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Sir Gary Streeter (in the Chair)
Welcome, everyone, to this important debate. I remind hon. Members that some changes have been made to normal practice, to support the new hybrid arrangements. Timings of debates have been amended to allow technical arrangements to be made for the next debate. There will be a suspension between each debate. I remind Members participating physically and virtually that they must arrive for the start of debates. Members are expected to remain for the entire debate.
I remind Members participating virtually that they are visible at all times, both to one other and to us in the Boothroyd Room. If Members attending virtually have any technical problems, they should email the Westminster Hall Clerks’ email address. Members attending physically should clean their spaces before they use them and before they leave. I would also like to remind Members that Mr Speaker has stated that masks should be worn in Westminster Hall.
Before I call Catherine McKinnell to move the motion, I must say that we have 12 Back-Bench speakers. We normally allow 10 minutes for each Front-Bench speaker. If Catherine speaks for about 10 minutes, that should allow for in the region of four minutes for each Back-Bench speaker. I will not impose a formal time limit, but I ask everyone to try to deliver your speech within four minutes. That would be most helpful.
Catherine McKinnell (Newcastle upon Tyne North) (Lab) [V]
I beg to move,
That this House has considered e-petition 301079, relating to Black maternal healthcare and mortality.
It is an honour to speak under your chairmanship, Sir Gary. I am also honoured to open this debate on behalf of the Petitions Committee and the more than 187,000 people who signed the petition organised by campaigners Tinuke Awe and Clo Abe.
The petition highlights the shameful fact that in 21st-century Britain, the colour of a woman’s skin affects how safe she and her child are during pregnancy and birth. That is one of the starkest examples of racial health inequalities in this country. As Tinuke and Clo have pointed out, the latest data show that black women are more than four times more likely than white women to die during pregnancy or in the six weeks after giving birth. Women from Asian backgrounds are twice as likely as white women to die during pregnancy. To put that into context, I should state from the outset that the UK is one of the safest countries in the world to give birth. Deaths during pregnancy are very rare. I am sure the Minister will reiterate that in her response.
Around one in 10,000 pregnant women dies every year from causes related to their pregnancy. Every single one of those deaths is a tragedy, but they are a very small proportion of all pregnancies. The situation has also improved slightly over the last 10 years. Those figures mask the underlying, long-standing and shocking inequalities in maternal mortality, yet we do not have a base of research and evidence to fully explain their root causes and to point the way forward. There is still no Government target to eliminate the gap. That needs to be addressed urgently.
What do we know about women who die during or shortly after pregnancy? Pregnancy alters the way the body works. Two thirds of all pregnant women who die fall victim to complications such as heart disease or the care they receive while pregnant. Most do not die during childbirth itself. Dr Christine Ekechi, co-chair of the race equality taskforce at the Royal College of Obstetricians and Gynaecologists, points out that black women are more likely to have pre-existing health conditions that lead to greater risks during pregnancy. However, she also highlights that the obvious question to ask is why black non-transmissible health issues such as cardiac disease and high blood pressure are more prevalent in the first place. If it is a result of existing social and economic inequalities, that must be addressed.
Across all ethnicities, most pregnant women who die have complex medical needs, but leading maternal health researchers such as Professor Marian Knight have expressed concerns that our health and social care system is just not set up to deal with that complexity. Clinics are often based at different hospitals, requiring separate appointments. Communication between them does not seem to happen in the way it should. Women are often expected to juggle other childcare and work commitments while attending myriad appointments at a range of different institutions. Not all women have the same support and security at home and at work, and the system does not account for that.
Accounts have shown that the symptoms that pregnant women present with are too often dismissed and attributed to pregnancy itself, when they could be indicators of serious underlying medical complications. Pregnant women from all backgrounds report not being listened to despite the fact that that is crucial to the physical and mental wellbeing of both mother and child. Professor Knight points to what she calls the “constellation of biases” that black and Asian women are subject to. Those range from lack of listening, learning and nuance around women’s backgrounds and the most appropriate care, to micro-aggressions, all the way to completely unacceptable race-related perceptions such as the entirely unsubstantiated notion that black women have higher pain thresholds. If pregnant women are not being listened to and their symptoms are not taken seriously, or if they feel that they will not be, that is a recipe for tragedy.
