Severe multiple disadvantage

Severe multiple disadvantage

Experiences of domestic abuse, substance use, contact with the criminal justice system and homelessness often overlap. Combinations of these experiences are known as severe multiple disadvantage (SMD), as described in Chapter Two. There is no local or national data on the prevalence SMD during the perinatal period (122).


Many women with experiences of SMD report experiencing co-occurring or recent trauma around the perinatal period, including from domestic abuse and having their babies removed from their care (122).


  • Experiencing SMD during pregnancy is associated with poor maternity outcomes and poorer experiences of maternity care (123). SMD can contribute to feelings of ‘powerless[ness], self-stigmatisation and low self-esteem’, which can make it difficult to navigate the maternity care system (123).
  • Research led by women with experience of SMD highlighted that many women feared and distrusted services, including maternity services; and felt excluded from decision-making (122). They valued compassionate and non-judgemental approaches to care; continuity of carer; specialist midwives; and ongoing support post-birth.
  • Another study in which women with experience of SMD were interviewed about their experienced of pregnancy found that (124):
    • All women brought experiences of prior/current trauma, or ‘very difficult life circumstances’, to their maternity care.
    • Almost all were living in temporary, unstable or unsuitable housing; many described their housing as a central problem in their life that was either causing or exacerbating mental health problems.
    • 1 in 3 were current or recent asylum seekers, who were less likely to be offered support than other women in this study and more likely to have unstable housing.
    • 3 in 4 had experienced situations in maternity services in which their choices were not respected or they were not supported to give informed consent.
    • Over half received some level of continuity of carer, which helped them build trusting relationships.
    • Many were in contact with a range of support services, which could be confusing to manage.


Additional resources


122. Cardwell V, Wainwright L, Doohan D, McNally L, Pinnock T, Power C, et al. Making Better Births a reality for women with multiple disadvantages [Internet]. 2022 [cited 2023 Feb 17]. Available from:
123. Royal College of Midwives. Supporting midwives to address the needs of women experiencing severe and multiple disadvantage [Internet]. 2020 [cited 2023 Mar 13]. Available from:
124. Birthrights, Birth Companions. Holding it all together: Understanding how far the human rights of women facing disadvantage are respected during pregnancy, birth and postnatal care [Internet]. 2019 [cited 2023 Feb 17]. Available from: