Pregnancy and complex social factors

Short Text

Pregnancy and complex social factors: a model for service provision for pregnant women with complex social factors


This pathway covers service provision for pregnant women with complex social factors.
The NICE Pathway on antenatal care outlines the care that women should be offered during pregnancy. However, pregnant women with complex social factors may have additional needs. This pathway sets out what healthcare professionals as individuals, and antenatal services as a whole, can do to address these needs and improve pregnancy outcomes in this group of women. This pathway has been developed in collaboration with the Social Care Institute for Excellence and will also be of relevance to professionals working in social services and education/childcare.
The pathway applies to all pregnant women with complex social factors and contains a number of recommendations on standards of care for this population as a whole. However, four groups of pregnant women were identified as exemplars:
  • women who misuse substances (alcohol and/or drugs)
  • women who are recent migrants, asylum seekers or refugees, or who have difficulty reading or speaking English
  • young women aged under 20 years
  • women who experience domestic abuse.
Because there are differences in the barriers to care and particular needs of these four groups, specific recommendations have been made for each group. Specific issues addressed in the pathway include:
  • the most appropriate healthcare setting for antenatal care provision
  • practice models for overcoming barriers and facilitating access, including access to interpreting services and all necessary care
  • ways of communicating information to women so that they can make appropriate choices
  • optimisation of resources.

Source guidance

The NICE guidance that was used to create the pathway.
Pregnancy and complex social factors. NICE clinical guideline 110 (2010)

Quality standards

Quality statements

Effective interventions library

Successful effective interventions library details



These resources include support for commissioners to plan for costs and savings of guidance implementation and meeting quality standards where they apply.
These resources will help to inform discussions with providers about the development of services and may include measurement and action planning tools.

Education and learning

NICE produces resources for individual practitioners, teams and those with a role in education to help improve and assess users' knowledge of relevant NICE guidance and its application in practice.

Pathway information

Information for the public

NICE produces information for the public that summarises, in plain English, the recommendations that NICE makes to healthcare and other professionals.
NICE has written information for the public explaining its guidance on:

Patient-centred care

Patients and healthcare professionals have rights and responsibilities as set out in the NHS Constitution for England – all NICE guidance is written to reflect these. Treatment and care should take into account individual needs and preferences. People should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals. If the person is under 16, their family or carers should also be given information and support to help the child or young person to make decisions about their treatment. Healthcare professionals should follow the Department of Health's advice on consent. If someone does not have capacity to make decisions, healthcare professionals should follow the code of practice that accompanies the Mental Capacity Act and the supplementary code of practice on deprivation of liberty safeguards.
For young people moving between paediatric and adult services, care should be planned and managed according to the best practice guidance described in the Department of Health’s Transition: getting it right for young people.
Adult and paediatric healthcare teams should work jointly to provide assessment and services to young people. Diagnosis and management should be reviewed throughout the transition process, and there should be clarity about who is the lead clinician to ensure continuity of care.

Updates to this pathway

11 March 2014 Minor maintenance updates.
2 January 2014 Minor maintenance updates.
22 October 2013 Minor maintenance updates.
22 February 2013 Minor maintenance updates

Supporting information


Examples of complex social factors in pregnancy include: poverty; homelessness; substance misuse; recent arrival as a migrant; asylum seeker or refugee status; difficulty speaking or understanding English; age under 20; domestic abuse. Complex social factors may vary, in both type and prevalence, across different local populations.
An incident of threatening behaviour, violence or abuse (psychological, physical, sexual, financial or emotional) between adults who are or have been intimate partners or family members, regardless of gender or sexuality. It can also include forced marriage, female genital mutilation and 'honour violence'.
Women who moved to the UK within the previous 12 months.
Morbidity that has a lasting impact on either the woman or the child.
Regular use of recreational drugs, misuse of over-the-counter medications, misuse of prescription medications, misuse of alcohol or misuse of volatile substances (such as solvents or inhalants) to an extent where physical dependence or harm is a risk (to the woman and/or her unborn baby).

Pregnant women with complex social factors

Pregnant women with complex social factors

Pregnant women with complex social factors

Offer all women routine antenatal care in line with the antenatal care pathway. The pregnancy and complex social factors pathway specifies the care that women with complex social factors should receive that is additional to routine antenatal care.

Source guidance

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What discourages some pregnant women with complex social factors from using antenatal care services

What discourages some pregnant women with complex social factors from using antenatal care services

What discourages some pregnant women with complex social factors from using antenatal care services

  • They are overwhelmed by the involvement of multiple agencies.
  • They are not familiar with antenatal care services.
  • They have practical problems that make it difficult for them to attend antenatal appointments.
  • They find it hard to communicate with healthcare staff.
  • They are anxious about the attitudes of healthcare staff.

Source guidance

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How can these problems be addressed?

How can these problems be addressed?

Patient experience in adult NHS services pathway

View the 'Patient experience in adult NHS services overview' path

Paths in this pathway

Pathway created: March 2012 Last updated: March 2014

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