Human Rights, Equality, Anti-Discriminatory & Culturally Sensitive Care
Key Takeaways
The Human Rights Act 1998 requires NHS bodies and staff to act compatibly with Convention rights, including Article 8 respect for private and family life.
The Equality Act 2010 protects nine characteristics, including pregnancy and maternity, race, religion or belief, disability and sex, in England, Wales and Scotland.
Midwives must challenge discriminatory behaviour, make reasonable adjustments, and use professional interpreters rather than family members, especially children.
Maternity care is always treated as immediately necessary under NHS charging rules, so it must never be withheld or delayed because of immigration status.
Under Doogan (2014), conscientious objection to abortion covers only hands-on participation, and the NMC Code requires the midwife to arrange care by a colleague.
Human Rights, Equality, Anti-Discriminatory & Culturally Sensitive Care
The Future Midwife standards expect midwives to promote and protect the human rights of women and newborn infants at all times, including sexual and reproductive rights (1.3), to challenge discriminatory behaviour (1.8), and to give culturally sensitive, individualised care to every woman, partner and family, whatever their social situation (3.27). These duties sit alongside the NMC Code's requirements to treat people as individuals, uphold their dignity and avoid making assumptions.
The Human Rights Act 1998
The Human Rights Act 1998 brings the rights in the European Convention on Human Rights into UK law. Under section 6, public authorities, including NHS trusts, health boards and the staff who work for them, must act compatibly with these rights. The Articles most relevant to maternity care are:
| Article | Right | Maternity Example |
|---|---|---|
| Article 2 | Right to life | Systems for recognising and escalating deterioration, such as early warning charts and escalation policies. |
| Article 3 | Freedom from torture and inhuman or degrading treatment | Never leaving a woman in soiled bedding or without pain relief she has requested; never performing procedures without consent. |
| Article 5 | Right to liberty | A woman with capacity cannot be detained in hospital simply because she declines advice. |
| Article 8 | Respect for private and family life | Choices about place of birth, who is present, intimate examinations and confidentiality. |
| Article 9 | Freedom of thought, conscience and religion | Respecting religious beliefs, for example about blood products or modesty. |
| Article 14 | Freedom from discrimination in the enjoyment of these rights | Ensuring that care is not worse because of race, disability, age or other status. |
The European Court of Human Rights has confirmed that Article 8 covers the circumstances of giving birth. In Ternovszky v Hungary (2010), the court found that the right to respect for private life includes the right to choose the circumstances in which to give birth. Most Convention rights are qualified, so they can be limited only when this is lawful, necessary and proportionate. This is why decisions to restrict a woman's choices must be justified, recorded and reviewed.
Sexual and Reproductive Rights
Sexual and reproductive rights include the right to decide whether and when to have children, to access contraception and accurate information, to have care in pregnancy and birth that is free from coercion and violence, and to make decisions about pregnancy, including abortion within the law:
- In England, Wales and Scotland, abortion is governed by the Abortion Act 1967.
- In Northern Ireland, abortion was decriminalised in 2019 and is now provided under the Abortion (Northern Ireland) Regulations 2020.
- Under section 4 of the Abortion Act 1967, a person may conscientiously object to participating in treatment, but not to treatment needed to save life or prevent grave permanent injury.
- In Greater Glasgow Health Board v Doogan [2014] UKSC 68, the Supreme Court held that "participate" means taking part in a hands-on capacity. The right does not cover supervisory, administrative or managerial tasks associated with abortion care.
- The NMC Code (4.4) requires a midwife with a conscientious objection to tell colleagues, her manager and the person receiving care, and to arrange for a suitably qualified colleague to take over, so care is never delayed.
The Equality Act 2010
The Equality Act 2010 applies in England, Wales and Scotland (Northern Ireland has separate equality laws). It protects people from discrimination because of nine protected characteristics:
- Age
- Disability
- Gender reassignment
- Marriage and civil partnership
- Pregnancy and maternity
- Race (including colour, nationality and ethnic or national origin)
- Religion or belief
- Sex
- Sexual orientation
Forms of Unlawful Conduct
- Direct discrimination: treating someone less favourably because of a protected characteristic (for example, assuming a Black woman has a higher pain threshold and delaying analgesia).
- Indirect discrimination: applying a rule that applies to everyone but disadvantages a group without a fair justification (for example, offering antenatal classes only in English, with no alternative).
- Harassment: unwanted conduct that violates dignity or creates a hostile environment.
