Saving Mothers' Lives: - Public Health Agency for Northern Ireland

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1 Which mothers died, and why
and cultural and geographical isolation meant they were also probably unaware of the maternity services
available and where and how to access them. In this triennium at least one other such woman appears to
have died for the same reasons. In previous Reports the majority of these women came from Thailand, but
in this triennium three Vietnamese women also died.
New countries of the European Union (EU)
There were several maternal deaths of women who had recently arrived from countries newly admitted to
the European Union. This refl ects the experiences of the maternity services in general who report rising
numbers of women from the expanded EU, many of whom do not speak English. As there are now 49
countries in Europe, with some of the best and poorest maternal health outcomes in the world, providing
translation services is an ever increasing challenge. For the fi rst time in this Report, there were a few
maternal deaths in women from Turkey, an EU accession country.
“Health tourism”
Deaths amongst pregnant women who had specifi cally travelled to the UK for NHS health care is a new
category for this Enquiry. There were at least fi ve cases where women with pre-existing or past medical
or obstetric complications came to the UK for NHS treatment. From the case details provided it is also
possible six other women, who claimed to be refugees, may have entered the UK in order to obtain
medical assistance. One European holiday maker, early in pregnancy, died of a pulmonary embolism
shortly after her arrival.
Translation
Thirty-four women who died from maternal causes, another six who died from Coincidental causes, and
eight who died some months after childbirth spoke little or no English. Very few had access to translation
services and in most cases family members or friends were used as interpreters. Several of these were the
woman’s own children, who may have been the only family members who could speak English. The use of
family members or friends as translators causes concern because:
• The woman may be too embarassed to seek help for intimate concerns or discuss her past history
• It is not clear how much correct information was conveyed to the woman as the person who was
interpreting did not have a good grasp of the language, or may have withheld information. In some
cases the woman’s pre-existing medical condition meant she was at considerable risk
• In some cases the translator was a perpetrator of domestic abuse against his partner, thus not
enabling her to ask for advice or help
• It is not appropriate for a child to translate intimate details about his or her mother and unfair on
both the woman and child.
Cultural practices and /or attitudes of male partners
Some women who died seemed to have been denied access to care because of cultural beliefs and
practices where the responsibility for decision-making fell to their husbands or other family members. This
was especially true for women who could not speak English. For example:
A pregnant woman who spoke no English had a port of arrival chest x-ray which was indicative
of cardiac disease. Her English speaking husband was told by the port authorities that she