3.1.3. Women and families in vulnerable situations
In the documents published during the first weeks of the pandemic, there was almost no mention of women and families in vulnerable situations in either country. From the end of March 2020, the attention on women and families in vulnerable situations increased, especially in service-user organisation outputs.
On 22 March 2020, the Dutch organisation Birth Movement published an ethical statement about maternity care during the COVID-19 pandemic, in which they encouraged healthcare professionals to continue to consider exceptions in certain situations; for example, if a pregnant woman had different needs because she was anxious after a previous traumatic birth or a previous stillbirth (GB_1). In response, several professional organisations started to offer advice specifically relating to families in vulnerable situations, e.g., the Royal Dutch Organisation of Midwives published a document on 1 April 2020 in which the objectives of post-partum care during COVID-19 included ‘coping with how birth went, pay attention to the transition to parenthood’ (KNOV_14). In the UK there were similar changes: service user organisations emphasised the need to consider women and families in vulnerable situations following which some professional organisations adjusted their policies.
‘To prevent avoidable suffering – in some cases tragedy – and reduce the huge economic burden on society, the mental health of pregnant women and new mums needs to be given equal priority to physical health, including by mums and families themselves’ (Maternal Mental Health Alliance, MMHA_1, 5 May 2020).
‘Women with known psycho-social vulnerabilities, operative birth, preterm/low birth weight baby and/or other medical or neonatal complexities need to be prioritised for face-to-face care’ (Royal College of Midwives, RCM_14, 20 May 2020).
In June 2020, a study was published that demonstrated that in the UK, women from ‘black or minority ethnic groups’ were significantly more likely to be admitted to the hospital with COVID-19 than other women [4]. In response to this, several UK documents were produced which emphasised that women from black or ethnic minority communities were more vulnerable to COVID-19 infection, were more likely to be hospitalised for COVID-19, and had an increased risk of adverse perinatal outcomes during the COVID-19 pandemic (BR_10, _18; MBRR_1; NHSE_5, _12; NHSR_1; RCM_2, _3, _5, _6, _13, _14, _16, _17, clarifying the increased risk for women from minority ethnic backgrounds, many of these documents also provided recommendations for practice, such as to lower the threshold for admission for women from these groups where necessary (RCM_1, _32, _37; NHSE_5).
In the NL, no data were published about the percentage of women with a Black or other minority background that were hospitalised with COVID-19. In NL documents, there was some emphasis on the increased vulnerability of migrant women, asylum seekers, and women with Dutch as a second language during the COVID-19 pandemic (NVOG_1; KNOV_30), but less attention was placed on vulnerable women in NL documents, compared to those from the UK.