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No description available.

Addressing modifiable factors in perinatal mortality is a key priority for commissioners and service providers, aiming to improve birth outcomes and reduce preventable deaths (Department of Health, 2016; National Maternity Review, 2016). Luton, a town with a plural population, experiences higher rates of perinatal mortality than the national average (CDOP, 2015). Figures show an ethnic variation; Pakistani and Bangladeshi mothers experience higher rates of perinatal mortality in England compared with White British mothers, and the reasons for this are unclear. Much of the existing literature approaches the problem by examining individual risk factors quantitatively or exploring South Asian women’s experiences qualitatively. There is little research considering how Pakistani, Bangladeshi and White British women’s health beliefs impact on their health behaviour through the maternity care pathway, in Luton, and how this might contribute to perinatal mortality. This study takes an intersectional approach, using a convergent mixed-methods research design, reviewing retrospective secondary data (2008-2013) from the Luton and Dunstable Hospital NHS Foundation Trust’s Circona Maternity information System, to identify risk factors for perinatal mortality in Luton. Additionally, focus groups were conducted with lay women (aged over 16, living in LU1-LU4, who had experienced a live birth, at 37 weeks of gestation in the previous 6-24 months), and face-to-face interviews were held with bereaved mothers (aged over 16, who suffered an infant bereavement in the preceding 6-24 months, living in LU1-LU4). Health care professionals working on the maternity care pathway also took part in focus groups or interviews, providing their views on the service needs of Pakistani, Bangladeshi and White British women. The results/findings showed that risk factors varied according to ethnicity. Pakistani mothers had a greatest number of risk factors i.e. birthweight, diabetes, gestational diabetes, BMI < 18kg/m2, parity two, three and four and later booking (> 12 weeks). Deprivation featured in 81% of all deaths in 2014. The findings with the mothers revealed mostly similarities among women, regardless of their ethnicity; the majority of women wanted more pregnancy-related information, especially in respect of stillbirth and adverse outcomes. Similarly, bereaved mothers regardless of their ethnicity also reported mostly similarities, which included experiencing intuition when things were not right with the pregnancy. A few differences according to ethnicity were also identified, which focused on cultural or religious needs, such as cultural therapies (mostly dietary restrictions) undertaken by Pakistani and Bangladeshi women. The intersectional approach allowed simultaneous and aggregated factors (i.e. heritable, socio-economic status, structural factors and health beliefs and health behaviours) to be exposed; staff believed Pakistani and Bangladeshi women were not proactive in seeking pregnancy-related information, relying on verbal information and staff assumed mothers were literate and understood health messages. The intersected findings also revealed that few women took folic acid preconception, and many women co-slept with their baby. This study contributes new knowledge to the understanding of how Pakistani, Bangladeshi and White British women’s health beliefs influence their health behaviour, and contributes to perinatal mortality in Luton.

This research explores how race, class arid gerider act together in constructing black women's experiences of managing health arid everyday life. The methodology takes a feminist perspective, rendering the women interviewed subjects rather than objects. This is central for acknowledging and countering our different experiences of race arid class. One finding was that for women, health is inseparable from everyday life. Maintaining health is integral to the emotional arid material reproductiors of the family. In this management of everyday life the women Interact with a range of 'resources' which are themselves historically structured. This led to a consideration of the theoreti cal nature of resources. Following Giddens, 'resource' is used to provide a conceptual bridge between individual arid social structure. Resources are differentially distributed along the lines of race, class arid gender arid are the media through which power is exercised arid structures of domination reproduced. Resources may, however, be both enabling arid constraining. This use of resources avoids a deterministic view of r-ace, class and gender, allows a dynamic coriceptualisatior, of culture, arid refutes the labelling of the black family as 'pathological'. Rather, black family or-garsisatiori enables the coristructiori of black women's ideology of emotional and material independence. Then detailed are the women's childhood and migration experiences. Also consider-ed as resources for managing everyday life are sever-al areas of health care. These are Caribbean systems, home remedies, OPs arid hospitals. The analysis of these experiences provides a framework for- exploring their- relation to private medicine. Finally, a brief overview is giver, of the wider areas of everyday life which the women felt integral to their- accounts of managing health. The research concludes by suggesting that these women's experiences illustrates both the way in which resources are differentially structured by race, class and gender and how this constructs their experience of managing health and daily life.

