Persistent inequalities and poorer maternal outcomes among women who speak languages other than English (LOTE) in the UK have been identified as being shaped, in part, by inadequate interpreting provision. While video-mediated interpreting (VMI) is often presented as a solution to access barriers, far less attention has been paid to a more fundamental question: how are decisions actually made about when, how, and by whom interpreting is used in practice?
Drawing on a transformative mixed-methods doctoral study conducted between 2019 and 2022, this seminar examines interpreting as an outcome of organisational decision-making rather than as a neutral communicative add-on. The research engaged eight stakeholder groups across maternity services, including LOTE-speaking women and families, support workers, maternity professionals, bilingual health advocates, interpreters, language service providers, trainers, and a commissioner, through interviews (n=47), surveys (n=189), focus groups, an ethnographic case study of VMI implementation in an NHS Trust, service provision records, and documentary analysis.
The findings demonstrate that modality choices (in-person, audio, video) are rarely determined by care or clinical needs alone. Instead, interpreting use emerges from intersecting organisational logics: procurement arrangements, infrastructural constraints, risk management practices, professional hierarchies, and assumptions about efficiency. These dynamics shape what I conceptualise as interpreting configuration engagement, the patterned ways in which interpreting modalities and providers are selected, combined, or bypassed in maternity care.
By shifting analytical attention from feasibility to decision-making, the seminar argues that persistent inadequacies in maternity language services cannot be understood solely as resource deficits or technological limitations. Rather, they reflect systemic constraints embedded in how interpreting is organised, commissioned, and operationalised within the NHS.
The presentation concludes by reflecting on the implications of this systemic perspective for interpreting studies and healthcare communication research, and considers how we might more fully theorise interpreting as organised work within institutional systems. It also outlines how this framework is being extended in ongoing research to examine interpreting governance and modality decision-making beyond maternity care.
