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Cited by 42Maternal and Perinatal Health InterventionsMaternal and Neonatal HealthcareGlobal Maternal and Child Health

‘I know my place’; a meta-ethnographic synthesis of disadvantaged and vulnerable women’s negative experiences of maternity care in high-income countries

Heys, Stephanie, Downe, Soo, Thomson, Gill·2021·Midwifery
DOI 10.1016/j.midw.2021.103123
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Abstract

Objective During pregnancy and childbirth, vulnerable and disadvantaged women have poorer outcomes, have less opportunities,face barriers in accessing care,and are at a greater risk of experiencing a traumatic birth. A recent synthesis of women's negative experiences of maternity care gathered data from predominantly low-income countries. However, these studies did not focus on vulnerable groups, and are not easily transferable into high-income settings due to differences in maternity care provision. The aim of this study was to synthesise existing qualitative literature focused on disadvantaged and vulnerable women's experience of maternity care in high-income countries.Methods A systematic literature search and meta-ethnographic methods were used. Search methods included searches on four databases, author run, and backward and forward chaining. Searches were conducted in March 2016 and updated in May 2020.Findings A total of 13,330 articles were identified and following checks against inclusion / exclusion criteria and quality appraisal 20 studies were included. Meta-ethnographic translation analytical methods were used to identify reciprocal and refutational findings, and to undertake a line of argument synthesis. Three third order reciprocal constructs were identified, 'Prejudiced and deindividualized care', 'Interpersonal relationships and interactions' and 'Creating and enhancing insecurities.' A line of argument synthesis entitled 'I know my place' encapsulates the experiences of disadvantaged and vulnerable women across the studies, acknowledging differential care practices, stigma and judgmental attitudes. A refutational translation was conceptualised as 'Being seen, being heard' acknowledging positive aspects of maternity care reported by women.Conclusion Insights highlight how women's vulnerability was compounded by complex life factors, judgmental and stigmatizing attitudes by health professionals, and differential care provision. Further research is needed to identify suitable care pathways for disadvantaged and vulnerable women and the development of suitable training to highlight negative attitudes towards these women in maternity care settings.

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  • In contexts of social vulnerability, neglect, lack of information, and barriers to accessing care compromise prenatal follow-up and lead to traumatic birth experiences.

    “In-line with the findings, such weaknesses are exacerbated in contexts of social vulnerability, where neglect, lack of information, and barriers to accessing care compromise prenatal follow-up and lead to traumatic birth experiences (50).”

    From Experiences and long-term repercussions of perinatal grief in women after perinatal bereavement: a meta-ethnography (2025) · cites this paper as [50]

    The Introduction reports barriers to healthcare access for disadvantaged and vulnerable women and links poor information-giving and negative provider interactions with traumatic birth experiences. The “Abusive and neglectful care” section also describes a woman experiencing birth as traumatic after a painful procedure. The paper does not establish that these factors compromise prenatal follow-up, or that the access barriers themselves lead to traumatic births. Page numbers for these sections are unavailable in our copy. (LLM, conf=0.85)

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Research works printed but not linked: 9

  1. Atkins, S., Lewin, S., Smith, H., Engel, M., Fretheim, A., & Volmink, J. (2008). Conducting a metaethnography of qualitative literature: lessons learnt. BMC medical research methodology, 8(1), 21.
  2. Barker, M., Baird, J., Lawrence, W., Vogel, C., Stommer, S., Rose, T., ... & Cooper, C. (2016). Preconception and pregnancy: opportunities to intervene to improve women's diets and lifestyles. Journal of developmental origins of health and disease , 7 (3), 330.
  3. Dikmen-Yildiz, P., Ayers, S., & Phillips, L. (2018). Longitudinal trajectories of post-traumatic stress disorder (PTSD) after birth and associated risk factors. Journal of affective disorders , 229 , 377-385.
  4. Dixon-Woods, M. D., Kirk, M. D., Agarwal, M. S., Annandale, E., Arthur, T., Harvey, J., & Riley, R. (2005). Vulnerable groups and access to health care: a critical interpretive review. National Coordinating Centre NHS Service Delivery Organ RD (NCCSDO) Retrieved May, 27, 2012.
  5. Downe, S., Finlayson, K., Walsh, D., & Lavender, T. (2009). 'Weighing up and balancing out': a metasynthesis of barriers to antenatal care for marginalised women in high-income countries. BJOG: An International Journal of Obstetrics & Gynaecology , 116 (4), 518-529.
  6. England, N. H. S. (2016). National maternity review. better births; improving outcomes of maternity services in England. London: NHS England .
  7. Mead, G. H. (1934). Mind, self and society (Vol. 111). University of Chicago Press.: Chicago.
  8. Ronsmans, C., Graham, W. J., & Lancet Maternal Survival Series steering group. (2006). Maternal mortality: who, when, where, and why. The lancet , 368 (9542), 1189-1200.
  9. Shafiei, T., Small, R., & McLachlan, H. (2012). Women's views and experiences of maternity care: a study of immigrant Afghan women in Melbourne, Australia. Midwifery, 28(2), 198-203.

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Authors
Heys, S., Downe, S., & Thomson, G.
Affiliations
  • University of Lancashire (GB)
  • Dalarna University (SE)
ORCID
Venue
Midwifery
Publisher
Elsevier BV
Published
2021-12
Volume
103
Pages
103123
ISSN
0266-6138 (ISSN-L)
DOI
10.1016/j.midw.2021.103123
OpenAlex
W3195880746
Cited by
42
References
79
Citations by year
2026: 7 · 2025: 7 · 2024: 12 · 2023: 9 · 2022: 6 · 2021: 1
FWCI
1.28
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • Midwifery (publishedVersion)
  • PubMed (publishedVersion)
  • CLOK (University of Central Lancashire) (acceptedVersion)
Funders
NIHR CLAHRC
Topics
  • Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
  • Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
Keywords
disadvantaged women, vulnerable women, obstetric care, women's experiences of childbirth, stigma, insecurity, high-income countries, maternal health equity
MeSH terms
Anthropology, Cultural, Female, Humans, Maternal Health Services, Pregnancy, Developed Countries, Vulnerable Populations, Qualitative Research, Parturition

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