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Group 4

a mix of epidemiologists, clinicians, economists and behavioural scientists.

The group broadly agreed with the high ranking of tackling poverty, tackling mental health and addressing barriers to access. expected tackling racism to be higher.

Tackling poverty:

The group suggested that tackling the wider determinants of maternal disparities would require making a health and an economic argument to demonstrate how the existing structural inequalities leads to poor outcomes. Then demonstrate the public health impact of reducing economic inequality.

An argument was made to build the evidence base to influence economic policy change at the national level. For example removal of the 2 child benefit cap. Or greater housing and employment protections for pregnant women.

Disadvantaged communities

The group expanded on the specific issue that women and pregnant people are part of communities where there is intergenerational transmission of mental health risk and poverty. Research which addresses inequality at the community level is required.

KPIs around establishing the impact of reducing economic and regional inequality of access to services.

KPIs on

Mental Health - growing recognition that mental health problems are increasingly being reported, particularly by young women, and women in particular parts of the country. Access to mental health services is limited to those who meet a required threshold. Known issues of racial inequality in screening for and following-up on mental health concerns means some women's mental health issues are not known and women do not receive timely intervention.

KPIs around reducing inequality of access and use of tailored interventions could be set.

Integration of community and secondary care services was seen as a key mechanism to mitigate inequality risks (encompasses continuity of care models, digital integration and better knowledge sharing so that the social circumstances women present with are known and accounted for were also highlighted as themes).

Discussion of climate (ag. air water) how it contributes to inequality and where it should rank took place.

Argument against: is this out of scope and too tentative or far from making a difference to outcomes.

Argument for: if there is evidence that these environmental factors are contributing to maternal disparities then there are actions that can be taken by the consortium to influence policy to improve air quality etc.

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Noted focus on the original purpose.

Themes and principles: there is an overarching set of principles (which themselves may be too broad as themes) which we fully support, addressing poverty, racism, sustainable change etc.

Themes would best stem from an understanding of population need. These populations being those which experience health inequalities. We noted the importance of considering scale when defining groups and how change would be evaluated.

Once populations are agreed, noted the need for clear outcomes that we will look to improve (narrow the inequality).

This too be supported by evidence led approaches and a focus on improving access, experience and outcomes from care for the population groups in question.

Research could focus on addressing barriers to implementation and addressing variation.

Build on known modifiable risk factors and test through a logic model to ensure that planned changes are likely to deliver the intended health gain.

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what makes sense to be a theme - input/approach/outcome/concept? Should this be homogenous across the themes?

not methodological advancement but transformative change therefore should themes be outcome based? Then research questions are based around what would be needed to achieve that outcome. This could help with framing/narrative for the business case.

definitely things that could be combined (e.g. nutrition/obesity) but data and digital are different and could be split.

some of these things e.g. poverty, racism are absolutely vital to tackle for the outcomes, but are these things that are can be changed by a £50m research consortium? no, but we can do tangible things e.g. improve access to maternity care through implementation and evaluation of evidence based interventions (that would need to take these things in to account by co-production, working with underserved communities etc which would be cross cutting themes)

don't waste the 5 years talking about the problem, the focus should be on intervention

How to understand how co-produced interventions work in order to be able to think about how the findings might be transferred to a different underserved population/setting. Understanding what is core v what is adaptable in terms of the intervention, and not just adapting to population (ie ethnicity) but rurality, economics etc

How to share emerging findings about what works within collaboration to enhance speed of adoption.

We can't do everything!! Need to focus on a few things

KPI - need overall for the consoritium eg inequalities, mortality, morbidity, unplanned pregnancy and then more specific KPIs for the themes (which is hard to say what they should be as it depends on theme and research question)

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Within themes or priorities (even those not highlighted above) which resonate within your breakout room:

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Within themes or priorities (even those not highlighted above) which resonate within your breakout room:

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•What KPIs might be useful to consider?

•What research questions do you think we should be trying to answer?

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·  Substance use in pregnancy

·  Immigration and social policies

·  Translation and communication

·  Support for families and partners

·  Postnatal and aftercare services

·  Social influences and connections

·  Service location and accessibility

·  Commercial determinants of health

·  Workplace wellbeing and maternity leave policies

·  Intersectionality of disparities

·  Maternal death

·  Social housing and stability

·  Adolescent pregnancy support

·  Traditional medicine and integrative care

·  Community-based models

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•Any other reflections or ideas to strengthen our approach.

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•Do the selected themes reflect your understanding of the priorities?

•Are there gaps or missing areas we need to address?

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·  Tackling poverty

·  Optimising the climate/environment

·  Improving nutrition

·  Maternal obesity

·  Tackling violence and promoting trauma-informed care

·  Tackling racism

·  Addressing delays and barriers in access to healthcare

·  Workforce development

·  Health literacy

·  Mental health

·  Miscarriage, stillbirth, and infant death

·  Multimorbidity

·  Infant feeding

·  Genetic disorders

·  Pre-pregnancy, pre-conception, and inter-pregnancy care

·  Community engagement and co-production

·  Working with underserved groups

·  Data and digital solutions

·  Addressing variation in clinical healthcare services

·  Improving the integration of the maternity ecosystem