It is important that public awareness of that issue has finally begun to increase, which is in no small part thanks to the work of such campaigners as Tinuke and Clo and the initiatives that they have launched, such as Black Women’s Maternal Health Awareness Week, which was first held last September, and the petition that we are debating. More women are now coming forward with their experiences, and five times more have shared their stories. One woman recounted:
“As soon as the second midwife was on shift she just seemed to have one goal in mind and that was delivering my baby as soon as possible, she didn’t seem to care about easing any part of my pain or reassuring me for the many worries I had at the time—she rushed my labour along and as a result almost cost me my sons life.”
Another said:
“I already seemed like that hyper-emotional black woman worried about nothing and I let that silence me. I really wish in this moment I expressed my concern or spoke up, because I honestly couldn’t have fathomed that what happened next would come.”
The reaction on social media to Channel 4’s recent “Dispatches” documentary was also very telling. One Twitter user said:
“For many Black women ‘The Black Maternity Scandal’ on Ch 4 is sadly not shocking or eye opening at all. Not being listened to in times of pain has become far too normal and it has to change.”
Another wrote:
“For many of us Black and Brown women, this felt like the first time our stories and traumatic, hurtful experiences got a small hearing on national TV.”
Pregnancy can be a special and exciting time, but it can also be exhausting and terrifying. For any woman to have to spend it not being listened to or not receiving the most appropriate care because of the colour of her skin is nothing short of appalling, so it is unsurprising that there is now an increasingly vocal consensus on the urgent need for more research and evidence, and for firm commitments from the Government and the NHS to end the scandal. We need to address the under-researching of health issues that black women face, and get a clear picture of the data on maternal deaths among different ethnic groups. Many different ethnicities are grouped together under broad categories, which risks missing cultural nuances, misrepresenting experiences and leading us to the wrong conclusions.
Maternal deaths are just the tip of the iceberg. For every woman who dies, many more will have severe pregnancy complications, and there is evidence of disparities between ethnic groups in that respect, too. However, the number of those cases and the impact on their families and lives is not recorded. Lack of research on those so-called near misses is a gap in the knowledge base that must be urgently and proactively corrected.
Tinuke and Clo are asking MPs to act by signing up to the Five X More black maternal health pledge, which I know many colleagues who have spoken today have already supported. One of the asks is that the Government implement the recommendations of the Joint Committee on Human Rights, including the introduction of a firm target to end the disparity in maternal deaths. I would be grateful if the Minister would tell us whether the Government agree with the Joint Committee on Human Rights, the chief midwifery officer and the petitioners that such a target must be put in place. It would also be useful to know whether the Government intend to address the data gap in medical research in the upcoming women’s health strategy.
I want to end by quoting what Tinuke said in an interview with The Guardian last year:
“In 1991 when my mum gave birth to me she was at greater risk of dying. In 2020 when I gave birth to my daughter that risk had increased and I was five times more likely to die…I’ll be damned if my daughter, whenever she decides to give birth, is 25 times more likely to die.”
That truly is a source of shame for this country, which is why today must mark the day that future generations start to look back and wonder how on earth this situation was ever tolerated for so long.
Ms Harriet Harman (Camberwell and Peckham) (Lab)
I thank the members and Chair of the Petitions Committee for choosing this subject for debate. My constituency contributed the second highest number of signatures to this petition, which reflects the concerns of both black and white people in my constituency.
It is particularly tragic when a new mother dies. She will die early in life, leaving behind a newborn or other children. Everyone in maternity services wants maternity care to be a properly resourced and highly professional team. A black woman is four or five times more likely than a white woman to die during childbirth or shortly thereafter, and nobody wants that to be the case. It is a dreadful situation and it must be addressed. I have four proposals for the Minister. I know that she understands this issue very well, having worked in the health service. She cares about it, so I look forward to hearing her response.
First, the monitoring must be clear and publicly accessible. The publication of covid statistics has provided a real example of this. It has shown how, when information needs to be brought into focus and targeted at the public and everybody in the health service, the regular and consistent publication of statistics can enjoin us all in a public effort. Coherent statistics must, therefore, be published.
Secondly, as my hon. Friend the Member for Newcastle upon Tyne North (Catherine McKinnell) has said, we must have a target to end this black maternal mortality gap, with milestones set for progress year by year. The Joint Committee on Human Rights, which I chair, heard evidence from the chief midwifery officer that there is a great deal of concern about this issue but no targets have been set. We know that the NHS works to targets and to milestones. Good intentions are not enough.
Thirdly, we have to reduce health inequalities—this is a general but important point—and income inequalities, which mean that if someone is black they are more likely to have a low income, and if they are on a low income they are more likely to have poorer health.
