Pre-pregnancy primary care and accident and emergency interactions among interpreter-users versus non-interpreter-users in England: a retrospective cohort study

Introduction

Non-English-speaking migrant women who need interpreters face healthcare barriers, exacerbating maternal health inequalities. Primary care-based preconception interventions can reduce preconception risk factors but require patient engagement, which has been affected by COVID-19. We aimed to identify whether women interact with general practice (GP) and accident and emergency (A&E) in the year pre-pregnancy, differences between interpreter-users and non-interpreter-users, and changes during COVID-19.

Methods

English population-wide linked patient-level administrative data including primary, secondary and maternity care were used. Women with estimated pregnancy start dates from 1 March 2019 to 29 February 2024, aged 18–49 were included.

Outcomes were interactions with GP and A&E in the year pre-pregnancy (yes/no) according to interpreter-use. Outcomes were recorded according to pregnancy start date: 1 March 2019 to 29 February 2020 (pre-pregnancy-year pre-COVID-19-onset), 1 March 2020 to 28 February 2021 (pre-pregnancy-year overlapping with COVID-19-onset) or 1 March 2020 to 29 February 2024 (pre-pregnancy-year after COVID-19-onset). Logistic regression compared GP/A&E interaction pre-pregnancy among interpreter-users versus non-interpreter-users.

Results

Among 2 182 280 women, 61 140 (2.8%) used interpreters. Median age was 31.0 among interpreter-users and 30.9 among non-interpreter-users. 49.7% (n=30 370) of interpreter-users were in the most deprived quintile versus 22.7% (n=480 470) of non-interpreter-users, and 62.5% (n=38 150) were of ethnic minorities (excluding white minorities) versus 22.1% (n=468 530) of non-interpreter-users.

79.5% (n=48 625) of interpreter-users interacted with their GP pre-pregnancy, versus 85.0% (n=1 802 925) of non-interpreter-users. Interpreter-use was associated with lower adjusted odds of GP interaction (aOR 0.74 (95% CI 0.72 to 0.75)), with lower odds among women whose pre-pregnancy year was post-COVID-onset.

Adjusted odds of A&E interaction in the year pre-pregnancy were lower among interpreter-users, with minimal change during COVID-19.

Conclusions

Although interpreter-users were less likely to interact with GP, indicating barriers to healthcare access, most still did, making GP a promising avenue for addressing preconception health. Ensuring interpreter-need is recorded at GP registration is important. Widening inequalities since COVID-19 suggest a proactive approach is required to reduce inequalities.