Equal Start Oxford: trusted advocates bridging the gap for migrant mothers

In East Oxford, one in five children grows up in poverty. For migrant mothers, three barriers compound that disadvantage: language, cultural difference, and limited access to services that should support them through pregnancy and early parenthood.

Research by Healthwatch Oxfordshire and Oxford Community Action confirmed what community midwives already knew. Mothers from Black and ethnic minority communities reported feeling unheard by health professionals and struggling with language barriers. Midwives, meanwhile, described being pulled away from pregnancy care by urgent social needs – housing, immigration, domestic safety – they had no capacity to address.

The question was not whether support was needed, but how to build it in a way the community would trust.

Our approach and partners

Early Lives Equal Start launched in late 2022, co-designed from the outset by local mothers, community midwives, and representatives from Oxfordshire Maternity and Neonatal Voices Partnership. It is delivered from Flo's – The Place in the Park, a community hub in Cowley, in partnership with Oxford Community Action and Oxford University Hospitals NHS Foundation Trust (Maternity).

At the heart of the project is a new role: the Maternity Advocate. These are local women, drawn from the communities they serve, trained to provide personalised, rights-focused support on housing, immigration, and domestic violence. They connect families with NHS, statutory, and community services through trusted relationships that formal referral pathways alone cannot build.

Beyond one-to-one advocacy, Equal Start runs antenatal classes with translation, peer-led groups on mental health and child development, first aid training, visits to the local birthing unit, and play-based learning for children. The project also tackled digital exclusion by partnering with Oxford University Hospitals to provide free SIM cards with unlimited data.

The Buckinghamshire, Oxfordshire and Berkshire West Integrated Care Board (BOB ICB) funds the project through the Local Maternity and Neonatal System. The NIHR ARC Oxford and Thames Valley, through its Centre for Research Equity at the University of Oxford, provides evaluation support – facilitating a Theory of Change workshop, developing a logic model, and funding qualitative research and the Maternity Advocates and Community Organisers groups.

What we found – and why it matters

1. Over 100 families now receive support spanning pregnancy through a child's first 1,000 days, with 64 women referred in the project's first eight to ten months alone.
2. Antenatal classes reached 73 women from August 2023, connecting them with previously inaccessible information about NHS services, pregnancy care, labour, and postnatal recovery.
3. The Maternity Advocate role works. Midwives report that sharing complex social needs with trained advocates frees them to focus on clinical care, while families receive more sustained support.
4. Emerging evaluation evidence secured additional ICB funding – including investment in formal qualifications for community members acting as translators, recognising skills that were previously invisible to the system.
5. NHS England featured Equal Start Oxford as a case study in its national toolkit for improving postnatal care, published in January 2026.

What this means

Equal Start demonstrates that trusted relationships – built by people who share a community's language and lived experience – can reach families that statutory services alone do not. Mothers access antenatal education, midwives focus on clinical care, and children enter life with stronger support around them. The model shows that relatively modest investment in community infrastructure can shift how a local system works for its most underserved families.

What needs to happen next

A formal evaluation report due in 2026 will be critical for making the case for sustained funding. The project team is pursuing social finance through Oxford University Hospitals to secure the model beyond current commissioning cycles.

Other areas are already watching. Buckinghamshire is exploring how to establish similar initiatives, and discussions across England suggest the community advocate model could be adapted for wider determinants of health. For that to happen, commissioners need to see the evidence – and be willing to fund community-rooted, relationship-based work that does not fit neatly into conventional service specifications.

Lessons for future research

Community projects like Equal Start keep applied researchers grounded in what impact looks like beyond publications.

The ARC's role here was not to design an intervention but to bring evaluation expertise to a community-led initiative – helping it articulate its theory of change, gather evidence, and build the case for continuation. That model of responsive evaluation support is one other research organisations could usefully adopt.