A new Saving Babies’ Lives 2025 Progress Report from baby loss charities, Sands & Tommy’s, has highlighted the UK’s poor progress in reducing stillbirth and neonatal (newborn death) and tackling inequalities in maternity and neonatal care. The report calls for a renewed commitment from government and new targets to replace the unmet, current National Maternity Safety Ambition for the reduction of stillbirth, neonatal death and premature births, and a ‘comprehensive, cross-government programme of work’ to achieve those targets, supported by stronger national leadership, and clear, robust accountability. The charities set out ten policy priorities for government based on their Joint Policy Unit’s analysis of collected data and maternity and neonatal safety reports from other organisations, including MNSI and the CQC, which together demonstrate an ‘increasing consensus that the current situation is unacceptable’ and that harm is ‘at risk of being normalised’ in maternity care. Unmet ambitions to improve maternity care In November 2015, the government launched The National Maternity Safety Ambition, which aimed to halve the 2010 rates of stillbirth, neonatal and maternal deaths and neonatal brain injuries in England by 2025. The ambition also aimed to reduce the proportion of babies who are born pre-term, as premature birth increases the baby’s risk of neonatal death. Whilst the rates of stillbirth and neonatal death are lower than they were in 2010, data from both the Office for National Statistics (ONS) and MBRRACE-UK’s perinatal surveillance programme indicate that stillbirth and neonatal mortality rates are not on track to meet England’s 2025 target. There has also been little progress to reduce the pre-term birth rate. Sands & Tommy’s’ analysis suggests that if the government’s mortality targets had been met, 2,500 fewer babies would have died since 2018. Sands & Tommy’s’ new policy priorities for government and policymakers Sands & Tommy’s’ report sets out ten policy priorities for government and policymakers, which the charities believe are essential to reduce the unacceptable rates of stillbirth and neonatal death. 1. Renew commitments to save babies’ lives They urge the government to replace the current, unmet ambitions with new targets for 2035 to align with the NHS 10 Year Plan. These include new rates for stillbirth (2 per 1,000 total births), neonatal death (0.5 per 1,000 births of babies born at 24 or more weeks), and pre-term births (6%). Within these targets, ethnicity and deprivation-related inequalities should be eliminated. Data on miscarriages should be routinely collected, so that a target can then be set to reduce the (currently unknown) miscarriage rate. The charities acknowledge that these targets are ambitious and require transformative change but point to other European countries which have achieved them. They emphasise that action within and outside the health service is necessary to tackle social and health inequalities. 2. Count miscarriages in the UK Unlike preterm births, stillbirths and neonatal deaths, the rate and number of miscarriages are not reported, and are probably underestimated, making it difficult to track the miscarriage rate over time. Once miscarriage data is routinely collected, a commitment can then be made to reduce the UK’s miscarriage rate. 3. Take coordinated and meaningful action to eliminate inequalities The report highlights that despite a decline in stillbirth rates in 2022, there were stark deprivation and ethnicity-related inequalities in outcomes for babies, with the neonatal mortality rate among Asian babies being 60.3% higher than that for White babies. The charities call for government commitment to eliminate inequalities in pregnancy and baby loss by 2035. They recommend specific actions to help achieve this including better recording of data on ethnicity, social and other factors which may be driving inequalities, and tackling barriers (such as poor provision of translation and interpreting services) to ensure there is equitable access to maternity services. Sands & Tommy’s emphasise that the causes of disparities in healthcare outcomes are multiple, complex and not fully understood, and may be over-simplified by broad classifications, such as ethnicity and deprived geographical area. The charities’ more detailed review of the many factors affecting inequalities in pregnancy outcomes, and their review of translating and interpreting services in maternity care, will be published later this year. 4. Strengthen leadership to address safety issues in maternity and neonatal care Sands & Tommy’s point to the many maternity and neonatal care safety reports and reviews which identify similar but recurring themes, and the lack of improvement, despite attempts to implement their recommendations. It is not enough to provide support for individual ‘failing’ NHS trusts. Instead, they call for a new, comprehensive, national approach, with a process for prioritising, sequencing and defining responsibility for implementing recommendations, supported by clear national leadership and robust oversight and accountability. They call for NHS trust board-level leadership for patient safety, support for staff in reporting meaningfully to the board, and support for board members to understand, in context, the information that they receive. 