The role of racism in the “appalling” disparity in maternal deaths may have been underestimated by the Government and NHS, MPs have warned.
A target is needed for eliminating the disparity between black and other minority ethnic women and white women, and the related gap between those living in the most and least deprived areas, the Women and Equalities Committee said.
Research has previously found that black women are almost four times more likely to die in pregnancy, childbirth and the period afterwards than white women.
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— Women and Equalities Committee
The 2022 MBRRACE-UK annual report concluded there was a more than three-fold difference in maternal mortality rates, with black women 3.7 times more likely to die than white women, equating to 34 women per 100,000 giving birth, and Asian women were 1.8 times more likely to die than white women.
It also found that the maternal mortality rate among women who live in the most deprived areas is increasing.
In its report published on Tuesday, the committee said the causes of the “appalling disparity in maternal deaths are multiple, complex and still not fully understood”.
The committee said: “Fixating on any one cause risks over-simplifying the problem and placing blame on the very women who are most at risk.
“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.
“The maternity workforce must be properly equipped to understand and recognise the significant disparities that exist, and to use that knowledge to deliver personalised, effective and respectful care.”
Among their recommendations, the MPs called for Health Education England to lead a co-ordinated review involving the National Midwifery, Royal College of Midwives and others “to ensure that both the training curricula and continuing professional development requirements for all maternity staff include evidence-based learning on maternal health disparities, its possible causes and how to deliver culturally competent, personalised and evidence-led care”.
The committee also called for “continuity of carer” for patients – something it said is currently difficult “due to the considerable staffing shortages across maternity services”.
MPs said a fully staffed, properly funded maternity services workforceis “fundamental to delivering safe, personalised care to pregnant women and new mothers” and called on the Government to commit to increasing the annual budget for maternity services to £200–350 million from the next financial year.
The Government has put forward “necessary but insufficient” solutions to tackle the problem of the disparity in maternal deaths, the committee said.
It urged a cross-government target and strategy, led by the Department of Health and Social Care, for eliminating maternal health disparities, which it said the Maternity Disparities Taskforce should consult on.
The report said: “A target for eliminating the disparity between black and other minority ethnic women and white women, and the related disparity between those living in the most and least deprived areas, is needed.
“This will focus minds, help to embed a strategy, and keep the issue firmly on the political and health agenda. Focus on a single number alone is a crude and unhelpful measure.”
Better data is also needed, the committee said, as it noted that black women are “regularly underrepresented in research or data and therefore in policymaking” and that ethnicity data held by trusts is “incomplete or inaccurate”.
We are also afraid the Government and NHS have not fully grasped that racism has played a key part in the complex reasons underlying the disparities, and that eradicating it is part of the solution— Caroline Nokes, committee chair
The Government should publish measures for gauging the success of the Maternity Disparities Taskforce, the committee said, as it noted the group had not met for nine months by the time its report was written.
Committee chair Caroline Nokes described the disparities with deaths among black women as “shocking” and said while the “tireless work of campaigners” has ensured more attention has been paid to this in recent years “improvements are not happening quickly enough”.
She said: “One of our biggest concerns is staffing shortages in maternity care. We need to see a sustained uplift in funding to bolster a workforce that has been stretched to its limits.
“We are also afraid the Government and NHS have not fully grasped that racism has played a key part in the complex reasons underlying the disparities, and that eradicating it is part of the solution.
“It is unacceptable that we consistently hear poor quality data on ethnicity is hindering efforts to address inequality. The onus is on authorities to improve data collection practices. We cannot let these women remain invisible to the systems supposed to serve them.
“Government must be more ambitious and set a national target to end disparities. It is frankly shameful that we have known about these disparities for at least 20 years. It cannot take another 20 to resolve.”
A Department of Health and Social Care spokesperson said: “While the NHS is already one of the safest places to give birth in the world, we are absolutely clear that we must ensure maternity care is of the same high standard, regardless of race.
“We’ve invested £165 million since 2021 to grow the maternity workforce and are promoting careers in midwifery with an extra 3,650 training places per year, while every local NHS maternity system has a plan in place to tackle disparities on a local level.
“The Maternity Disparities Taskforce – a collective of mothers, clinicians and key organisations – is being chaired today by Minister Maria Caulfield to focus on how we can eradicate disparities and improve maternity outcomes for all mothers.”
