Exploring the evidence

The systematic review of migrant women’s experiences found that some women had difficulty accessing care as they were unaware of their entitlement to care, were unfamiliar with the maternity care system in the new country, and faced practical barriers such as communication challenges, lack of cultural understanding amongst healthcare professionals as well as transportation and financial barriers. This also showed that continuity of care, being listened to, not being stereotyped and developing a trusting relationship between professionals and mothers were important⁸.

Community engagement and incorporating MPSs in maternity care

The ORAMMA project adopted a community engagement approach that capitalised on the experiences of migrant women who had been living in the host country for a longer period of time or who were second generation migrants. Within the UK, 25 women were recruited from ethnic minority communities and undertook training to become MPSs, with 17 MPS matched to one or more newly arrived migrants to support them through pregnancy, birth and the early postnatal period; promoting cultural understanding and communication with healthcare professionals; providing social and emotional support; and enabling childbearing migrant women to navigate the unfamiliar healthcare system. The women who volunteered to become an MPS were motivated by their own experiences of being newly arrived migrants in the past or a sense of altruism. Table 1 gives some illustrative quotations from MPSs and pregnant migrant women.

There was a range of benefits of this model of peer support for newly arrived childbearing migrant women. As well as support to access maternity care and overcome language barriers, MPSs advocated for them in their encounters with healthcare professionals when the woman desired it. MPSs provided emotional support and increased the women’s confidence, helping them overcome loneliness, encouraging them to build relationships with others and promoting bonding with the new baby.

The MPSs were a valued source of information in a new place, and the women appreciated the practical support they received from their MPS who helped them address a range of issues and needs including: housing, arranging bill payments, benefit applications, and acquiring equipment and clothing for the new baby.

The MPSs found that being involved in the project gave them a sense of personal satisfaction, feeling valued and boosting their self-esteem. They appreciated the opportunity to have a new experience and challenge, gain new knowledge and skills, and make a difference to newly arrived migrant women in the community.

Moving beyond the project to create positive local community impact

The ORAMMA project was completed in March 2019, however, the MPSs were enthusiastic and motivated to develop further their community-based initiatives to support recently arrived migrant women. Links with local Refugee Council project workers allowed the research team to share lessons learnt from the ORAMMA project and has led to the involvement of ORAMMA MPSs in an emerging project ‘Health Access for Refugees Programme’ (HARP). ORAMMA MPSs have had the opportunity to share their ORAMMA training and experience with other HARP volunteers and offered peer support to recently arrived migrant women in the local area within weekly community-based antenatal and postnatal groups. The MPSs have participated in further opportunities across the city for volunteering roles within a number of community groups who support asylum seekers, refugees and vulnerable migrants in accessing health and maternity services such as ‘Pregnancy Birth and Beyond’, ‘Breastfeeding Peer Support’, and ‘Empowering Parents, Empowering Communities (EPEC)’. They have also been working with Forging Families and LIGHT (local perinatal health/mental health support charities) who have reached out to the MPSs due to limited availability of volunteer peer supporters from ethnic minority backgrounds in their organisations. They viewed this as an excellent opportunity to expand their services and capitalise on the skills, training and helping attitude of these volunteers to support mothers from diverse communities and those from migrant backgrounds. The support has been recognised as a pathway to aid the transition back to community services after receiving specialised perinatal mental health input.

The group has evolved to a volunteer group called ‘Friendly Mothers’ who share information about lifestyle and reproductive health matters (doubling in numbers to 40 members so far, as the original ORAMMA MPSs have encouraged more women from ethnic minority backgrounds to volunteer locally), suggesting evidence of adaptation, growth and sustainability. The group’s adaptive capacity has been demonstrated during the COVID-19 pandemic by the setting up of its own WhatsApp facility to aid communication and sharing of knowledge amongst members. The social capital impacts can be seen in the bonding qualities of the relationships, and mutual support established between MPSs and migrant mothers, with the expressed sense of reduced isolation and loneliness whilst being empowered to articulate their needs and pregnancy health concerns. MPSs’ narratives demonstrate personal benefits in terms of skill development, boosts to self-esteem, career-building and satisfaction from having helped vulnerable women at a critical period in their lives. The continued impact has been captured in a recent Migrant Matters Festival – broadcasted ‘virtually’ due to COVID-19 pandemic⁹.

The ORAMMA MPS training materials have been adapted to enhance both the recruitment of peer supporters from ethnic minority groups, also making the training more relevant and culturally sensitive. Furthermore, the training package for healthcare professionals in culturally sensitive care has been delivered in continued professional development sessions to further train General Practitioners within the locality. The training resources also continue to be developed for further online distribution among midwives and other healthcare professionals.