5. Clarify the workforce needed to deliver safe care Sands & Tommy’s criticise workforce discussions which focus on staffing numbers without prior understanding and agreement about what safe care looks like and the staff mix and numbers needed to deliver it. They call for action to provide a maternity and neonatal workforce that meets the correct staffing requirements to deliver safe care, in line with nationally-agreed standards. This requires a comprehensive assessment of maternity and neonatal services’ capacity and demand, taking into account the increasing level of ‘complexity’ in the patient population, as well as the staff numbers, mix, training, knowledge and support that are required to provide safe maternity and neonatal care. 6. Put the resources needed in place to deliver safe care Sands & Tommy’s repeat their concern that government funding for maternity and neonatal services in England remains significantly below the level needed to make meaningful improvements in care. They call for fuller and better funding if the NHS is to meet the government’s commitment to reduce stillbirth and neonatal death rates and eliminate inequalities. 7. Make informed choice a reality National guidelines make clear that mothers should be able to make informed choices during their maternity care, but Sands & Tommy’s found that safety and informed choice were often affected by a perceived tension between delivering care in line with national guidelines and personalisation of care. They call for action to address this, to ensure that women and birthing people’s choices about birth are properly informed by unbiased, evidence-based advice about available options, and access to evidence-based antenatal care. Everyone should know about the care that they are entitled to receive, and maternity services should have the resources and capacity to provide patients with a meaningful choice. 8. Address unwarranted variation in care Sands & Tommy’s found that too many babies are dying because their care is not in line with nationally-agreed standards. Data from the Perinatal Mortality Review Tool (PMRT) suggests that 1 in 5 late miscarriages, stillbirths and neonatal deaths could have been prevented with better care. For example, the report referred to evidence-based national recommendations that babies born before 27 weeks’ gestation should be delivered in a hospital with a neonatal intensive care unit (NICU) on site, however, 1 in 5 eligible babies were not born in a maternity unit with a NICU in 2023. In some areas of maternity care, a lack of agreed national standards and guidance is known to contribute to the risk of perinatal deaths. For example, currently there are no national standards for maternity triage services, a risk area highlighted by numerous maternity safety reports. Pregnant mothers are advised by their hospital to contact their hospital’s maternity triage department if they have concerns in pregnancy or early labour. However, Sands & Tommy’s have found that NHS Trust websites’ advice for women and birthing people on when to contact maternity triage in pregnancy and labour varied in the language used to describe symptoms, including waters breaking, contractions and reduced fetal movements, and half of those maternity services encouraged mothers to stay at home if they did not have the symptoms listed, on an assumption that home would be safer and more comfortable than hospital for them in early labour. The report referred to recent maternity safety reviews and inquiries which found that women were wrongly advised to stay at home after contacting maternity triage. The charities call for clear national standards to improve the consistency of maternity care, a focus on addressing unwarranted variation, and clarity about the circumstances in which local variation from national standards may be justified. 9. Ensure lessons are learned when babies die Sands & Tommy’s’ Saving Babies’ Lives Progress Report 2025 warns that the NHS is still not learning lessons so that they can improve care when babies die or listening to bereaved families’ experiences. The need for greater openness and transparency is a consistent theme in maternity and neonatal safety, but this requires a culture of learning rather than defensiveness when things go wrong. They call for improved Perinatal Mortality Review Tool (PMRT) reviews of baby deaths, which have been criticised as lacking timeliness, parents’ involvement and transparency, or meaningful, system-level action. When recommendations are made following reviews by PMRT or the Maternity and Newborn Safety Investigations (MNSI) programme, there should be robust oversight to ensure implementation. 10. Prioritise research into pregnancy and baby loss Sands & Tommy’s final recommendation addresses the decline in clinical research taking place in this importance area of NHS care. They found that less than 2% of working nurses and midwives were engaged in research in 2022 and the number of obstetricians and gynaecologists working as clinical academics has fallen over the last ten years. They highlight the importance of clinical academics in bridging the gap between research and clinical practice, to provide evidence-based care in the areas of greatest need. They call on government to invest in research into pregnancy baby loss. 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