Finally, we must recognise that this is not just about the health status of the mother; it is also about the delivery of care. We have to face up to a difficult truth. Polling by the Joint Committee on Human Rights found that 60% of black people felt that they were not likely to get equal care in the NHS, and 78% of black women felt that the NHS would not give them equal treatment. For white people, those are shocking statistics, particularly as so many black women and men play such a crucial part in providing NHS services. Those figures are based on the experiences and expectations of black women in a society where black people are not treated equally.
This is a matter for the consideration not only of everyone in every part of our society, but of everyone in every part of the NHS and everyone involved in maternity care. Like the Chair of the Petitions Committee, I hope that this debate will mark the start of rapid and transparent progress towards ending this egregious inequality.
Kate Osamor (Edmonton) (Lab/Co-op) [V]
It is an honour to serve under your chairmanship, Sir Gary. First, I congratulate Tinuke and Clo, the co-founders of Five X More, on working tirelessly to change black women’s maternal health outcomes, and on putting forward this petition, which gained over 187,000 signatures.
The racial disparities in maternal mortality rates are completely unacceptable. A black woman is four times more likely than a white woman to die in the UK due to pregnancy or childbirth. Just think about that—that is four times as many women passing away well before their time, and four times as many families suffering the pain and grief of losing a loved one.
It is not just those women who have sadly died who have been victims of this disparity. Research by the Nuffield Department of Population Health has shown that women of black African and black Caribbean heritage are, respectively, 83% and 80% more likely than white European women to suffer a near miss of maternal death. That reflects, and is the consequence of, the wider disparities in care, which countless women have recounted from their experiences. As well as the socioeconomic inequality that disproportionately affects black people, a study by MBRRACE-UK showed that only 29% of women who died during pregnancy and childbirth were deemed to have received good care, with improvements in care being judged to have potentially made a difference to the outcome in 51% of those cases—evidence that there are clearly improvements to be made.
The attention shone on this issue in recent months, and highlighted by the sheer number of people who have signed the petition, must be used as a spur for the Government and the NHS to develop a clear action plan. Furthermore, it highlights the damaging nature of the Government’s recent race report, which sought to sideline almost any suggestion that racism could be a factor in the different outcomes experienced by people in Britain today. Racism is not just a perception or historical experience, as Tony Sewell wrote in his foreword to the recent report.
This is not about a chip on our shoulder; it is about addressing the real inequality of black maternal mortality rates, which result in women unnecessarily passing away. It is a disparity that requires the Government to take seriously racial and ethnic disparities. Therefore, what we are asking today, and what the campaigners have been asking the Government to do, is to listen and to really take the data seriously. I hope the Minister will introduce an NHS target to end this disgusting disparity.
Florence Eshalomi (Vauxhall) (Lab/Co-op) [V]
It is a pleasure to serve under your chairmanship, Sir Gary. I thank the campaigners for bringing this really important issue to Parliament and for raising awareness on behalf of all women. Over 1,186 Vauxhall constituents signed the petition that has led to this important debate.
As the mother of two young children born just over the road from Parliament, at St Thomas’ Hospital, I know that giving birth should be one of the most natural and exciting experiences that any mother can have. I think back to my first pregnancy—the fear, excitement and mixture of emotions. Like many women from a black or minority ethnic community, I was not aware that I suffered from a disease called fibroids until I had my first maternal scan. That brought additional fear and anxiety around my childbirth, but for far too many women, pregnancy and childbirth can be complicated and dangerous. When I got pregnant, I also realised that I was a sickle cell carrier.
We have known for some time that maternal and perinatal mortality rates are significantly higher for women of black, Asian and mixed heritage and their babies. That is why we have to do everything we can to ensure that pregnancy and childbirth is as safe as it can be for all women in this country. We have the data. We know that the death rate in childbirth for black women is five times that for white women. In 2021, that cannot be acceptable.
To tackle the problem, we must first acknowledge the structural and institutional racism that exists in our healthcare system. We know that black and minority ethnic women are sometimes not listened to during the course of their care, and this can be subject to unconscious bias and microaggression. As a result, their symptoms are dismissed as normal during pregnancy, whereas they should be investigated a lot further.
The NHS is aware of the disparity, but it has no target to end it. I hope that by raising awareness of this issue, we will help to kickstart a national debate that will lead to the Government taking real action to address it. My colleagues have already asked the Minister to respond by looking at those key targets. We need to work with the NHS to implement the Joint Committee on Human Rights’ recommendations, which are clear. They are about reducing racial disparities in black and minority ethnic maternal health outcomes, and specifically about introducing those targets, so that we can measure those protections.
