Exploring women’s views and experiences of language barriers in high income maternity care settings: a qualitative systematic review and thematic synthesis

In high-income countries (HIC), an increasing number of women giving birth require support to communicate in the host-country language. Interpreter services and translated resources should be provided for all who require them in healthcare settings. However, interpreter and translation provision in maternity services remain inconsistent. Language barriers are associated with poorer birth outcomes and contribute to maternal morbidity and mortality. This qualitative systematic review and synthesis explored women’s experiences of language barriers in high-income maternity settings. Systematic searches across six electronic databases yielded 2652 results between January 2013 and November 2025. Two reviewers independently screened titles, abstracts, and full text against eligibility criteria, resolving discrepancies through discussion with team members. Data were analysed using interpretive thematic synthesis and reported and interpreted against the Socio-Ecological Model framework. Eighty-four studies (86 articles) encompassing 1,801 women’s voices from 22 HICs were included. Themes were integrated into a model describing outcomes for women based on interactions with maternity services and interpreting provision in the context of language barriers. Women’s experiences of maternity services in the context of a language barrier were mediated by two key factors: 1) interactions with professional interpreters and 2) ‘Work arounds’ in the absence of a professional interpreter. Women frequently reported inadequate or lack of interpreter and translation provision, inconsistent communication and system-level failures to recognise and address linguistic needs. These experiences contributed to disengagement, isolation and reduced trust in services, while increasing perceived and actual risk for women and infants. The model illustrates how structural and organisational constraints perpetuate inequalities in maternity care. This synthesis highlights the inconsistency in provision of professional interpreting services and how this perpetuates disparities in care in high-income maternity settings. Institutional and individual level understanding of language barriers may contribute to perpetuating lack of access to safe care for women. System and personal changes are required to improve equity, understanding, and safety in maternity care. Appropriate, effective, 24/7 interpreter services and enhanced cultural awareness among healthcare providers are essential. Failure to address language barriers negatively impacts women’s maternity experiences leading to disengagement and isolation of women, increasing risks to safety. This review was prospectively registered on PROSPERO (CRD42023416095).