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Written on 10th November 2021 by Susan Brown

In October 2021, MBRRACE-UK published their latest Perinatal Mortality Surveillance Report. The report focussed on births in 2019 where the baby was stillborn or died within 28 days after birth. They found that 2019 saw an overall improvement in the UK’s stillbirth and newborn (neonatal) death rates, but stark differences in a mother’s risk of losing her baby based on whether she lives in a deprived area, her ethnicity and age.

Reduction in stillbirths and neonatal (newborn) deaths

In general, MBRRACE found the following improvements in the rates of stillbirths and neonatal deaths:

  • 18% drop in the overall death rate for babies over the six years from 2013 to 2019, or 770 fewer deaths in 2019;
  • Over two fifths of the improvement has been since 2017, as a result of initiatives to reduce baby deaths in the UK;
  • Stillbirth rates have dropped by just over 20% from 2013 to 2019, or 610 fewer stillbirths in 2019;
  • 12% drop in neonatal deaths from 2013 to 2019, or 160 fewer newborn deaths in 2019.

How late in pregnancy did the stillbirths and neonatal deaths occur? 

  • The drop in the stillbirth rate was mainly due to a 19% drop in babies who were stillborn at term (from 37 weeks).
  • For newborn babies, the largest improvement came from a 14% drop in newborn deaths of babies born very premature between 28 and just under 32 weeks.
  • 75% of stillbirths and 73% of neonatal deaths related to preterm births (before 37 weeks).
  • 38% of stillbirths and 46% of neonatal deaths were extremely premature babies from 22 to nearly 28 weeks.

How did living in a deprived area affect the risk of losing a baby before or after birth?

Even though the overall figures showed a drop in stillbirth and neonatal death rates:

  • Women living in the most deprived areas were twice as likely to have a stillbirth compared with babies whose mothers lived in the least deprived areas;
  • Their newborn babies also had an extra 73% risk of neonatal death, compared with babies born to women living in the wealthiest areas;
  • The smallest improvement in death rates occurred for those who were deprived, and their extra risk was increasing, causing the gap to widen even more;
  • There was a direct link between greater deprivation and increasing stillbirth and neonatal death rates across all years.

Did ethnicity make a difference to the risks of stillbirth and neonatal death?

  • Initiatives to reduce stillbirth and neonatal death rates seemed to have a greater impact on babies of White ethnicity.
  • Mortality (death) rates were still exceptionally high for babies of Black/Black British ethnicity, who had:
    • more than double the stillbirth rate (124% increase in risk) than babies of White ethnicity;
    • 43% higher neonatal death rate.
  • Stillbirth and neonatal death rates for babies of Asian/Asian British ethnicity were 60% higher than for babies of White ethnicity.

How did the mother’s age affect their risk of stillbirth or losing a newborn baby?

  • Mothers aged 30 to 34 years had the lowest stillbirth and neonatal death rates.
  • The greatest drop (improvements) in stillbirth and neonatal mortality rates were for babies born to the oldest mothers.
  • Mothers aged under 20 years had a 33% increased risk of stillbirth and a 75% increased risk of neonatal death, compared to mothers aged 30-34.
  • Mothers aged 40 and over had a 41% increased risk of stillbirth and a 37% increased risk of neonatal death, compared with mothers aged 30-34.

What were the combined effects of ethnicity, deprivation and mother’s age on the rates of stillbirth and neonatal death?

The report highlighted how the combination of ethnicity, deprivation and mother’s age, further increased some women’s risk of having a stillbirth or losing a newborn baby.

  • Stillbirth and neonatal mortality rates were lowest for babies of White ethnicity born to mothers aged 25 to 34 who lived in the wealthiest (or least deprived) areas.
  • The rates of stillbirth and neonatal mortality increased with greater deprivation, and were higher for mothers aged below 25 and over 35 years in all ethnic groups.
  • At its worst, the stillbirth rate was 10.54 per 1,000 total births for Black/Black British babies and 6.91 per 1,000 births for Asian/Asian British babies with mothers aged over 35 years living in the most deprived areas.
  • Neonatal death rates were over 3 per 1,000 live births for Black/Black British and Asian/Asian British babies born to mothers under 25 and over 35 living in the most deprived areas.
  • The high proportion of Black/Black British babies being born to mothers living in deprived areas means they are disproportionately affected by the higher rates of stillbirth that are linked to deprivation.

What happens now?

MBRRACE-UK’s report provides valuable, if depressing, insight into how much work still needs to be done to reduce the UK’s unacceptable rates of stillbirth and neonatal (newborn) death. It points out that although England met its target to reduce stillbirths by 20% by 2020, this target will not be met for neonatal deaths. MBRRACE highlight that even for stillbirths, much more must be done if the Department of Health and Social Care hopes to meet its revised target of a 50% drop in death rates by 2025. This work is needed to improve England’s mortality rates compared with other high-income countries, but will only succeed if action is taken to address the widening gap in the risks faced by women and babies of White, Black, Asian, mixed and other ethnicities.

MBRRACE say this will depend on women and babies receiving the highest quality healthcare which meets relevant standards and guidance throughout their care pathway. It will also require initiatives to address widespread inequalities in levels of social deprivation (poverty), and investigation of the causes of increased stillbirth and neonatal mortality for Black, Asian and other ethnic minority populations. Their babies not only have a higher risk of being stillborn or dying in the days soon after birth, but they are also more likely to suffer from a combination of other risk factors, such as maternal age and deprivation.

MBRRACE-UK’s current confidential enquiry, which will report in 2022, is now reviewing the quality of care provided for mothers and babies of Black/Black British ethnicity to identify where care could be improved, and to assess whether the care provided for these communities is acceptable and fair.

Boyes Turner welcome MBRRACE-UK’s valuable work, and the transparency of their reporting, in the hope that action will be taken to provide safe care for all babies born in the UK, regardless of postcode, social background or ethnic origin.

If someone in your family has been seriously injured as a result of medical negligence, and you would like to find out more about making a claim, you can talk to one of our solicitors, free and confidentially, by contacting us here.