Table 4

Impacts of remote care on equity

Indicator of risk of disadvantageIllustrative quotes
Digital poverty and exclusion
Access to care for women who did not have easy access to devices or video consulting platforms, the credit to connect, or may not have had a device at all
‘There’s constantly a push for things to be digital; and there are huge advantages of that, but, until you make internet free for everyone and give everyone a smart phone, then, you know, the people that really need us are the ones that get left behind.’ H24
‘Some ladies, saying my phone’s not working, my phone’s broken, I haven’t got credit. And then ringing up, well, I couldn’t answer because I’ve got no credit on my phone or without a signal. Those things for the vulnerable women.’ H13
Domestic abuse/violence
For those experiencing domestic abuse, telephone appointments obscured many cues and clues that midwives would be able to pick up on in person
‘Sometimes women appear to be a certain way but once they’ve got your trust you can find out so much and, actually, she might have a dreadful life and sometimes it’s that midwife that helps that woman out.’ H18
‘More often than not their partner didn’t come, and so it provided a safe space for women to talk about their issues at home. And enabled us to pick on subtleties in terms of any domestic abuse, any physical abuse; you know, you’d sometimes be able to see that physically on their body. So, you don’t necessarily see that remotely. And for a lot of people, they don’t have an extra room where they could go in and have their appointment; they might be living in a one-bed bedsit, so a remote appointment is completely inappropriate. So, accessibility was certainly a problem.’ H24
Women who have experienced trauma or previous pregnancy loss‘No, my booking wasn’t face to face. That was over the telephone, and that was more difficult because you have to disclose a huge amount of information. So I was in a violent relationship before and had to tell her all about that over the phone(…)and that’s a lot to do with somebody you’ve never met over the phone.’ W35
Multiple deprivation, cared for a cross multiple agencies‘Most of our ladies are deprived financially, they don’t have any Wi-Fi, they don’t have a smartphone (or laptops) to be able to do that. So a language barrier can be very difficult as well. Because like you got a link sent, that person on the other end might not be able to read English and not be able to understand the simple instructions.’ H30+H31
Sociocultural influences‘So the Asian women that we were looking after prior to lockdown who’ve stayed on as clients, all, one hundred per cent of them, told us they didn’t need our support during lockdown. And the only reason that I can guess that was just because they didn’t have space to talk to us, we’re talking around about 50 women. They’ve said that they wanted to come back when we do face to face again, but they didn’t want support via telephone, video or any online activity.’ M02
Women with learning difficulties or low levels of literacy‘Obviously, the worry with it (provision of additional information online) is that there is always going to be somebody who can’t quite access it because they just don’t do computers or are a bit dyslexic or what have you.’ H04
Language barriers‘I find it hard sometimes depending on the accent to follow through, so I felt like it was really…she was talking really fast, and maybe I could have said, like, for…ask for her to slow down a little bit. But, yeah, I think that the main barrier was actually getting a bit lost in translation, 'cause at the end of the call, for example, I didn't even realise the call was about to end (laugh) (… maybe there was)a sentence that maybe would be obvious for a native speaker, that that was the end of the call, but for me it wasn't. And then I realised I hadn't asked any of my questions, 'cause I was waiting for that moment of, like, do you have any questions (laugh).’ W29