The Government was urged to set a timetable for eliminating "glaring and persistent" disparities in maternal outcomes for women depending on their ethnicity, after MPs found that ministers and NHS leaders had underestimated the extent to which racism contributed to "appalling" inequalities.
An inquiry by the Commons Women and Equalities Committee found that the rate of maternal mortality among Black women was 3.7 times higher than for White women, whilst Asian women were 1.8 times more likely to die than their White counterparts.
Maternal death rates in deprived areas were rising, with women in the most deprived areas 2.5 times more likely to die than those in the least deprived areas, according to the findings. The inquiry drew partly on findings from the Maternal, Newborn, and Infant Clinical Outcome Review Programme (MBRRACE-UK), which also reported that 1 in 9 women who died during or up to a year after pregnancy in the UK were at severe and multiple disadvantage. Cardiac disease remained the largest single cause of indirect maternal deaths, followed by neurological causes, whilst thrombosis and thromboembolism was the leading cause of direct maternal death during or up to 6 weeks after the end of pregnancy, according to the report.
Ethnicity data from confidential enquiry reporting had demonstrated a greater risk for mothers from ethnic minority backgrounds compared with those from White backgrounds since the year 2000. MPs said Black women had consistently remained at highest risk, whilst the risks had also been elevated for Asian women and those of mixed ethnicity since 2012 to 2014.
The cross-party Committee noted that in 2017, the Government and the NHS announced a 'national ambition' to reduce stillbirths, neonatal, and maternal deaths and neonatal brain injuries by half by 2025. However, MPs said little progress had been made in reducing the maternal death rate and that, excluding maternal deaths from COVID-19, maternal mortality between the period 2010-12 and 2018-20 had increased by 3%.
Workforce Shortages 'A Problem'
The report warned against "fixating on any one cause", which risked "placing blame on the very women who are most at risk". Instead, the maternity workforce should be "properly equipped to understand and recognise the significant disparities that exist". However, MPs highlighted that maternity staffing shortages were a barrier to tackling inequalities and implementing safety measures, including continuity of care. MPs backed the call made by the Commons Health and Social Care Committee for an annual uplift of £200 to £350 million to resource maternity units appropriately.
The report also criticised the Government's handling of the taskforce established to tackle disparities in maternity care, saying that while it had intended to meet every 2 months, it had not met for 9 months. MPs were also "concerned" that the taskforce's remit failed to include any mention of racism as a cause of disparities. They also highlighted "missing and inadequate data collection on ethnicity" as a persistent challenge.
Caroline Nokes, chair of the Committee, 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."
The Government needed to be "more ambitious and set a national target to end disparities", Ms Nokes said.
NHS providers, which noted that the Maternity Disparities Taskforce was due to meet today (Tuesday), said NHS trust leaders would be "deeply concerned" by the MPs' report. Its Chief Executive, Sir Julian Hartley, commented: "Trust leaders are committed to addressing inequalities in maternal care and providing high-quality personalised care to all mothers. As this report shows, much more progress is needed to improve care and outcomes for black mothers as well as efforts to tackle staff shortages in maternity services."