Sarah Owen (Luton North) (Lab) [V]
It is a pleasure to serve under your chairship, Sir Gary. I thank the right hon. Member for South West Surrey (Jeremy Hunt), the Chair of the Health and Social Care Committee, for asking me to respond on behalf of the Committee. Too often our Parliament is viewed as old, with blind spots on issues such as the health inequalities that affect black people, and black women in particular, so I am grateful to each of the nearly 200,000 people who signed the petition.
We have already heard that black women in the UK are four times more likely to die during pregnancy or childbirth than other women, and up to twice as likely to experience a stillbirth than white women. This is not coincidence or fluke. We see in the available data and in people’s experiences how health services, designed disproportionately by non-black people, fail to meet the needs of black people. It is an institutional problem.
The Select Committee is currently looking into the safety of maternity services in England. The brilliant Tinuke and Clo from Five X More came to speak to us and share their experiences, and I thank them for leading this petition and for their campaigning work. Clo told the Committee that there needs to be greater investment to understand the huge disparity in health outcomes for black women. We currently do not collect data on near misses, morbidity, illnesses or poor outcomes for black women. I hope the Minister announces some changes to that.
Clo also told us that only once we uncover the experiences of black women going through maternity services and set targets to do better will we have better outcomes for all black women. The same sentiment was echoed when I met Mars Lord, a doula and birth activist working on the Black Mums Matter Too campaign, which is not only highlighting the shocking inequality facing black women and their children relating to maternal mortality, but taking action to save lives. Mars is working with Peppy Baby, which gives black birth parents free expert support, delivered remotely via an app.
In my own constituency, I have been doing my best to support my constituent Ernest Boateng. His wife, Mary Agyeiwaa Agyapong, sadly lost her life to covid-19. Mary was pregnant, and a nurse at Luton and Dunstable University Hospital in my constituency. Shortly after undergoing a C-section, Mary sadly died. I have been so moved by Ernest’s resolve and commitment over the last year to seek answers and to make sure that no other family faces such a tragic loss in the same way. I presented Ernest’s petition for greater protections for pregnant women during the pandemic to Parliament earlier this year. This is hugely important, especially as 55% of pregnant women hospitalised during the first months of the pandemic were from black, Asian and minority ethnic backgrounds.
I have written to the Minister multiple times to ask her to meet Ernest. He is the father of two children, and his one-year-old, little Mary, will never get to meet her mum. He is campaigning to make things better and safer for other expectant parents, but sadly every time I have asked, the Minister has responded that she is too busy to meet me and Ernest, so I use this opportunity to ask for even just 20 minutes of her time. I am sure that she will stand up and say the right things, and I know that her heart is in the right place. I am more than happy to assist, if she is willing to listen to the experiences of Ernest, so that no family has to face the devastating loss that his has.
Bell Ribeiro-Addy (Streatham) (Lab) [V]
It is a pleasure to serve under your chairmanship, Sir Gary. I start by paying tribute to Tinuke and Clo from Five X More, who have been leading the charge in calling for action on black maternal health. Black women are four times more likely to die in pregnancy and childbirth—we have heard that many times today, and we will probably hear it some more, but I really want it to hit home. We know this, but we have no target to end it.
During my own pregnancy, it was not hard to find instances where, as a black woman, how I was perceived or believed drastically impacted the care I received, from complaints about how I was feeling to being denied scans. We know that black women are perceived to experience less pain. We know this, and we have no target to end it.
Things went from bad to worse for me. I was swollen. My blood pressure would get so high that I would feel dizzy and my nose would bleed. My doctor eventually had me rushed to the hospital for further tests and scans, and I was admitted to the hospital with pre-eclampsia. My last conversation with the consultants was harrowing. They said that my pregnancy had become very dangerous and there were only two outcomes: my child would die, or both myself and my child would die. My diagnosis was too late for any intervention, and simple steps—which I soon found were simple things such as taking aspirin—were no longer an option for me. The consultants’ advice was for a late termination and a delivery to save myself. They also explained that my condition was deteriorating so quickly that I would immediately have to nominate someone to make the decision for me if I should become unconscious.
