Promoting equity in medical device use during pregnancy
Operating within the department’s Global Health theme, this interdisciplinary research project is jointly led by Prof. Aris Papageorgiou and Prof. Lisa Hinton.
Perinatal and Obstetric Medical Devices: Solutions for Equity (PROMISE)
The PROMISE project investigates how bias in medical devices used during pregnancy and the neonatal period affect health outcomes especially for minority ethnic and socio-economically disadvantaged groups. We will map how these devices are used in clinical settings, gather diverse women’s experiences, and identify specific biases in device performance and access. Working closely with patients, experts, and community groups, we aim to develop clear policy and research recommendations to ensure these technologies support equitable and effective care for all.
Why this project is important?
Despite improvements in overall UK maternity care, outcomes are not equal. The most recent Mothers and Babies: Reducing Risk through Audit and Confidential Enquiries (MBBRACE) report, published in October 2024, highlights ongoing disparities for women from minority ethnic backgrounds and those living in deprived areas, noting that women in the poorest areas face a maternal mortality rate more than double that of women in affluent areas.
These disparities are complex and are not sufficiently addressed by national programmes targeting solely women’s behaviour and access to antenatal care. In fact, research has indicated that systemic biases within the medical system may restrict access to high-quality maternal and neonatal healthcare.
How the PROMISE study can help
To effectively address these inequalities, it is essential to integrate maternity services users’ voices throughout the research process. Including their perspectives will help identify which medical devices are encountered and assess whether biases in their use contribute to disparities in health outcomes.
By starting from the user perspective, the PROMISE study aims to determine if medical devices need to be rethought, redesigned, and delivered in more inclusive ways that ensure equitable maternal and neonatal health outcomes.
Video: Equity in Medical Devices: Independent Review - Purpose and Findings
A short animation outlining the purpose of findings one behalf of Equity in Medical Devices: Independent Review.
A group of patients were involved in the development of this video to make sure it is easily understandable and accessible to a diverse audience.
The Approach
Collaborating with women who have lived experience, clinicians, and key stakeholders in device development, we will devise practical strategies for ensuring equitable access and outcomes. Our work is guided from start to finish by our Patient and Public Involvement (PPI) advisory group, to ensure the research is useful and reflects the real experiences of people affected by bias in medical devices.
Recognising the complexities involved in identifying and addressing equity in medical device use, the PROMISE project is organised into four themes that are thoughtfully structured to triangulate information, thereby fostering a multidimensional approach to tackling bias.
Mapping Medical Device Use
The PROMISE project aims to identify and map medical devices used during pregnancy and the neonatal period from both healthcare system and patient perspectives, producing a detailed guide for further research. The healthcare system approach involves rapid ethnographic research in five diverse hospitals across England, where clinical settings are observed and clinicians are interviewed to understand device use and practices.
In addition, PROMISE surveys midwifery units across the UK using the UK Midwifery Study System (UKMidSS) to gather data on device use patterns and challenges in different settings and populations.
Gathering Women’s and Pregnant People’s Perspectives
Through in-depth interviews with women from diverse backgrounds across the UK, PROMISE explores experiences of medical devices. Using open-ended questions and visual prompts, we investigate knowledge, feelings, and concerns about medical tools encountered during pregnancy and neonatal care.
These findings will highlight how devices impact women’s experiences and inform policy development.
Identifying Bias in Medical Devices
PROMISE examines whether bias exists in the design, performance, or access to medical devices used in maternity care. A rapid review of existing evidence identifies where disparities may influence outcomes.
An expert panel of clinicians, patients, researchers, and regulators then prioritises the devices with the most concerning evidence of bias, considering clinical impact, patient experience, and the strength of available data. These findings guide targeted research and inform policy recommendations.
Inequities in access to medical devices form only one part of the wider problem of inequitable access to the health services that people need, which is largely due to structural biases in the broader health ecosystem. Addressing inequities in access is therefore an essential task for the government and leadership of the NHS. - Equity in Medical Devices: Independent Review – Summary Report, Department of Health and Social Care, 2024
Developing Research and Policy Recommendations
PROMISE works with a broad scientific advisory and PPI panel to translate findings into actionable guidance for equitable device use in maternity care. The project will produce comprehensive white papers, targeted policy briefs, and accessible summaries for both policymakers and the public.
We engage actively with healthcare leaders, regulators, and professional bodies to support the adoption of recommendations. Stakeholder roundtables further facilitate the integration of findings into clinical guidelines and help identify training needs related to equity in device use.
Dissemination and Public Engagement Outputs
Our research will generate a broad range of outputs targeting academic, clinical, public, and policy audiences. These include peer-reviewed publications, conference presentations, and invited talks at national and international forums.
We will produce patient-friendly materials, infographics, and summaries co-developed with our Patient and Public Involvement (PPI) group, and disseminate findings through community networks, charities, and social media. Engagement with stakeholders such as the Royal College of Obstetricians and Gynaecologists, Royal College of Midwives, NHS England, the Department of Health and Social Care, and the NHS Race and Health Observatory will ensure policy impact.
We will also collaborate with the Policy Research Unit and Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries (MBRRACE) to influence clinical practice and national health strategies. Workshops and roundtables will support co-creation of educational resources and ongoing dialogue with public and professional audiences.
Useful links
Independent review of equity in medical devices
Read the full Independent Review of Equity in Medical Devices report.
Equity in Medical Devices - full
Download the full Equity in medical devices: independent review.
Equity in Medical Devices - short
Don't have time for the full version of the Equity in Medical Devices report? Read this summary.
Latest publications
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Illusory finger stretching and somatosensory responses
Journal article
Hansford KJ. et al, (2025), Neuropsychologia, 217, 109243 - 109243
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Effect of supine or semi-recumbent positions on arterial stiffness among pregnant women
Journal article
Ali S. et al, (2025), Pregnancy Hypertension, 41
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Subclinical Postpartum Renal Structure After Hypertensive Pregnancy Disorders.
Journal article
Cutler HR. et al, (2025), Hypertension
The research team
Professor of Fetal Medicine and Director of Research of the Oxford Maternal and Perinatal Health Institute (OMPHI)
MSc by Research Student
Research Assistant
External members of the research team
Associate Professor, senior social scientist in the Nuffield Department of Primary Care Health Sciences, Director of Oxford Qualitative Courses and Research Fellow at Green Templeton College.
Associate Professor Nuffield Department of Primary Care Health Sciences, Director of the NIHR Community Healthcare HRC.
Consultant Obstetrician and Clinical Lead for both Maternity Safety and Maternity Equality, Diversity and Inclusion at Oxford University Hospitals NHS Trust.
PPI Lead. Keji is a bereaved parent and founder of Mayah’s Legacy, a charity established to raise awareness of the often-overlooked mental health impact of pregnancy loss and the inequalities within maternity care.
Research Assistant. Nuffield Department of Primary Care Health Sciences.
Find out more
If you'd like to learn more about the PROMISE project or explore upcoming opportunities to get involved (including PPI opportunities), please get in touch using the link below or contact a member of the team directly.