Review Article| Volume 36, ISSUE 1, P30-38, February 2023

Experiences and needs of women from ethnic minorities in maternity healthcare: A qualitative systematic review and meta-aggregation

  • Remus Kin Chon Toh
    Nursing Division, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
    Search for articles by this author
  • Shefaly Shorey
    Correspondence to: Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11,10 Medical Drive, Singapore 117597, Singapore.
    Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
    Search for articles by this author



      To consolidate the available evidence around ethnic minority women’s experiences and needs when accessing maternity care.


      A qualitative systematic review and meta-aggregation of qualitative data were conducted. Nine electronic databases were searched for qualitative or mixed-methods studies from the inception of each database until January 2022. Using the Nested-Knowledge software, meta-aggregation was conducted according to the Joanna Briggs Institute (JBI) data synthesis approach to identify all potential intersections between different themes. Methodological quality of included studies was assessed using the JBI Qualitative Assessment and Review Instrument (JBI-QARI) and the mixed-methods appraisal tool (MMAT) checklists for qualitative and mixed-methods studies, respectively.


      Twenty-two studies (nineteen qualitative and three mixed-methods) were included. All studies were of good methodological quality. An overarching theme ‘the struggles and fears of ethnic minority women’ was identified. The negative experiences with maternity care were attributed to barriers including ineffective communication, cultural and religious insensitivity, inattentiveness and disregard for women’s needs, and isolation-related impact due to the COVID pandemic.


