The material in this series of papers is derived from a Department of Health funded evaluation of the MIDIRS Informed Choice leaflets (Kirkham and Stapleton, 2001). The ‘inverse care law’ was first described over 30 years ago (Hart, 1971) and this paper reveals how little has changed in respect to the pregnancy and related health needs of the poorest and most marginalised women. Inequalities in the delivery of maternity care are examined and examples of midwifery practices which support, rather than challenge, service-related inequity are described. The assumed correlation, made by many midwives in this study, between a woman's social class and her knowledge base was not supported by data from the randomised, controlled trial. The stereotyped assumptions midwives made, however, had a direct and negative impact on the care of materially deprived women. The pressures upon midwives' time and the organisational constraints on their practice hindered the development of trusting relationships with those women most in need of strong midwifery support.
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Kirkham et al. (2002) studied this question.