Factors Contributing to Higher Maternal Mortality and Preterm Birth Rates Among Black and South Asian Women Than Caucasian Women in Leicester: A Narrative Review.

This narrative review aims to explore why ethnic inequalities in preterm birth and maternal mortality are present, specifically among Black and South Asian women within the United Kingdom. We are particularly focusing on Leicester and Leicestershire. This review aims to address the underlying reasons as to why these inequalities are present. Leicester has a high proportion of ethnic minorities compared with the rest of the United Kingdom, making it an important context for exploring disparities in maternity outcomes.  A structured search in Medline (OVID) was conducted using keywords and MeSH terms related to ethnicity, maternal mortality, and preterm birth. Studies conducted only within the UK were included, as no Leicester-specific studies were identified; findings were therefore considered in relation to Leicester's diverse demographic to assess the likely relevance in this setting rather than direct evidence for this population. Overall, 90 studies were screened against the inclusion criteria; 18 studies were deemed relevant; however, due to time constraints, 8 were included within this narrative review.  The findings showed consistent evidence of increased risk of preterm birth and maternal mortality within the Black and South Asian population. Socioeconomic and demographic factors were unable to explain this increased risk. Some studies did show that these ethnic minorities engaged in more positive health behaviors than Caucasian women, therefore suggesting that lifestyle and health factors are not an adequate explanation for these inequalities. Some suggested explanations for these inequalities include language barriers, limited access to care due to a lack of knowledge regarding services available, and negative experiences with the NHS. However, many of these explanations do not fully explain inequalities in ethnic minorities who were born within the UK, who have no language barriers present, and who are aware of the services available. Overall, no definitive cause was found across the studies. Also, no specific study was found in Leicester or the surrounding Leicestershire area.  This review further demonstrates that there is a substantial inequality present in preterm birth and maternal mortality within the UK; however, the exact amount of inequality within Leicester and surrounding areas is unknown due to a lack of research. Given Leicester's exceptionally high minority population, it is plausible that these inequalities may be similar or more prevalent within Leicester and Leicestershire due to the higher ethnic minorities compared with the rest of the UK; however, this remains an inference drawn from wider UK evidence rather than local evidence. This narrative review suggests that multiple complex factors could explain these inequalities; however, it is unlikely that lifestyle factors alone explain these inequalities. Further research is needed, particularly within Leicester, to understand why these inequalities are present and to provide solutions to help remedy these inequalities.