Improving obstetric outcomes in ethnic minorities: an evaluation of health advocacy in Hackney.

Ethnic differences in birthweight, perinatal mortality and other obstetric outcomes are now well known. In some districts with a significant ethnic minority population, services are provided for non-English-speaking women using maternity units. Various models have developed, including translators, interpreters, Linkworkers, the Department of Health funded Asian Mother and Baby Campaign and health advocates. This paper describes the evaluation of a health advocacy programme in Hackney, East London. The advocates do more than simply interpret language. Anecdotal examples of how this approach changes clinical practice encouraged the project steering group to commission a study to test the hypothesis that health advocacy could improve obstetric outcomes in non-English-speaking women. A retrospective study was carried out comparing 1000 non-English-speaking women delivering at the Mothers' Hospital, Hackney, in 1986 who had been accompanied by an advocate with women delivering at the same hospital in 1979 and at a reference hospital, Whipps Cross. The study found significant differences between the groups in three outcomes: antenatal length of stay, induction and mode of delivery. The changes in Caesarean section were of particular note. The rates rose from 11 to 17 per cent at the reference hospital, whereas they fell from 10.8 to 8.5 per cent at the Mothers' Hospital. This is highly statistically significant. Although these changes cannot be directly attributed to health advocacy, it was considered reasonable to deduce that improved communication could have influenced clinical practice. These findings suggest that health advocacy may offer a mechanism to address some of the adverse obstetric outcomes observed in ethnic minorities.