Peer-reviewed article
Targeted health and social care interventions for women and infants who are disproportionately impacted by health inequalities in high-income countries: a systematic review.
Khan Z, Vowles Z, Fernandez Turienzo C, Barry Z, Brigante L et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This systematic review examined targeted health and social care interventions for disadvantaged women and infants in high-income countries. The review identified 46 studies from six countries and found three main intervention types: midwifery models of care, interdisciplinary care, and community-centred services. Overall, these interventions showed positive associations with maternal and infant survival outcomes, though the significance and impact varied. The review suggests that combining midwifery-led care with community approaches may be most effective for reaching at-risk populations.
Key points
- Three intervention types identified: midwifery models of care (continuity, home visiting, culturally appropriate care), interdisciplinary care (multi-agency coordination), and community-centred services (place-based approaches)
- Interventions showed positive associations with maternal mortality, perinatal mortality, infant mortality, and secondary outcomes including breastfeeding, immunisations, and quality of care
- Midwifery models of care took an interpersonal and holistic approach focused on accessibility and cultural appropriateness
- Interdisciplinary care coordinated services for women requiring multi-agency health and social support
- Multi-interventional approaches combining midwifery and community-centred services recommended to enhance accessibility and engagement with at-risk populations
Limitations
This is a narrative synthesis of heterogeneous studies across different contexts and maternity care systems, so the significance and impact of interventions vary considerably. The review cannot determine which specific components of these interventions are most effective or provide precise effect sizes for specific outcomes.
Abstract
Background Disadvantaged populations (such as women from minority ethnic groups and those with social complexity) are at an increased risk of poor outcomes and experiences. Inequalities in health outcomes include preterm birth, maternal and perinatal morbidity and mortality, and poor-quality care. The impact of interventions is unclear for this population, in high-income countries (HIC). The review aimed to identify and evaluate the current evidence related to targeted health and social care service interventions in HICs which can improve health inequalities experienced by childbearing women and infants at disproportionate risk of poor outcomes and experiences. Methods Twelve databases searched for studies across all HICs, from any methodological design. The search concluded on 8/11/22. The inclusion criteria included interventions that targeted disadvantaged populations which provided a component of clinical care that differed from standard maternity care. Results Forty six index studies were included. Countries included Australia, Canada, Chile, Hong Kong, UK and USA. A narrative synthesis was undertaken, and results showed three intervention types: midwifery models of care, interdisciplinary care, and community-centred services. These intervention types have been delivered singularly but also in combination of each other demonstrating overlapping features. Overall, results show interventions had positive associations with primary (maternal, perinatal, and infant mortality) and secondary outcomes (experiences and satisfaction, antenatal care coverage, access to care, quality of care, mode of delivery, analgesia use in labour, preterm birth, low birth weight, breastfeeding, family planning, immunisations) however significance and impact vary. Midwifery models of care took an interpersonal and holistic approach as they focused on continuity of carer, home visiting, culturally and linguistically appropriate care and accessibility. Interdisciplinary care took a structural approach, to coordinate care for women requiring multi-agency health and social services. Community-centred services took a place-based approach with interventions that suited the need of its community and their norms. Conclusion Targeted interventions exist in HICs, but these vary according to the context and infrastructure of standard maternity care. Multi-interventional approaches could enhance a targeted approach for at risk populations, in particular combining midwifery models of care with community-centred approaches, to enhance accessibility, earlier engagement, and increased attendance. Trial registration PROSPERO Registration number: CRD42020218357.