Pregnant women affected by social factors are hesitant to take antenatal health services. The responsibility of health care provider increases for taking care of this category of pregnant women.

1. PREGNANCY AND
COMPLEX SOCIAL FACTORS
.

2. CATEGORIES OF PREGNANT
WOMEN
 Women who misuse substances
 Women who are recent migrants, asylum seekers or refugee and
who have difficulties reading or speaking English
 Young women aged under 20
 Women who experience domestic abuse

3. AFFECTING COMPLEX SOCIAL
FACTORS
Some pregnant woman with complex social factors are discouraged from
using antenatal care services.
 Overwhelmed by the involvement of multiple agencies
 Not familiar with antenatal care services
 Practical problems that make it difficult for them to attend antenatal
appointments
 Finding hard to communicate with healthcare staff
 Anxious about the attitudes of healthcare staff

4. ME THODS OF ADDRE SSING PROBL E MS
 Improve service organization
 Provide training for healthcare staff
 Enhance care delivery

5. IMPROVE SERVICE ORGANIZATION
Work with
 Social care commissioners and providers
 Service for migrants, refugees and asylum seekers
 Substance misuse services
 Domestic abuse support services
 Housing services
 Education authorities
 Third-sector agencies

6. RECOMMENDATIONS
 Tailor services to meet the needs of the local population
• Maintain records for the no of woman presenting for antenatal care with
complex social factors
• Maintain records for each complex social factor grouping
• Maintain records for attendance of appointments by no of woman in
each complex social factor grouping
 Involve woman in their antenatal care
• Record, monitor and use as guide the women’s response on satisfaction of
services
• Involve women and their families in determining local needs
• Enable women to take a copy of their hand-held maternity notes when
moving from one area or hospital to another

7. PROVIDE TRAINING FOR
HEALTHCARE STAFF
Work with
 Social care professionals

8. RE COMME NDATION
 Provide training on multi-agency needs assessment and
information sharing

9. ENHANCE CARE DELIVERY
Work with:
 Social care professionals
 Substance misuse services
 Midwives and doctors with specific expertise (e.g. in the care of women who
misuse substances)
 Domestic abuse support workers
 Sexual health services
 Interpreters
 Link workers
 GPs

10. RE COMME NDATIONS
 Give information and offer referral at the first contact
 Reinforce contact at the booking appointment
 Coordinate care
 Communicate sensitively
 Keep the hand-held maternity notes up to date

11. RE COMME NDATIONS
 Offer referral to a substance misuse program
 Offer information and support
 Work with social care professionals to provide supportive and
coordinated care

12. P R E G N A N T W O M E N W H O A R E R E C E N T M I G R A N T S ,
A S Y L U M S E E K E R S O R R E F U G E E S O R H AV E
D I F F I C U L T Y I N R E A D I N G O R S P E A K I N G E N G L I S H
Issues:
 May not make full use of antenatal care services
 Unfamiliarity with the health service
 Finding hard to communicate with healthcare staff
Resolution:
 Use variety of means to communicate with women
 Telling women about antenatal care services and how to use them
 Undertaking training in the specific needs of women in these groups

13. RECOMMENDATION
 Adapt antenatal services to meet local needs
 Work with other agencies
 Allow enough time for interpretation
 Provide accessible information about pregnancy and how to find and use
antenatal services in a variety of :
• Formats such as posters, notices, leaflets, photgraphs, drawings/diagrams,
online video clips, audio clips and DVDs, interactive educational module
• Settings, including pharmacies, community centers, faith groups and centers,
GP surgeries, family planning clinics, children’s centers, reception centers and
hostels
• Languages

14. TRAINING FOR
HEALTHCARE STAFF
 Specific health needs of women such as needs arising from female
genital mutilation or HIV
 Specific social, religious and psychological needs of women in
these groups
 The most recent government policies on access and entitlement to
care for recent migrants, asylum seekers and refugees

15. RECOMMENDATION
 Offer information on access and entitlement to healthcare
 Disscuss the importance of keeping her handheld maternity record with her at
all times
 Avoid making assumptions based on woman’s culture, ethnic origin or religious
beliefs
 Provide woman with interpreter who can communicate with her in her preferred
language
 Ask the woman about her understanding of what she has been told to ensure
she has understood it correctly

16. REFERENCE
 http://www.jhpiego.org/en/node/1191 (MCHIP)
 http://www.guardian.co.uk/global-
development/video/2012/dec/05/female-genital-mutilation-women-
video
Molly Melching, founder of NGO Toshan
http://www.guardian.co.uk/global-
development/gallery/2013/feb/11/snapshots-suffering-survival-women-
africa#/?picture=403732993&index=16
http://www.jhpiego.org/en/node/1191