The House of Commons Women and Equalities Committee have published the findings of their inquiry into racial disparity in maternal deaths in a new report, Black Maternal Health. The report calls for action to address the ‘appalling disparity’ in the number of Black and Asian women in the UK who die from pregnancy and childbirth-related causes, compared with women who are White. The Committee reviewed research data, previous reports and heard evidence from maternity leaders in government, NHS, professional bodies, and maternity charity campaigners to try to understand the reasons and challenges associated with disparities in maternal deaths. They also scrutinised the slow progress of government and NHS action taken to date. The Black Maternal Health report acknowledges that there is no single, quick-fix solution but cuts through the commonly used excuses and recommends action to encourage an effective and coherent cross-Government strategy, to start making progress. As the introduction to the report notes, “We do not want to read the same tragic statistics for another 20 years.” Racial disparity in maternal mortality rates Maternal mortality means death of a mother during pregnancy, birth or up to six weeks after the pregnancy ends, from causes which are directly or indirectly related to the pregnancy. Maternal death is relatively rare in the UK but amongst those who have died the Committee described ‘glaring and persistent disparities in outcomes for women depending on their ethnicity’. The rate of maternal death is currently nearly four times higher for Black women than for White women, and almost two times higher for women of Asian and mixed ethnicity. These disparities have existed and been reported for at least 20 years but attracted little attention or government action, until recently when campaigners, such as Five X More and Birthrights, began to publicise the issue and bring it to the mainstream agenda. Maternal deaths in the UK and Ireland are reported by Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries (MBRRACE-UK) annually, with each report based on three years’ data. In 2018 to 2020, there were 229 maternal deaths in the UK out of the approximately 2 million women who gave birth. Every report since 2000 has shown a higher risk of maternal death for mothers from ethnic minority backgrounds. In 2017, the government and NHS set a goal to reduce stillbirths, neonatal and maternal deaths and neonatal brain injuries by 50% by 2025, but little improvement has been made in maternal death rate. MBRRACE-UK’s most recent report shows that maternal mortality (excluding deaths from covid-19) has increased 3% from the 2010–2012 period to 2018–2020. MBRRACE-UK found that compared with White women, Black women were 3.7 times more likely and Asian women were 1.8 times more likely to suffer maternal death. One in nine women who died during or up to a year after pregnancy were at severe and multiple disadvantage, with highest maternal mortality rates amongst those living in the most deprived areas. The most common medical causes were cardiac disease, epilepsy and stroke, and thrombosis and thromboembolism (VTE). MBRRACE-UK’s panel of experts considered that 38% of the women who died might have had a better outcome if they had received better care. What causes ethnic inequality in the maternal death rate? The Black Maternal Health report concludes that the reasons for ethnic disparity in women’s deaths in childbirth are multiple and complex and are not fully understood. The causes of death are the same for women across all ethnic groups but more Black and Asian women are dying. Factors which are thought to increase the risk of maternal mortality for Black and Asian women, over and above the risks to White women, include pre-existing conditions (comorbidity), socio-economic factors such as deprivation, and maternity care that involves ignorance, bias, microaggressions and racism. 60% of the women who suffered maternal death in 2018–20 had pre-existing medical problems. A disproportionate number of the Black and Asian women who died had pre-existing conditions, but the higher prevalence of conditions, such as diabetes and hypertension, in Black and Asian women, did not fully explain the disparities in maternal mortality. The Committee heard from experts who warned that pre-existing conditions and comorbidities are an important part of maternal inequalities but cannot be seen in isolation, as it is dangerous simply to attribute disparities to some single, identifiable ‘genetic’ cause. MBRRACE-UK’s 2022 maternal mortality report confirms the long recognised link between deprivation and poor health. Women living in the most deprived areas have the highest maternal death rates and are 2.5 times more likely to die than women living in the least deprived areas. Ethnicity and deprivation overlap, which means that addressing inequalities in maternity care requires a wider government approach than simply medical solutions. The government recently abandoned its plans to publish a health disparities White Paper, but is now intending to publish a strategy that it says will tackle conditions that contribute most to morbidity and mortality across the population in England and regional disparities in health outcomes. MBRRACE-UK’s maternal deaths reports have also found that Black women were less likely to have received individualised and culturally sensitive care. Common features of their care included being viewed by healthcare staff as ‘not like me’, or of having different pain thresholds, with a lack of consideration of how cultural factors and their socio-economic background affected their needs. Research by campaigners found that large numbers of Black and Asian women report experiences of discrimination and many feel deeply unsafe, such as from failure to recognise medical conditions in black and brown babies and their mothers, during their maternity care. In relation to this issue, the Committee concluded that, “Too many Black women have experienced treatment that falls short of acceptable standards, and we are concerned that the Government and NHS leadership have underestimated the extent to which racism plays a role.” Black Maternal Health report recommendations The Women and Equalities Committee’s Black Maternal Health report’s recommendations to government and the NHS included actions to address the previously reported need for training for health professionals on existing maternal health inequalities, and to challenge prejudices and assumptions based on race. The report also challenged the NHS’s ability to implement its ‘flagship policy’ of continuity of care which was intended to improve maternity care generally whilst specifically targeting the needs of women from BAME and deprived communities during their maternity and post-natal care. The Committee agreed with the findings of the Ockenden Review that despite strong evidence for the benefits of continuity of carer for mothers and babies, the NHS does not currently have enough appropriately skilled maternity staff to deliver it safely or effectively. The Committee also agreed with the Health and Social Care Committee’s Expert Panel’s warning that continuity of carer cannot be seen as the one ‘fix-all’ solution to inequality in maternity outcomes. The Committee’s scrutiny of the government and the NHS’s past and current efforts to address health inequalities revealed a deeply disappointing lack of progress, with every key aspect of the government and NHS’s approach being ‘beset by problems concerning implementation and measurability’ and ‘no overall, focussed strategy for driving down the stark disparities in maternal outcomes.’ The report called for targeted action and greater accountability from government and health leaders, and emphasised that urgent, significant further funding is needed for the NHS to provide safe, equitable care. We welcome the forthright findings of the Black Maternal Health report, and the Women and Equalities Committee’s urgent call to action and accountability. Women throughout the UK should be able to depend on safe maternity care, regardless of their income, postcode, racial and cultural background or skin colour. 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