How Do We Address Inequalities For Pregnant Women And Their Babies?

Coproduction as a solution for tackling inequalities at work and within public sector services

We are excited and proud to announce that Ascent Wellbeing has been asked to support an NHS Maternity project to reduce health inequalities in perinatal care (maternity and neonatal care).   Although our directors have a vast amount of experience in addressing inequalities at work and in the community, we have learned so much more about the significant inequalities pregnant women and their babies face since being involved with this new project. 

Health Inequalities in Maternity Outcomes

It was music to our ears when we heard that the NHS wanted to use an approach involving true coproduction and asset/strengths led approaches with pregnant families who were experiencing inequalities and poor health and wellbeing. This way of thinking is everything we are about at Ascent, and we can’t wait to use this approach to make a real difference.  

On International Women’s Day, it is important that we stop for a minute and recognise the huge inequalities that many women and their babies face; there is a significant journey that we have to make in order to effectively address this social injustice.

The MBRRACE-UK report 2021 shows inequalities in maternal and perinatal mortality outcomes for women and babies from Black, Asian and Mixed ethnic groups  and for women and babies who live in the most deprived areas. This report shows that:

·         Women from Black ethnic groups are four times more likely to die than women from White groups.

·         Women from Asian ethnic backgrounds are almost twice as likely to die in pregnancy compared to White women. 

·         Women living in the most deprived areas are twice as likely to die than those who live in the most affluent areas.

The NHS People Plan notes that “there is strong evidence that where an NHS workforce is representative of the community that it serves, patient care and the overall patient experience is more personalised and improves”. Workforce Race Equality Standard (WRES) data shows that people from ethnic minorities are much more likely to be nurses, midwives and health visitors compared to the rest of the population, yet are under-represented in senior Agenda for Change pay bands across the NHS.

Coproducing Solutions in the Workplace and in Communities

Ascent Wellbeing focusses on both workplace & community wellbeing and equalities.  I, as the Founder and Director of Ascent, have been passionate about and have worked on supporting agendas to reduce health inequalities for the last 20 years.  

What I’ve realised recently is that although the language is very different between the private and public sector, the challenges and solutions are similar to tackling inequalities and poor wellbeing in the workplace and within community services.

What does coproduction even mean?

Coproduction is a real buzz word in the public sector but we have found that there are varying levels of understanding in what it means.  Think Global Act Personal explain the ‘Ladder of Participation’ including the following steps below.

Many in the public sector feel that coproduction is the ultimate goal and we agree it is the ideal.  However, we have worked extensively with people living in poverty where people can be experiencing huge challenges such as lack of money, food or work, digital exclusion, discrimination and racism, poor housing and poor health outcomes.  It can be very difficult then to have the time or energy to focus on getting involved in coproduction activities.   People may, however, still want to share their stories so that services learn and improve and become fairer and more inclusive. 

Telling a story about an experience of a community service or at work, possibly negative, needs to be easy to do and requires managers to listen and not be defensive. The person needs to know their story is important and there will be no repercussions and that the service/workplace values feedback as it is a way of learning and improving.

A bureaucratic complaints system may exacerbate inequalities as people experiencing inequalities are even less likely to be able to access it due to issues such as literacy levels, confidence, digital exclusion, not speaking English as a first language to name a few. Similarly, in the workplace there needs to be a way of telling your story so the company can learn without just relying on formal potentially stressful processes like the grievance process.

Approaches for tackling inequalities and poor wellbeing at work and in communities

There was a lightbulb moment for me fairly recently when I realised that approaches we were using in communities to tackle inequalities were similar to those we were using in the workplace.  In summary these are:

a)   Identifying risks and challenges affecting people experiencing inequalities/poor wellbeing.  In workplaces, this may be a psychological risk assessment such as the HSE Management Standards, whereas in communities this may involve engaging with local residents about issues and challenges or using community surveys.

b)   Identifying and harnessing strengths and assets to solve the challenges identified -  in communities we called this approach asset based community development and in the workplace at Ascent we use techniques such as Strengthscope strengths profiling and coaching for staff, teams and leaders.  We frame both of these approaches in the Science of Positive Psychology using evidence based approaches.  

c)    Engagement and Coproduction – This approach is vital for both communities and workplaces – aspects to consider when engaging people to be involved in identifying challenges and creating solutions include:

                  i.        Involving the people experiencing inequalities and poor wellbeing in any change process affecting them from start to finish

                ii.        Creating a culture where both positive and negative feedback is welcome and actively sought

               iii.        Providing safe spaces where people feel they can speak out about inequalities or risks to their wellbeing without repercussions

               iv.        Addressing power inbalances e.g. workplace managers and staff, authority figures in communities and residents

                v.        Engaging people in the type of communication format people feel comfortable with e.g. face to face, surveys, 121 etc.

               vi.        Using coaching techniques with excellent listening, helping people to expand their ideas and solutions with phrases such as ‘what would that  look like’ ‘tell me more about that idea’ etc

              vii.        Appreciative Inquiry can be helpful as a method of coproduction, using phases Discover, Dream, Design, Deliver and coaching people on their ideas and feedback at each stage of the process.  Dream is fantastic for encouraging people to think big and then design adds a touch of reality (not too much though!).  Appreciative Inquiry encourages people to focus on what is working well and build on strengths rather than deficits. 

Nothing without us is for us!

To summarise, there are similarities in how we can approach issues of poor wellbeing and inequalities in workplaces and communities.  Furthermore, creating  a more inclusive and ethnically diverse workforce will directly and positively affect the experience of service users in communities and staff in the workplace.  

We believe these similarities exist partly because we are human and inequalities and poor wellbeing are often the result of human behaviours and actions.

How we treat people, how we talk to them, how truly respectful we are, the extent to which we really listen and hear people’s stories, how inclusive and kind we are, and the extent we celebrate people’s differences affects the outcomes of any situation whether at work or within services people access in the community such as maternity and neonatal care.   

It is no surprise, therefore, that our approach at Ascent, which ensures that people experiencing inequalities and poor wellbeing are at the heart of the planning process, is successful both in businesses and within the development of public sector community services.  

We are so proud to be supporting the NHS with this project and our hope is that this leads to women and families experiencing inequalities feeling that they can share their stories easily and codesign what future services look like.  We are so happy the NHS is investing in this important work and we hope we can do them proud too. 

If you want to learn more about reducing health inequalities and co-production, come along to our free interactive online workshop.

Happy International Women’s Day Everyone!