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No description available.

Ethnic minorities in the UK Parliament are numerically under represented, despite recent increases in the number of Black and Minority Ethnic (BME) Members of Parliament in the 2010 and 2015 General Elections. This under-representation is a problem for several reasons but especially because of the possibility that their interests are not adequately represented. In this thesis I ask the complex question of how, why, and when substantive representation of ethnic minorities takes place in the Parliament of the United Kingdom, using a multi-pronged approach. I draw on theories and concepts developed in studies of representation of other historically marginalised groups, including female political representation, gaining insights mainly from those writing in Europe and the USA. In the first of four empirical chapters I examine substantive representation by those Members of Parliament from BME communities, and who thus are descriptive representatives of those communities. Second, I explore substantive representation amongst those who operate as critical actors, who are not necessarily descriptive representatives of these communities. Third, I ask whether Members of Parliament respond in the same way to BME constituents. Finally, I test certain mechanisms that have been proposed as factors underlying substantive representation. I find considerable evidence for a link between descriptive and substantive representation, with BME Members of Parliament responding in ways that are different from their non-BME counterparts when critical events occur, in the way that they speak about and represent ethnic minorities in debates (Chapter 3). I also find that non-BME Members of Parliament, or their offices, are less responsive to an ethnic minority constituent, even when the question asked of the representative is of critical importance (Chapter 5). In each of these chapters I find evidence that both electoral incentives and the political party of the Member of Parliament are important. I also look at substantive representation without descriptive representation, or the potential for non-BME representatives to act for ethnic minorities. I find, in Chapter 4, that these critical actors are most likely to be in the Labour Party and represent ethnically diverse seats, as well as being most often found among BME Members of Parliament. In Chapter 6 I test certain mechanisms proposed as underpinning the relationship between descriptive and substantive representation. There, I find good evidence supporting intrinsic mechanisms; linked fate and a sense of responsibility to represent, and some evidence for electoral incentives as a mechanism. By taking this multi-pronged approach I am able to capture how the substantive representation of ethnic minorities takes place in the UK Parliament, from initial contacts between constituents and their Members of Parliament to how their interests are presented in the House of Commons. Substantive representation is, I argue, a journey, although not necessarily a linear one, which involves constituents' attitudes, how they communicate their concerns to their representatives, and how their representatives communicate them to Parliament. The approach I have taken has allowed me to understand how substantive representation happens at these different stages, and explore why and when representatives are motivated to act for ethnic minorities.

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This thesis is about the experience of Muslim British Pakistani families coping with thalassaemia (a chronic, inherited blood disorder) and the implications for service delivery. Its central concern is to illustrate that simplistic and culturally-biased assumptions are an unsatisfactory base on which to devise health service delivery for minority populations, and that with careful study it is possible to deliver culturally sensitive and appropriate services. The thesis is written in four parts. The first part contains the research methods and the clinical aspects of thalassaemia. It also provides an introduction to the families in the study. The British Pakistani population is considered in the context of migration to Britain, which has created a plural society requiring adaptations to services to meet the diverse health needs of the different ethnic minorities. The second part deals with the socio-economic and cultural background of British Pakistanis in Pakistan: this (is) crucial to an understanding of their present situation. Family dynamics, marriage patterns and decision-making processes are explored, as is the central role of religion and kinship networks in the lives of British Pakistanis. It also examines their settlement process and present living conditions and illustrates how the social structures prevalent in Pakistan have been re-established in England, albeit in a modified form. The third part documents, using case studies, the experiences of British Pakistani families with thalassaemic children. These are analysed to highlight deficiencies in health service delivery and areas where cultural misconceptions exist. These areas require attention to provide an effective genetic counselling service for this population. The final part examines the social and clinical implications of consanguineous marriage. It gives the results of a study showing increased frequency of consanguineous marriage among British Pakistanis than among Pakistanis in Pakistan. It then illustrates how kinship networks within communities practising this marriage pattern provide an opportunity to offer a genetic counselling service in a unique way, by making positive use of the practice. This proposed approach applies not only to thalassaemia but also to other inherited diseases.