How has the Covid-19 pandemic affected care-seeking behaviour of pregnant women from underserved groups in south London?
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20 February 2023 — adopted February 2023 • completing September 2028
How has the Covid-19 pandemic affected care-seeking behaviour of pregnant women from underserved groups in south London?
Lower rates of maternity care use and poorer outcomes in pregnancy for women from underserved groups has highlighted the urgent need to understand the dynamic context of seeking care and how pregnant women engage with the health system during a health system shock.
Background to the study
Delayed or reduced use of perinatal care services — such as antenatal care and vaccinations during pregnancy — results in poorer outcomes for both mother and baby. Research shows that pregnant women from underserved groups are less likely to use perinatal care.
Underserved groups include:
- Women from minority ethnic backgrounds
- Women from socio-economically disadvantaged areas
- Young mothers
- Those with complex social lives
The decision to seek and actively engage in care is a complex phenomenon, dependent not simply on the availability of knowledge, but on various social, cultural and contextual factors — for example, trust in healthcare providers and narratives in social media. With rapid reconfiguration of services and mixed messaging, the Covid-19 pandemic made it even harder for women from these groups to navigate the complex NHS care structure.
Project aims
To understand how a health system shock such as the Covid-19 pandemic impacts women seeking care, demonstrated by pregnant women from underserved groups in a diverse, inner-city population of south London.
The specific objectives are:
Use routinely-collected clinical data to quantify differences in delayed or reduced care-seeking behaviour between different underserved groups
Explore how broader lifecourse social and environmental factors influence differences in care-seeking behaviour of pregnant women during a health system shock
Understand women’s embeddedness and engagement with health systems and social structures, and contribute to policy development to improve care-seeking behaviour
How the research will be carried out
This project uses a mixed methods design comprising three components:
Systematic literature review
Consolidating and synthesising existing literature on care-seeking behaviour — specifically facilitators and barriers to women identifying themselves as viable candidates to seek care
Quantitative analysis using eLIXIR (Born in South London)
Investigating comparative rates of service use between different groups in pre-, during- and para-pandemic periods. The eLIXIR database contains linked, routinely collected maternal and neonatal health records, primary care data, and socio-demographic information from women giving birth at two acute NHS hospitals in south London, representative of the local population.
Qualitative exploration
Using participatory appraisal activities and in-depth interviews to elaborate on statistical findings — exploring women’s experiences of seeking care, nuanced social and cultural factors that impact their decision-making, and changes needed to increase uptake and use
How patients and the public will be involved
This project benefits from strong links to the PPIE groups of the eLIXIR study and the ARC South London adopted RESILIENT study. Both groups comprise women from underserved groups who have given birth in south London, have lived experience of accessing complex care during pregnancy, and are passionate about supporting research in maternal health inequalities.
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The project will be presented to these groups at regular intervals to help guide the research process and ensure relevance of methods and results
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Selected patients and the public will be involved in co-production of research in the qualitative component through participatory appraisal methods
Potential benefits of the study
The findings will be used to better target interventions and to develop a more patient-centred and culturally-competent service for pregnant women from underserved groups who are at risk of poorer health outcomes — thereby reducing the health inequality gap.
By actively engaging with the community, this project hopes to critically examine and shift the narrative on social and racial inequality in healthcare and help to envision a better future for maternity services in a diverse inner-city population.
Meet the team
 Dr Hannah Rayment-Jones NIHR postdoctoral research fellow, King’s College London (secondary supervisor) |
 Sergio A Silverio Research fellow in social science of women’s health, King’s College London (tertiary supervisor) |
Related content
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Using electronic patient records from maternity and mental health to improve care — about the eLIXIR database - →
Improving maternal and child health for migrants with no recourse to public funds (NoRePF project) - →
Maternity and perinatal mental health research at ARC South London
Original source: arc-sl.nihr.ac.uk — NIHR ARC South London legacy content archived May 2026.