Some 83% of women of African origin, like myself, and 80% of Caribbean women suffer a near miss in pregnancy and childbirth. Not only do we not have a target to end this, but we do not have information about the health issues that black women go on to face. I did not have to make this decision, because a scan scheduled the day after that meeting showed that my baby’s heart had stopped beating. I was induced, and after something like 18 hours of labour, she was born. As a person of faith, even then, I still had faith that maybe the doctors were wrong and everything would be okay, but she did not move, she did not cry, and there was no miracle. Black babies have a 50% increased risk of neonatal death, and a 121% increased risk of stillbirth, like my own daughter. With figures like that, I wonder how much of a chance she really had. We know this, and we have no target to end it.
When I talk about this, I am asked how long ago it was and how far along I was. I just want to say that when any woman loses a baby, however her pregnancy ends—miscarriage, stillbirth, or even an abortion if she had to have one—it is not for anyone else to quantify how much pain she must feel, as if to decide how much empathy to show, and it is certainly not for them to decide how much care she should be shown.
I would like people to stop blaming black women—that is all I have heard in response to some of the messages that have been put out. So often, black women are viewed as the problem, but we could be the solution if people would just listen to us, respect us and care for us. We are not a lump of comorbidities—some of us who go on to have these tragic experiences did not even have any comorbidities. We are black women who have decided to bring life into this world, and that choice has become a matter of life and death and health. The inequality we face is not our fault. Inequality is an institutional and political outcome—an institutional and political choice—and it is the duty of the Government to end it, not to outsource responsibility and blame those who are suffering.
In the US, they have just had a Black Maternal Health Week, and $200 million were put towards ending this disparity in training clinicians. In the UK, we have a Government who have ordered reports saying that institutional racism does not exist. So when the Minister responds today, I do not want to hear what the Government think is wrong with women who look like me; I want to hear what they will do to protect women who look like me, and the children we have. I want to hear that this Government realise that if they are not part of the solution, they are part of the problem, and I want them to acknowledge the institutional racism that we face and to have a target to end it. The colour of a woman’s skin should have no bearing on whether she or her child live or die.
Abena Oppong-Asare (Erith and Thamesmead) (Lab) [V]
It is a pleasure to serve under your chairmanship, Sir Gary. I thank my hon. Friend the Member for Newcastle upon Tyne North (Catherine McKinnell) for bringing this e-petition debate on black maternity healthcare and mortality before the House. I also thank Tinuke and Clo, the founders of the Five X More campaign, who have been fighting to get this issue taken seriously.
Other Members have touched on these heartbreaking and stark statistics, but they bear repeating: black women are four times more likely to die during pregnancy or up to six weeks postpartum, women of mixed heritage are three times more likely to die, and Asian women are twice as likely to die. Each loss of life is a tragedy, and that disparity is unacceptable. It needs to be understood and it needs to change.
I also want to mention the Royal College of Obstetricians and Gynaecologists’ term “near misses”. The numbers of women who survive childbirth and are left with long-term morbidity are currently not recorded, but are part of a wider health picture. They must be taken into account. For the past year, covid has exacerbated many of these issues. In fact, even when other factors such as age, obesity and location were taken into account, black and Asian women are more likely than white women to be hospitalised. We need to understand why that is the case, because the statistics can only tell us so much. A commitment to looking into how and why that is the case is urgently needed. I am sure that all of us in the debate today would welcome that.
These tragic deaths are part of a wider picture, a story of health inequality, with black women facing disparities when it comes to stillbirths, cancer diagnoses and outcomes, and access to fertility treatment, among other things. We must recognise that disparities in health outcomes are driven by social factors—poverty, education and housing—as well as discrimination. None of that is new. It is not earth-shattering. It is not changing, either. That simply is not good enough. So we need action, and we need action now.
The Government must commit to a target to reduce the disparity in mortality rates. The Government must support Five X More pledges, including the recommendations relating to black maternity health in the report “Black people, racism and human rights” produced by the Joint Committee on Human Rights. There needs to be a full and independent review that seeks to end the disparity once and for all. The NHS must commit to robust data collection to aid the understanding of these outcomes. For a start, we need to move beyond the term BME. When women are dying, it is not good enough use data catch-all terms. We need to do more to deliver a workforce that reflects the diversity of the communities it serves.
On a final and quick point, I have not mentioned “no recourse to public funds”. That is, of course, the huge elephant in the room when it comes to health outcomes. Some women face costs of £7,000 or more for essential maternity care. These are the very women who are at risk of increased mortality. It is time for that practice to end.
Janet Daby (Lewisham East) (Lab) [V]
I am pleased to be speaking today on such an important but also disturbing issue. I commend my hon. Friend the Member for Streatham (Bell Ribeiro-Addy) for sharing such a personal, moving story that is so relevant to the debate.