- Victimisation: treating someone badly because they made or supported a complaint about discrimination.
- Failure to make reasonable adjustments for disabled people, such as longer appointments, easy-read information, accessible rooms or a British Sign Language interpreter.
Service providers must not treat a woman unfavourably because she is breastfeeding, which supports the midwife's duty to protect breastfeeding in all settings. Public bodies also have the Public Sector Equality Duty (section 149), which requires them to have due regard to the need to eliminate discrimination, advance equality of opportunity and foster good relations.
In England, the Accessible Information Standard requires NHS organisations to identify, record, flag, share and meet the communication needs of people with a disability, impairment or sensory loss.
Recognising and Challenging Discrimination
MBRRACE-UK reports repeatedly show that women from Black and some minority ethnic groups, and women living in deprived areas, are more likely to die or experience severe harm. Enquiries highlight that women's concerns are sometimes not heard or believed, that interpreters are not used, and that stereotypes affect clinical decisions. The charity Birthrights described these patterns in its 2022 inquiry into racial injustice in maternity care.
Midwives challenge discrimination by:
- Listening to and believing women, taking reported symptoms seriously and escalating concerns promptly.
- Recognising bias: using skin assessments that do not rely only on redness or pallor, because signs such as jaundice, cyanosis and rashes can look different on darker skin.
- Speaking up: challenging discriminatory comments or practices from colleagues, using the trust's raising-concerns route or the Freedom to Speak Up Guardian if needed.
- Recording and reporting: documenting concerns accurately and reporting incidents where discrimination may have affected care.
Culturally Sensitive and Individualised Care
Cultural sensitivity means asking, not assuming. A woman's culture, faith, family structure and previous experiences can shape her preferences about modesty, who is present at the birth, diet, fasting, birth rituals and infant feeding. Good practice includes:
- Cultural humility: recognising that the woman is the expert in her own beliefs, and avoiding stereotyping based on her ethnicity or religion.
- Professional interpreters: using trained interpreters for all clinical conversations, including safeguarding and consent. Family members, and especially children, should not interpret, because accuracy and confidentiality cannot be assured and abuse may be hidden.
- Faith-based decisions: for example, a Jehovah's Witness who declines blood products should have an individual plan made early in pregnancy, covering alternatives such as optimising haemoglobin, cell salvage and early escalation if bleeding occurs.
- Inclusive language: respecting how people describe themselves and their families, including same-sex parents and trans or non-binary people who are pregnant.
Access to Care for Migrant Women
Women who are asylum seekers, refugees, undocumented migrants or overseas visitors can face fear of charges, language barriers and frequent moves. Under the NHS charging regulations in England, maternity care is always treated as immediately necessary, so it must never be refused or delayed because of a woman's immigration status or ability to pay, even though charges may later be raised. Midwives can help by explaining this clearly, linking women with specialist midwives and voluntary organisations, and ensuring records follow women who move.
Gypsy, Roma and Traveller Communities and Other Marginalised Groups
Women from these communities often experience poorer outcomes and lower uptake of screening. Flexible appointments, continuity of carer, outreach and trusted community link workers help women to access care.
A midwife has a conscientious objection to abortion. She is working on a ward where a woman is having a medical termination for a severe fetal anomaly. Which statement reflects UK law and the NMC Code?
She may refuse to book the woman's bed, order drugs or allocate staff, because any connection with abortion care is covered by conscientious objection
She may decline hands-on participation, but must tell colleagues and her manager and ensure a suitably qualified colleague takes over, and must still give emergency care
She may refuse all care for the woman for the whole shift, including observations and pain relief, because of her beliefs
She must participate fully, because conscientious objection does not apply to midwives under the Abortion Act 1967
A woman who speaks limited English attends a booking appointment with her 12-year-old son, who offers to interpret. What is the most appropriate action for the midwife?
Accept the son as interpreter to avoid delaying the appointment
Ask the woman's partner to interpret by telephone instead
Use simple English and gestures because an interpreter is not legally required
Arrange a professional interpreter and avoid using family members, especially children, for clinical conversations
An undocumented woman at 30 weeks' gestation tells a community midwife that she is avoiding the hospital because she fears she will be charged and reported. What should the midwife explain?
Maternity care is treated as immediately necessary and must not be refused or delayed because of immigration status, although charges may be raised later
She must pay for all care in advance before any further antenatal appointments can be booked
She can receive care only in an emergency, so routine antenatal checks will not be available
She should wait until labour starts and then attend the emergency department to avoid charges
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