Developing effective maternity services for refugee and asylum seeking women with symptoms of perinatal depression: Increasing the visibility of an invisible population

Background: Perinatal depression is the most frequently diagnosed perinatal mental health condition in the general population, but global research shows that refugee and asylum seeking women are less likely to have their symptoms recognised or appropriately managed by healthcare services. Perinatal mental health is a key public health concern, with new services and models of care currently being commissioned and implemented across the NHS. At a time where finances are being invested and new services commissioned, it is important that ensure that those who are most marginalised are represented. Midwives and women are required to navigate maternity services and it is important that the systems work effectively for those providing the care and those accessing the care. Therefore, the aim of this qualitative research project was to investigate how midwifery services can be developed to support refugee and asylum seeking women with symptoms of perinatal depression.

Methods: 20 refugee or asylum seeking women and 14 midwives were recruited from across England to participate in the project. Semi-structured interviews were conducted by telephone or video-calling software due to the geographical spread of the participants and the impact of the Covid-19 pandemic national lockdowns. Interviews were audio recorded and transcribed verbatim. Reflexive thematic analysis was used to analyse the data.

Findings: Two themes were developed from the data, each with further sub-themes. Theme one exposes systemic inequities experienced by both women and midwives which influenced the ability to support symptoms of perinatal depression. Theme two displays what midwives need to be able to thrive in the role of supporting women’s mental health, which is supported by narratives from women.

Recommendations: The participants of this project demonstrate the authentic diversity of the models of maternity care, experiences of women and experiences of midwives in England’s maternity services. The report suggests that system level change is necessary but acknowledges that change evolves slowly in healthcare. It proposes that a ‘one size fits all’ guideline or service would not meet the needs of women accessing services or midwives providing care, suggesting that incremental change is initiated at the ground level to meet the needs of individual midwives and women who work in geographically and demographically diverse areas. The key recommendation of this report is the development of a national network for midwives who care for refugee and asylum seeking women. The aim of the network would be for midwives to share resources, expand training opportunities and provide peer support so that they can corporately and individually develop the role of the midwife in supporting refugee and asylum seeking women’s mental wellbeing.