Every death in maternity is a tragedy, but it is wrong that we are having to speak on the issue of black women dying during pregnancy or soon after giving birth in the UK. It is unacceptable that the disparity exists between women from different ethnic backgrounds. It is most distressing that when a mother dies, a child or children are left motherless, not to mention the loss to their partner or spouse and to the wider community. Too many unanswered questions need to be asked, and too many changes need to be made, and that is why we request that the Government work with the NHS to improve maternal health outcomes of black women, women of mixed heritage and Asian women.
As we have already heard, compared with white European women, black women in the UK are four times more likely to die in pregnancy and childbirth, women of mixed heritage are three times more likely to die, and Asian women are two times more likely to die. African women are 83% more likely to suffer a near miss in childbirth, and black Caribbean women are 80% more likely to do so. That is all happening in the UK. It is shameful and outrageous. How and why is it happening? It is a huge concern regarding equality of care. Why are non-white women’s experiences so different compared with those of white women? Change needs to happen, and it is this Government’s responsibility to make the change happen.
These babies are 121% more at risk of stillbirth. Their life chances are limited before they are even born. Do these little black lives matter? I think they do, and I know that many Members in this Chamber agree with that. Immediate interim changes and safeguards need to be put in place now for these vulnerable women to protect their lives: the lives of the mothers and children.
I call on the Government to implement the recommendations in the Joint Committee on Human Rights report on black maternal health, “Black people, racism and human rights”, to ensure that all health professionals record and identify those who are most at risk of poor outcomes, so that protective factors are implemented. I also call on the Government to ensure that there is increased support for at-risk pregnant women. I ask the Secretary of State for Health and Social Care to introduce a plan and target to improve maternal outcomes for black women. Professor Maggie Rae, president of the Faculty of Public Health, has 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.”
Naz Shah (Bradford West) (Lab) [V]
It is a pleasure to serve under your chairmanship, Sir Gary. May I associate myself with all the comments that have been made? I commend in particular my hon. Friend the Member for Streatham (Bell Ribeiro-Addy) for the courage and bravery with which she spoke.
The disparity of maternity care outcomes in England is already well known. Black women are four to five times more likely than white women to die during pregnancy, birth and the postpartum period, while our Asian women, most of whom are from Pakistani and Bangladeshi backgrounds, are two to three times more likely than white women to die during those periods. Those statistics have been known for many years, but in the last 20 years or so they seem to have gone the wrong way and got worse.
We must find out why black and south Asian women and their babies are more likely to die. In addition, we need to find out why black women and then south Asian women are most likely have an emergency C-section. Why are black women and then south Asian women most likely to have excessive bleeding? Are those factors contributing to their deaths? Are those women receiving the right care at the right time? We need to look further into all those questions, because most of the deaths are likely to be preventable.
Why do racial and ethnic variations in health outcomes occur? The Government’s latest report suggests that institutional or structural forms of racism just do not exist, and that, in fact, they are just in our minds, or they are narratives pushed by groups that lobby on racism. I would be really grateful if the Minister explained why, if there is no racism, those disparities exist.
I am co-chair of the all-party parliamentary group on Muslim women, which is currently conducting research to find out about Muslim women with babies and maternity care, so that lessons can be learned to mitigate existing inequalities. Muslim women are from diverse ethnicities, and in the UK they are mostly from black and south Asian backgrounds, but we wanted to take an intersectional approach to find out how overlapping factors, such as ethnicity and faith, could affect their healthcare. The aim is to find out why those women have poor health outcomes, and to understand their perspectives and experiences of the healthcare during and after pregnancy. The findings of the inquiry are set to be published in the autumn.
This debate signifies just how important such an inquiry is, so I will end by expressing my gratitude to the whole team in the APPG on Muslim women, to the Muslim Women’s Network UK, and to all colleagues across the House who raise this important issue.
Claudia Webbe (Leicester East) (Ind) [V]
It is a pleasure to serve under your chairmanship, Sir Gary. I congratulate the campaign group Five X More, and the hon. Member for Newcastle upon Tyne North (Catherine McKinnell) on securing this hugely important debate, as well as the nearly 200,000 UK residents who signed the petition. The debate could hardly be more important, as it shines a light on a devastating and long-neglected area of institutional racism.
The latest UK data shows that black women are five times more likely to die in pregnancy, or up to six weeks after giving birth, compared with white women, yet there is no target to end that. This difference has almost doubled since 2011, with a 121% increased risk for stillbirth and a 50% increased risk for neonatal death, but there is no target to end this. It is not true that black women are superhuman. They do not have a higher pain threshold.
