Black women are up to six times more likely to experience some of the most serious birth complications during hospital delivery across England than their white counterparts, with the figures being described as “stark” and disheartening”, according to analysis.
Black women made up 26% of women who experienced the birth complication pre-eclampsia superimposed on chronic hypertension during delivery, despite making up just 5% of all deliveries across England, according to a Guardian analysis of NHS figures for 2022-23.
They were six times more likely to experience this pregnancy complication than their white counterparts, who made up 47.2% of these cases despite making up 70% of all deliveries.
Pre-eclampsia is a serious pregnancy complication that causes high blood pressure and protein in the urine, affecting between 1% and 5% of pregnant women across the UK. The condition can lead to serious complications for the mother and baby. Superimposed pre-eclampsia is when preeclampsia complicates another existing condition such as high blood pressure.
Black women were 1.5 times more likely to develop preeclampsia more generally than their white counterparts, and were also overrepresented in birth complications regarding high blood pressure, making up 16% of these cases.
Worldwide, pre-eclampsia affects up to 6% of all pregnancies and causes approximately 500,000 foetal deaths and 70,000 maternal deaths each year.
Experts said that in order to address the disparities in birth complications, the existing health inequalities such as why some ethnicities have higher rates of pre-existing conditions such as high blood pressure would need to be addressed.
Black women in the UK are almost four times more likely to die in pregnancy and childbirth than their white counterparts, while black babies are twice as likely to be stillborn.
Prof Asma Khalil, the vice president for the Royal College of Obstetricians and Gynaecologists, said structural racism and the unconscious bias of healthcare professionals could be a factor contributing to the disparity.
“The figures are striking and demonstrate inequality, but unfortunately I’m not really surprised,” Khalil said. “We know that women from a black background have a higher risk of pre-eclampsia and hypertension.
“Why this is the case is multifactorial, and I strongly believe that in order to find the solution, you need that also multidisciplinary approach. Healthcare professionals and doctors cannot fix the problem on their own, we need to work with public health doctors, policymakers, and the government need to prioritise and invest on the issue.”
Bell Ribeiro-Addy, the Labour MP and chair of black maternal health all party parliamentary group, said: “These stark figures highlight the continuing inequalities facing Black women at every stage of the birthing journey.
“With Black mothers 3.7 times more likely to die from pregnancy or childbirth, the government must urgently set a binding target to end this maternal mortality disparity and improve health outcomes for Black women across maternity care.”
Dr Anita Banerjee, an obstetric physician with expertise in high risk pregnancies, said the figures were “disheartening”, and that healthcare professionals building trust with marginalised communities was essential for reducing health inequalities.
Banerjee said: “We say that the NHS is free at the point of contact and that everybody should get the same, by why is it that if you’re from a black background you’re risk of complications seem to be higher, particularly in regards to maternity for pre-eclampsia.”
“What we saw during the pandemic is the importance of our cultural competency and understanding of the women that we serve, and also secondly them trusting us. We can’t stop everybody getting preeclampsia but there are certain people which have a prior propensity.
“It’s hard if you’re serving a population that isn’t used to getting that much information or understanding because they don’t feel that they’ve got our trust, it can be quite hard.”
An NHS spokesperson said: “The NHS is fully committed to ensuring all women receive high-quality care before, during and after their pregnancy – all local maternity and neonatal systems now have action plans in place to help ensure care is equitable for all mothers, babies and families, with staff having access to inclusive clinical training aids to support care for women and babies with Black or dark skin.
“As these figures demonstrate, further progress is needed, which is why the NHS is investing £10m this year to enable targeted action against inequalities, including providing more holistic support for women living in the 10% most deprived areas of England, who we know are more likely to experience adverse outcomes during pregnancy and birth.”