      Overall, our review highlighted several significant gaps between the care provided and the expected care among ethnic minority women accessing maternity care services. This mismatch between their expectations and care resulted in negative experiences, as the women reported being discriminated against and disrespected. There is an urgent need to develop and implement maternity care policies that are inclusive of needs of the ethnic minority women to optimize their maternity care experience.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Women and Birth
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Frenk J.
        • White K.L.
        The concept and measurement of accessibility.
        PAHO Sci. Publ. Pan Am. Health Organ. 1992; : 842-855
        • Levesque J.-F.
        • Harris M.F.
        • Russell G.
        Patient-centred access to health care: conceptualising access at the interface of health systems and populations.
        Int. J. Equity Health. 2013; 12: 1-9
        • Gulliford M.
        • Figueroa-Munoz J.
        • Morgan M.
        • et al.
        What does ‘access to health care’ mean?.
        J. Health Serv. Res. Policy. 2002; 7: 186-188
        • Penchansky R.
        • Thomas J.W.
        The concept of access: definition and relationship to consumer satisfaction.
        Med. Care. 1981; : 127-140
        • Khanijahani A.
        • Iezadi S.
        • Gholipour K.
        • Azami-Aghdash S.
        • Naghibi D.
        A systematic review of racial/ethnic and socioeconomic disparities in COVID-19.
        Int. J. Equity Health. 2021; 20: 1-30
        • Watson H.
        • Harrop D.
        • Walton E.
        • Young A.
        • Soltani H.
        A systematic review of ethnic minority women's experiences of perinatal mental health conditions and services in Europe.
        PLoS One. 2019; 14e0210587
        • Huang Y.
        • Shallcross D.
        • Pi L.
        • Tian F.
        • Pan J.
        • Ronsmans C.
        Ethnicity and maternal and child health outcomes and service coverage in western China: a systematic review and meta-analysis.
        Lancet Glob. Health. 2018; 6: e39-e56
        • Raleigh V.
        • Hussey D.
        • Seccombe I.
        • Hallt K.
        Ethnic and social inequalities in women’s experience of maternity care in England: results of a national survey.
        J. R. Soc. Med. 2010; 103: 188-198
        • Mahase E.
        Ethnic minority women and babies: outcomes worsen, and CQC demands action.
        Bmj. 2021; 374: n2317
        • Mahase E.
        Inequalities Responsible for Thousands of Adverse Birth Outcomes in Black and Asian Women.
        British Medical Journal Publishing Group, 2021
        • Wang T.F.
        • Shi L.
        • Nie X.
        • Zhu J.
        Race/ethnicity, insurance, income and access to care: the influence of health status.
        Int J. Equity Health. 2013; 12: 29
        • Shibli H.
        • Aharonson-Daniel L.
        • Feder-Bubis P.
        Perceptions about the accessibility of healthcare services among ethnic minority women: a qualitative study among Arab Bedouins in Israel.
        Int J. Equity Health. 2021; 20: 117
        • Alfayumi-Zeadna S.
        • Froimovici M.
        • Azbarga Z.
        • Grotto I.
        • Daoud N.
        Barriers to postpartum depression treatment among Indigenous Bedouin women in Israel: a focus group study.
        Health Soc. Care Community. 2019; 27: 757-766
        • MacLellan J.
        • Collins S.
        • Myatt M.
        • Pope C.
        • Knighton W.
        • Black Rai T.
        Asian and minority ethnic women’s experiences of maternity services in the UK: A qualitative evidence synthesis.
        J. Adv. Nurs. 2022;
        • Målqvist M.
        • Thi Phuong Hoa D.
        • Thanh Liem N.
        • Thorson A.
        • Thomsen S.
        Ethnic minority health in Vietnam: a review exposing horizontal inequity.
        Glob. Health Action. 2013; 6: 19803
        • Thummapol O.
        • Park T.
        • Barton S.
        Exploring health services accessibility by indigenous women in Asia and identifying actions to improve it: a scoping review.
        Ethn. Health. 2020; 25: 940-959
        • Adebayo C.T.
        • Parcell E.S.
        • Mkandawire-Valhmu L.
        • Olukotun O.
        African American women’s maternal healthcare experiences: a critical race theory perspective.
        Health Commun. 2021; : 1-12
        • Stephens C.
        • Nettleton C.
        • Porter J.
        • Willis R.
        • Clark S.
        Indigenous peoples' health--why are they behind everyone, everywhere?.
        Lancet. 2005; 366: 10-13
        • Premkumar G.
        Are we good at managing pregnancy in the ethnic minority?.
        J. Obstet. Gynaecol. 2008; 28: 373-376
        • Shorey S.
        • Ng E.D.
        • Downe S.
        Cultural competence and experiences of maternity health care providers on care for migrant women: a qualitative meta-synthesis.
        Birth. 2021; 48: 458-469
        • Chauhan A.
        • Walton M.
        • Manias E.
        • et al.
        The safety of health care for ethnic minority patients: a systematic review.
        Int J. Equity Health. 2020; 19: 118
        • Shamseer L.
        • Moher D.
        • Clarke M.
        • et al.
        Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation.
        Bmj. 2015; 349
        • Stern C.
        • Jordan Z.
        • McArthur A.
        Developing the review question and inclusion criteria.
        AJN Am. J. Nurs. 2014; 114: 53-56
        • Hupe M.
        EndNote X9.
        J. Electron. Resour. Med. Libr. 2019; 16: 117-119
        • Vegivinti C.T.
        • Pederson J.M.
        • Saravu K.
        • et al.
        Efficacy of convalescent plasma therapy for COVID‐19: A systematic review and meta‐analysis.
        J. Clin. Apher. 2021; 36: 470-482
        • Soilemezi D.
        • Linceviciute S.
        Synthesizing qualitative research: reflections and lessons learnt by two new reviewers.