The maternal mortality for women from Asian backgrounds is double that for white women. There is also a concerning increase in the maternal mortality rate for women from mixed ethnic backgrounds, who now have a three times higher risk compared with white women, yet there is no target to end any of this. There is no doubt that health disparities within maternity care settings have been amplified by the coronavirus pandemic. Indeed, African, African-Caribbean, Asian and minority ethnic women made up 56% of all pregnant women hospitalised in the early months of the pandemic.
Discrimination is ingrained in the social, political and economic structures of our economic system. According to the Office for National Statistics, key workers are more likely to be from black, Asian or minority ethnic communities, to be women, to be born outside the UK and to be paid less than the average UK income. These inequalities are grounded in class inequality and reflect the severe racial disparities in our economy. African, Asian and minority ethnic women are also more likely to be in insecure work, which can leave them without basic maternity rights and more exposed to discrimination when it comes to hospital treatment.
That said, we cannot ignore the issue of racism and implicit racial bias in our healthcare system, which can negatively influence diagnosis and treatment options provided by clinicians, including pain management, and indirectly affect medical interactions, through loss of patient-centredness in treatment and the removal of patient autonomy. That has a corrosive effect on trust in services, which creates a downward spiral of healthcare outcomes.
The demonisation and mistreatment of migrants and those with unsettled status must also end. Migrant women with insecure status face charges of £7,000 or more for NHS maternity care, which can deter women from accessing essential services. The Government cannot be serious about reducing maternal health inequalities unless they abolish the “no recourse to public funds” policy.
There is also a significant gap in the medical research community, contributing to disparity of access in the UK. Latest figures show that 0.7% of professors employed at UK universities are black. In 2018, there were just 25 black British female professors in UK universities. Much more must be done to invest in research and researchers who can help combat those unacceptable health inequalities.
I finish by saying how callous, how cruel and how ignorant the Government’s recent race and ethnic disparities report is in the context of this debate. The Government’s crusade to deny the existence of institutional racism means that the disproportionate suffering of pregnant women of African, Asian and minority ethnic backgrounds is ignored. This must change. The UK Government must urgently set a target to abolish racial disparity to combat maternal mortality, so that we can all hold them to account and work towards long-lasting change.
Wera Hobhouse (Bath) (LD)
I am grateful that we are debating this important petition today and pay tribute to the women who have bravely shared their stories, from those involved in the “Dispatches” documentary to the Five X More campaigners to some of my own constituents in Bath.
The disparity in maternal health outcomes between black and Asian women and white women is one of the most frightening elements of systemic racism in today’s society. The statistics revealed in the MBRRACE report should shock and horrify us all. It should go without saying that health outcomes should never be determined by race, but for too many women this is the awful reality when accessing healthcare. One of my constituents said:
“I have two dual heritage daughters. As things stand, they are three times more likely to die during pregnancy and childbirth than my white friends’ daughters.”
Another wrote to me to share her concern that her race affected the way she was treated.
She felt she was not properly informed about the options open to her, her concerns were not taken seriously, and she could not say no when she felt uncomfortable.
Closing the gap between maternal health outcomes for white women and for women of colour must be a priority for the Government. It is not enough merely to recognise the disparity; we need a specific target to dramatically cut the rate of maternal deaths among black women. I urge the Minister to ensure that targets are in place to halve the disparity in the next five years. We need more and properly funded investigations into maternal death, with recommendations that are actioned. We need national accreditation for those who provide language support in maternity care, and we need to look at health outcomes for those new mothers who have no recourse to public funds because of insecure immigration status.
On top of that, if we are serious about eliminating maternal health inequalities, we must tackle the inequalities that exist in all areas of society. We know that the pandemic has made all inequalities much worse. Women from ethnic minority backgrounds made up 56% of all pregnant women having to go to hospital in the early months of the pandemic. Women from ethnic minority backgrounds are more likely to be key workers, giving them an increased risk of contracting the virus. They are more likely to be in insecure employment, which leaves them without basic maternity rights. They are at risk of higher exposure to discrimination and poor treatment at work, affecting their mental health. Once again, I urge the Treasury to look at Maternity Action’s proposals for amending the furlough scheme. It would allow employers to claim 100% of the cost of maternity suspension for women who are over 28 weeks pregnant, or pregnant women with underlying health conditions—we have heard today that underlying health conditions make it much more risky for pregnant women from different ethnic backgrounds.
