New Amma report calls for improved maternity care for asylum-seeking and refugee women

PRESS RELEASE 

A report published by Amma Birth Companions has found instances of discrimination, high rates of intervention, and issues with interpretation and communication that contribute to disparities in perinatal care for women seeking asylum, refugees, and those with varied immigration statuses.

The Glasgow-based charity’s ‘Birth Outcomes & Experiences Report‘, which launches today (20 March) analyses the childbirth experiences of 100 individuals supported by Amma. The report amplifies the voices of refugee, asylum-seeking, and other migrant women who accessed NHS maternity care in Glasgow over a two-year period. The evidence presented includes case studies, testimonials, and observations from Amma’s birth and postnatal companions — all pointing to a critical need for reform in the perinatal healthcare system.

The report highlights how systemic racism, inadequate communication, limited choice, and a lack of person-centred care negatively affects the birth experiences of women who already face multiple inequities. Stressing the urgency of addressing racial disparities in the NHS, the report echoes wider trends showing disproportionately negative outcomes in pregnancy and childbirth for individuals of Black, Brown, and mixed ethnicities in the UK.

It also acknowledges the harmful impact of underfunded maternity care and calls for collaboration across healthcare and government to enhance conditions for both staff and patients. The report emphasises the need for a commitment from the Scottish Government to prioritise greater investment into maternity services.

Key findings from the report include:

• In 2021-22, birth companions noted instances of practice issues and discrimination in over a third (37%) of recorded cases, citing issues including delayed pain relief, restricted choice, disrespectful behaviour, and misinformation.
• Three in four (74%) of those who required an interpreter faced issues including a lack of availability; staff understanding and willingness to use interpreters; and technical issues.
• Induction rates rose from 46% in 2021 to 48% in 2022, 11 percentage points higher than NHS Greater Glasgow & Clyde figures. The average gestational age at the time of induction was 38 + 5 weeks.
• The average Caesarean section rate was 51%, spiking from 38% in 2021 to 60% in 2022. In 2022, Amma’s rate of Caesarean sections was 18 points higher than NHS figures, also surpassing overall rates reported by Public Health Scotland when broken down by ethnicity.

Maree Aldam, CEO of Amma Birth Companions, says:

“These findings force us to critically reflect on the systemic and structural inequalities that have already been proven to cause harm to both mothers and babies. This is not about blaming individual midwives and doctors — it’s about taking the opportunity to assess where improvements must be made. It’s also about making a concerted effort to understand the stories behind the statistics and the true impact of a negative birth experience. For the clients supported by Amma, the stakes around childbirth are particularly high, as many women lack the interpersonal support, access to resources, and financial means to facilitate an effective recovery from a difficult birth.”

The report features several first-hand accounts from women supported by Amma, including Kadija, who experienced issues with NHS interpreting: “An interpreter was not given—and when medication was given to me, I didn’t have an interpreter to explain to me how to take the medication…I was very confused. There were lots of things going in my mind. I wondered ‘What is happening to me?’ I didn’t understand anything.”

Key recommendations from the report include:

• Cultivate anti-racist healthcare practices, emphasising a steadfast commitment to education on cultural literacy, equality, diversity, human rights, and intersectionality.
• Increase awareness of the rights and experiences of individuals with varied immigration statuses.
• Develop and implement adequate resources and training to ensure consistent use of professional interpreters.
• Ensure the provision of person-centred and trauma-informed maternity care, prioritising individual choice and informed consent.
• Allocate adequate funding and resources for enduring change in maternity services, addressing staff burnout and improving working conditions.

Maree Aldam, CEO, Amma Birth Companions adds:

“We’re not trying to prove that racialised inequalities in maternity care exist – Public Health Scotland, MBRRACE-UK and others have already provided ample evidence of this. Instead, we’re aiming to build upon the existing body of evidence by providing nuanced insights into the experiences of migrant women within the Glasgow context. By aligning our efforts with broader NHS and Scottish Government initiatives, we hope to contribute to the ongoing dialogue and support the development of targeted interventions and policies that can address and alleviate these disparities.”

Mary Ross-Davie, Director of Midwifery, NHS Greater Glasgow & Clyde said:

“The experiences reported by these women in 2021 and 2022 are deeply disappointing and we are very sorry for the distress caused. Over the past two years, we have worked with colleagues to learn from these experiences and to address inequalities for refugee and asylum-seeking pregnant women. This includes additional training in trauma informed care, effective use of interpreters, and addressing unconscious bias. We’ll implement the recommendations as they apply to us and will to seek to influence those that apply more broadly to the NHS as a whole.”

Sarah Shemery, PhD candidate, University of Edinburgh:

“As a PhD candidate and woman of colour, my work is grounded in a commitment to social justice and equitable care for racialised communities. My work on this report can be considered a small contribution towards advocating for a more equitable maternal health system for all. I was truly honoured to be able to contribute to it. The stories in this report are much more than personal narratives, they are a call to action. I urge people to look beyond the statistics within these pages and see the human experience and dignity that is at the heart of maternal health and the birthing experience. My utmost gratitude goes towards the mothers who have bravely shared their journeys with me while collecting data for this report, allowing us to learn from them and work towards a future where maternal care is inclusive, compassionate, and equitable for all.”

Notes for Editors:    

For any media inquiries, please contact:

Amanda Purdie, amanda@ammabirthcompanions.org, 07307 835 908 (Available Monday-Thursday)

Kate Beard, katebeardcomms@gmail.com, 07950 585284 (Available Friday)

About the report

This report focuses on the experiences of 100 Amma clients, 40 of whom gave birth in 2021 and 60 in 2022. These individuals were from 31 different countries, primarily spanning Africa and Asia. Interviews and testimonials also include clients who gave birth in 2023. 71% of these individuals were in the asylum process.

A mixed-methods approach was used to gather the evidence for this report, which included:

• A rapid evidence review of grey and academic literature (e.g. government and NHS reports, policy documents, and statistics, as well as academic journal articles)
• An analysis of 100 birth outcomes & monitoring reports
• Semi-structured interviews with birthing parents
• Companion testimonials

The report is available on Amma’s website: www.ammabirthcompanions.org/outcomesreport

About Amma Birth Companions

Amma Birth Companions is a Scottish charity serving Glasgow. Amma provides care, information, and advocacy for women and birthing people who are facing birth and parenthood with little to no support. Amma’s clients include individuals seeking asylum, refugees, survivors of human trafficking, and other individuals experiencing multiple inequities.

Since its inception in May 2019, Amma has provided companionship and community to more than 300 birthing individuals on their journey to parenthood. The organisation’s services are focused on three core activities: companionship, peer support, and antenatal education.

To find out more visit: ammabirthcompanions.org

FAQs

What is the purpose of this report?

This report aims to spotlight systemic inequalities in perinatal care, particularly focusing on the often-overlooked experiences of refugee, asylum-seeking, and migrant women accessing maternity services. It is not an overall evaluation of maternity services and is not a critique of individual healthcare workers. Instead, it underscores systemic disparities, with a focus on practice issues, interpretation, and rates of intervention. Amma aims to contribute to ongoing discussions focused on creating a more equitable maternal care system, aligning with the efforts of organisations like MBRRACE-UK, Birthrights, 5x More, and various advocates working to tackle racialised maternal health disparities.

Who was involved in the creation of this report?

This report was authored by Sarah Zadik and Amanda Purdie from Amma Birth Companions and Sarah Shemery, PhD candidate. An expert advisory group of healthcare professionals, academic researchers, and other professionals who helped to guide the creation of the report.

This report includes first-hand testimonials from Amma’s volunteer birth and postnatal companions and clients. 

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