The COVID-19 pandemic, and the wider political and social response have brought health and social inequalities into sharp focus in the UK (and elsewhere) [1]. Black, Asian and minority ethnic groups and most deprived populations are at increased risk of virus exposure and pre-existing health conditions put them at increased morbidity and mortality if they contract the virus [2]. In pregnant women, over half of those recently admitted to hospital with the infection were from Black, Asian and minority ethnic groups [3]. Pre-pandemic enquiries of all maternal and perinatal deaths found these women and/or those living in deprived areas were more likely to experience mental illness, to lose their babies or die during or after their pregnancy [4, 5]. The COVID-19 crisis has exacerbated persisting vulnerabilities, socio-economic and structural disadvantage and discrimination faced by many communities of social disadvantage and ethnic diversity [6].
Measures introduced to control spread of the virus (e.g. lockdown, social distancing, suspension of non-urgent NHS services) have added social and economic burdens disproportionately on those already experiencing inequality, and the ensuing economic recession will worsen inequalities in maternal, child and family health for years to come [1, 7, 8]. For example, pregnant women from some Black, Asian and minority ethnic groups, and the most socially disadvantaged backgrounds are more likely to suffer severe maternal morbidities and experience poor infant outcomes such as stillbirth and preterm birth, which can led to significant problems and disabilities in the future [9, 10]. This can have major implications for the child, the mother and the family’ health and wellbeing, whose levels of vulnerability are likely to be exacerbated during the recession, affecting experiences and already limited access to specialist care, education and family building and support networks [11, 12]. Therefore, the time for action is now. Supporting community participatory research, in which community stakeholders’ partner with researchers to understand the interplay of complex and multiple factors (physical, mental and social, as well as cultural, structural, economic, religious, commercial), is crucial to inform public health strategies designed to reduce inequities among Black, Asian and minority ethnic and socially disadvantaged groups [6].
The National Institute for Health Research (NIHR) has provided £135 million for 5-years funding to 15 Applied Research Collaborations (ARCs) across the UK, establishing partnerships between NHS providers, universities, charities, local authorities and other organisations. The ARCs aim to support research that improves outcomes, quality, delivery, and efficiency of health services for patients and the public by directly responding to, and meeting, the needs of local populations and local health and care systems [13]. Our maternity and perinatal mental health research theme, part of ARC South London, plans to address poorer outcomes for childbearing women experiencing mental illness and those living in areas of social disadvantage and ethnic diversity, to reduce health inequities and have a positive impact on health and wellbeing of women and families in the local community. There is a focus on people-centre and place-based models of maternity care that integrate health and care by shifting the way services are funded, managed, and delivered “from health systems designed around diseases and health institutions towards health systems designed for people and communities” [14, 15].