Disparity with white women shows need for action, doctors say, despite slight improvement in mortality rate
‘We know from hearing black women’s stories that for every person who unfortunately dies there is a whole group of women behind them who are suffering from poorer outcomes.’ Photograph: Steve Prezant/Getty
Black women are still four times more likely than white women to die in pregnancy or childbirth in the UK, and women from Asian ethnic backgrounds face twice the risk, according to a new report.
The data shows a slight narrowing of the divide – last year’s report found black women were five times more likely to die – but experts say that is statistically insignificant and not a sign of progress.
The lead author of the MBRRACE-UK report, Prof Marian Knight, said: “The drop to a fourfold difference should not be a reason to lessen our efforts at a time when addressing these inequalities among pregnant women and new mothers should be a priority.
“The rate of deaths among white women has gone up by a tiny amount and the rate of black women has come down a little but neither of these are statistically significant changes because the overall rates are low.”
Prof Maggie Rae, president of the Faculty of Public Health, said: “This year’s coronavirus pandemic has brought this disparity even more starkly to the fore, and we must not lose sight of the actions that are required to address systemic biases that impact on the care we provide for ethnic minority women.”
The latest figures on maternal deaths and morbidity cover the period between 2016 and 2018, showing 217 women died during or up to six weeks after pregnancy out of 2,235,159 women giving birth in the UK. A further 349 women died up to a year after pregnancy.
“Maternal mortality is uncommon so while there is an unacceptable racial disparity, even for black women the rate is low,” said Knight. “But what is significant is the statistics are likely to be a marker of similar disparities in severe pregnancy complications and what we call ‘near misses’.
“What needs to happen now is more comprehensive research looking at maternal morbidity. Only then can we start to monitor the variations in outcome between different groups living in different areas of the UK.”
A report published in December by the joint committee on human rights highlighted the lack of an NHS target to end the disparity and urged the government to introduce one.
Tinuke Awe, co-founder of campaign group Fivexmore, supports such a target. She said: “Urgent research is required to understand those statistics but also what is going on behind the data.
“We know from hearing black women’s stories that for every person who unfortunately dies there is a whole group of women behind them who are suffering from poorer outcomes. Yet currently those near misses aren’t recorded anywhere.”
Almost all of those who died during or after pregnancy had multiple issues such as mental or physical health problems, were victims of domestic abuse, or were living in a deprived area. More than half of those who died were overweight or obese. Cardiac disease represents the largest single cause of indirect maternal deaths.
Also highlighted in the report was a twofold increase in the number of maternal deaths linked to epilepsy. Sudden unexpected death in epilepsy (Sudep) is uncommon but it occurred almost twice as often among women pregnant during 2016-2018 than in the previous three years.
Knight said changes from 2018 onwards to the types of medication prescribed to manage a pregnant women’s epilepsy may account for the rise.
Importantly, the report highlighted that preventive action is not just vital within maternity services. Public health actions are equally important.
Women living in the most deprived areas were three times more likely to die than those in more affluent areas. Social services were also involved in the lives of 20% of the women who died compared with 12% in 2012–2014, suggesting greater coordination is needed between social services and maternity care.
Kirsty Kitchen, head of policy at Birth Companions, said: “While the number of deaths remains low, inequalities are widening. These figures relate to a period pre-Covid-19 and we know those inequalities will become even more profound as women’s lives continue to be adversely impacted by the pandemic.”
Interventions to address poverty, bad housing, domestic abuse and racism were vital, she said. “While the ethnic disparities are shocking and stark we should be equally shocked by the disparities that are widening along the lines of deprivation and disadvantage.”
The Royal College of Obstetricians and Gynaecologists said it would continue working to address inequality through the Race Equality Taskforce. Its president, Dr Edward Morris, also urged the government to commit to a target of a 50% reduction in maternal mortality for black, Asian and minority ethnic women over the next five years.
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