Maternal mortality rates in the Black community

1. Disparities in maternal mortality

Maternal mortality refers to deaths due to complications from pregnancy or childbirth. For several years, research has shown Black women to be at a greater risk of maternal mortality in the UK when compared to White women.

Most recently, research by the Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK (MBRRACE-UK) collaboration considered the data on women in the UK who had died during or up to one year after pregnancy in 2018–20.^[1] Key findings showed that Black women were 3.7 times more likely to die during or in the first year after pregnancy than White women. This risk was lower than the figure reported in MBRRACE-UK’s 2020 report which showed maternal mortality rates amongst women from Black ethnic backgrounds to be four times higher during 2016–18 when compared to White women.^[2]

The research was based on the Confidential Enquiry into Maternal Deaths and Morbidity. Commissioned by the Healthcare Quality Improvement Partnership, this national programme investigates maternal deaths in the UK and Ireland. The programme is currently conducted by MBRRACE-UK, which is led by the National Perinatal Epidemiology Unit at the University of Oxford.^[3]

The government and NHS England have taken various steps to address ethnic disparities in maternal mortality. For example, the government announced the Maternity Disparities Taskforce in February 2022 to “explore inequalities in maternity care and identify how the government can improve outcomes for women from ethnic minority communities”.^[4] The 2019 NHS long term plan also includes a target to achieve a 50% reduction in maternal mortality by 2025.^[5]

Maternal support organisations such as Five X More have campaigned to address disparities in maternal outcomes for Black mothers.^[6] This includes hosting Black maternal health awareness week to raise awareness about disparities in maternal outcomes and empower Black women to make informed choices throughout their pregnancy and after childbirth.^[7] An inquiry by support organisation Birthrights into racial injustice in maternity care called for action to be taken to close the gap in maternal outcomes.^[8] Recommended actions included creating inclusive workforce cultures, changing national policy to remove barriers to racial equity and introducing a commitment to tackle racism in the maternity system.

The underlying causes of ethnic disparities in maternal mortality have been found to be complex and multifaceted. A recent inquiry by the House of Commons Women and Equalities Committee considered the reasons for disparities in maternal deaths, as well as actions taken by the government and the NHS to address the issue.

2. What the committee found

Published in April 2023, the House of Commons Women and Equalities Committee’s ‘Black maternal health’ report referred to several possible reasons for disparities in maternal mortality.^[9] This included pre-existing health conditions, socio-economic factors including deprivation, and factors such as bias, microaggressions and racism. However, the committee noted that causes of disparities were multiple, complex and not fully understood. It warned that “fixating” on any one cause risked “oversimplifying” the problem.

The committee gave several recommendations to address the issue. It called on the government to set a definitive target and strategy to eliminate disparities in maternal health. It argued that existing government and NHS measures to address disparity in maternal deaths were “necessary but insufficient”. Additionally, the committee expressed concern that the government and NHS leadership had underestimated the extent to which racism played a role in these disparities.

The committee also criticised the government’s handling of the Maternity Disparities Taskforce, which “ha[d] not met for nine months” at the time of writing the report. It said the government should publish measures for gauging the taskforce’s success and update the committee on a six-monthly basis on the taskforce’s progress. Another challenge raised by the committee was “missing and inadequate data collection” on ethnicity. The committee called on the NHS to prioritise capturing ethnicity data and reducing delays in data delivery.

3. Government response to the committee’s report

The government did not agree to several of the committee’s recommendations. In its response to the committee’s report, it disagreed with the recommendation to establish a target and strategy for eliminating disparities in maternal health.^[10] It argued that setting a target for a specific health disparity would “not necessarily” focus resource and attention on the right mechanisms. Instead, the government said it would measure progress against its equity aims for mothers and babies through metrics described in the guidance ‘Equity and equality: Guidance for local maternity systems’.^[11]

The government did not agree to publish measures for gauging the Maternity Disparities Taskforce’s success. It argued there was “clear value” in maintaining high level ambitions to ensure flexibility and adaptability, as opposed to focusing on specific deliverables. However, it did say it would be happy to update the committee every six months on the progress of the taskforce. On research and data, the government said NHS England was undertaking work to improve the recording of patient characteristics in frontline services.

Despite disagreeing with various recommendations, the government said it remained committed to tackling maternal inequalities and improving equity for mothers and babies. It described various actions already taken to address disparities in maternal health. For instance, it said equity had been embedded within all aspects of NHS England’s ‘Three-year delivery plan for maternity and neonatal services’, published in March 2023.^[12] It stated local maternity and neonatal systems had begun to publish equity and equality action plans to address disparities in outcomes and experiences of maternity care at local levels. It also noted that NHS England had developed 14 maternal medicine networks to ensure women with chronic and acute medical problems had access to specialist care.

Additionally, the government said it was working in collaboration with the Maternity Disparities Taskforce to create pre-pregnancy guidance targeted at ethnic minority women and those living in the most deprived areas. It said this guidance would encourage healthy behaviours and planning for pregnancy by supporting women to make informed choices about their health and wellbeing.

4. Read more

• Birthrights, ‘‘We must all play a part in the solution’: Birthrights responds to MBRRACE-UK ‘Saving lives, improving mothers’ care’ report for 2022’’, 10 November 2022
• Philippa Roxby, ‘End racial disparities in maternal deaths’, BBC News, 18 April 2023
• Hannah Devlin, ‘Maternal mortality rises by nearly 20% in UK, report finds’, Guardian, 10 November 2022
• Sustainable Development Goals data, ‘Maternal mortality rate per 100,000 maternities and maternal mortality ratio’, accessed 21 November 2023
• UNICEF, ‘Maternal mortality’, February 2023

---

Cover image by ar130405 on Pixabay.