development. Results: We identified themes surrounding communication, service delivery, referral delays, practical life concerns, lack of awareness of services, and cultural and racial sensitivity. Significant disparities in access, utilization, and service delivery due to socio-economic factors and ethnic differences, especially across diverse cultures, beliefs, and value systems, were identified. Tailored approaches or interventions to address perinatal health inequalities and a need for high-quality future research focused on optimizing services to promote equity and inclusion for socially disadvantaged ethnic minority women are required. We outline potential areas for research priority setting and the development of interventions. Conclusion: Significant disparities in various themes associated with perinatal health service delivery in the UK indicate an urgent need for further priority setting research and development.