        Int. J. Qual. Methods. 2018; 17 (1609406918768014)
        • Puthussery S.
        • Twamley K.
        • Macfarlane A.
        • Harding S.
        • Baron M.
        ‘You need that loving tender care’: maternity care experiences and expectations of ethnic minority women born in the United Kingdom.
        J. Health Serv. Res Policy. 2010; 15: 156-162
        • John J.R.
        • Curry G.
        • Cunningham-Burley S.
        Exploring ethnic minority women's experiences of maternity care during the SARS-CoV-2 pandemic: a qualitative study.
        BMJ Open. 2021; 11e050666
        • Peters I.A.
        • Posthumus A.G.
        • Steegers E.A.P.
        • Denktaş S.
        Satisfaction with obstetric care in a population of low-educated native Dutch and non-western minority women. Focus group research.
        PLoS One. 2019; 14e0210506
        • Muzik M.
        • Kirk R.
        • Alfafara E.
        • Jonika J.
        • Waddell R.
        Teenage mothers of black and minority ethnic origin want access to a range of mental and physical health support: a participatory research approach.
        Health Expect. 2016; 19: 403-415
        • Mohammadi S.
        • Carlbom A.
        • Taheripanah R.
        • Essén B.
        Experiences of inequitable care among Afghan mothers surviving near-miss morbidity in Tehran, Iran: a qualitative interview study.
        Int J. Equity Health. 2017; 16: 121
        • Chinouya M.J.
        • Madziva C.
        Late booking amongst African women in a London borough, England: implications for health promotion.
        Health Promot Int. 2019; 34: 123-132
        • Tobin C.
        • Murphy-Lawless J.
        • Beck C.T.
        Childbirth in exile: asylum seeking women’s experience of childbirth in Ireland.
        Midwifery. 2014; 30: 831-838
        • Davies M.M.
        • Bath P.A.
        The maternity information concerns of Somali women in the United Kingdom.
        J. Adv. Nurs. 2001; 36: 237-245
        • Hoang H.
        • Lê Q.
        • Kilpatrick S.
        Maternity care experiences of asia ethnic minorities in rural tasmania, australia: a mixed methods study.
        Health Well being Soc. Cult. Perspect. 2011; : 157-171
        • Jomeen J.
        • Redshaw M.
        Ethnic minority women’s experience of maternity services in England.
        Ethn. Health. 2013; 18: 280-296
        • McKinn S.
        • Duong T.L.
        • Foster K.
        • McCaffery K.
        ‘I do want to ask, but I can’t speak’: a qualitative study of ethnic minority women’s experiences of communicating with primary health care professionals in remote, rural Vietnam.
        Int J. Equity Health. 2017; 16: 190
        • Degrie L.
        • Dierckx de Casterlé B.
        • Gastmans C.
        • Denier Y.
        'Can you please hold my hand too, not only my breast?' The experiences of Muslim women from Turkish and Moroccan descent giving birth in maternity wards in Belgium.
        PLoS One. 2020; 15e0236008
        • Janevic T.
        • Sripad P.
        • Bradley E.
        • Dimitrievska V.
        “There’s no kind of respect here” A qualitative study of racism and access to maternal health care among Romani women in the Balkans.
        Int. J. Equity Health. 2011; 10: 53
        • Henderson J.
        • Redshaw M.
        Sociodemographic differences in women's experience of early labour care: a mixed methods study.
        BMJ Open. 2017; 7e016351
        • Liu R.
        • Chao M.T.
        • Jostad-Laswell A.
        • Duncan L.G.
        Does centeringpregnancy group prenatal care affect the birth experience of underserved women? A mixed methods analysis.
        J. Immigr. Minor. Health. 2017; 19: 415-422
        • Naylor Smith J.
        • Taylor B.
        • Shaw K.
        • Hewison A.
        • Kenyon S.
        ‘I didn’t think you were allowed that, they didn’t mention that.’ A qualitative study exploring women’s perceptions of home birth.
        BMC Pregnancy Childbirth. 2018; 18
        • Pullon S.
        • Gray B.
        • Steinmetz M.
        • Molineux C.
        Midwifery-led care embedded within primary care: consumer satisfaction with a model in New Zealand.
        J. Prim. Health Care. 2014; 6: 319-323
        • Aubrey C.
        • Mumtaz Z.
        • Patterson P.
        • Chari R.
        • Mitchell B.F.P.
        Perspectives of Immigrant Women on the Gender of Provider During Childbirth.
        J. Obstet. Gynaecol. Can. 2018; 40: 677-683
        • Asif S.
        • Baugh A.
        • Jones N.W.
        The obstetric care of asylum seekers and refugee women in the UK.
        Obstet. Gynaecol. 2015; 17: 223-231
        • De Freitas C.
        • Massag J.
        • Amorim M.
        • Fraga S.
        Involvement in maternal care by migrants and ethnic minorities: a narrative review.
        Public Health Rev. 2020; 41: 1-18
        • Khan Z.
        Ethnic health inequalities in the UK’s maternity services: a systematic literature review.
        Br. J. Midwifery. 2021; 29: 100-107
        • Sharma E.
        • Puthussery S.
        • Tseng P.-C.
        • et al.
        Ethnic minority women’s interactions with antenatal care providers in Europe.
        Eur. J. Public Health. 2021; 31 (ckab165): 516
        • Higginbottom G.M.A.
        • Evans C.
        • Morgan M.
        • Bharj K.K.
        • Eldridge J.
        • Hussain B.
        Experience of and access to maternity care in the UK by immigrant women: a narrative synthesis systematic review.
        BMJ Open. 2019; 9e029478
        • Mahmood F.
        • Acharya D.
        • Kumar K.
        • Paudyal V.
        Impact of COVID-19 pandemic on ethnic minority communities: a qualitative study on the perspectives of ethnic minority community leaders.
        BMJ Open. 2021; 11e050584
        • Fernandez Turienzo C.
        • Newburn M.
        • Agyepong A.
        • et al.
        Addressing inequities in maternal health among women living in communities of social disadvantage and ethnic diversity.
        BMC Public Health. 2021; 21