I hope that the powerful personal stories shared by so many brave women will spur urgent action from the Government. We need to listen to black women, to ensure that pregnancy and childbirth are safe for all.
Helen Hayes (Dulwich and West Norwood) (Lab) [V]
It is a pleasure to serve under your chairmanship, Sir Gary. I pay tribute to Tinuke and Clo for their vital work campaigning on black maternal health under the banner Five X More . I also pay tribute to my hon. Friend the Member for Streatham (Bell Ribeiro-Addy) for sharing her devastating experience so bravely and powerfully.
The statistics on maternal mortality are truly shocking. Skin colour should have no correlation with maternal health, yet in the UK, black women are over four times more likely than white women to die during pregnancy or childbirth; women of mixed heritage are three times more likely; and Asian women are twice as likely. What is even more shocking is that the gap has been widening—not for a short period of time, but for more than a decade.
The factors contributing to maternal mortality rates are complex and multiple. Social and economic factors have a strong influence on underlying health. Pressures such as insecure work, low income and fear of losing employment force some women into unsafe situations. Implicit racial bias in healthcare can lead to assumptions being made and some women not being listened to. The extent to which women are listened to, respected and empowered throughout pregnancy and childbirth has a vital bearing on ultimate outcomes.
The most shocking aspect is that every organisation concerned with maternal mortality says that more research is needed to understand why black women are at greater risk of death. After a decade of increasing black maternal health disparity, we still need more action to understand why there is such appalling racial healthcare inequality, so that action can be taken to stop it. That means better data collection, clear and measurable targets, and more funding for research.
We have to ask why those appalling statistics have been of so little concern to the Government that they have failed to undertake any major inquiry or fund significant research. There is a gender and ethnicity gap in medical research, and that must change. The Government must now commission an independent review of the ethnic disparity in maternal mortality, looking in detail at the data and capturing the lived experience of black women, Asian women and women of mixed heritage.
I want to highlight in particular some of the things that are known and on which action could be taken right away to make a difference, even as further research is commissioned. We know that women from black and Asian backgrounds are more likely to be key workers in frontline roles and physical roles such as social care. Many of those women are on low pay and in insecure work. Maternity rights and health and safety protections at work must be extended to all women, whatever their employment status or job role. It must not be the case that fear of losing pay or losing work forces pregnant women to risk their health, either through the work itself or through being unable to attend essential healthcare appointments.
The barriers to accessing healthcare that face some black and Asian women, particularly asylum seekers and women with no recourse to public funds, must be removed. In maternity care, relationships really matter. Women’s experiences during pregnancy and childbirth are far too inconsistent across the country, but often, the best care is delivered by community-based midwifery teams, working across both community and hospital settings and enabling women to get to know and trust the midwives who will eventually deliver their babies. Dealing with a birth is not like other forms of healthcare. Women in childbirth should feel that they are equal partners with midwives, doctors and the wider professional team to deliver their baby safely.
Finally, the racial disparities in maternal health further serve to underline the nonsense of the report by the Commission on Race and Ethnic Disparities. That report straightforwardly denies the lived experience of many black people and people of colour living in the UK. Addressing structural racism, shown so clearly in the health data we have been discussing today, must start with listening to and taking seriously the experiences of black people and people of colour in the UK, not denying those experiences. That report will not even help to get off the blocks the work that needs to be done to iron out and remove racial disparities in maternal health.
Kim Johnson (Liverpool, Riverside) (Lab) [V]
It is a pleasure to serve under your chairship, Sir Gary. I, too, would like to begin by thanking the Five X More campaign for raising awareness and bringing this important debate to Parliament, and my hon. Friend the Member for Streatham (Bell Ribeiro-Addy) for her bravery in sharing her devastating story with us all tonight.
I am a black mother of twins and I had a very positive experience, but sadly, too many black women are dying needlessly in childbirth. In today’s historic debate, we have already heard incredibly personal and heartfelt stories, and I pay tribute to my sisters’ strength and bravery in sharing their experience to help to bring about change.
The rate for black mothers dying during or just after childbirth is five times that of white mothers in the UK; and black babies have a 121% increased risk of a stillbirth. It is estimated that for every instance of maternal mortality, there are 100 severe maternal morbidities or near misses. Behind every one of these statistics is a story, and behind every one of these mothers who dies is a group of women who had a near miss.
The report by the Joint Committee on Human Rights, which was published last year, highlighted the lack of an NHS target to end this obscene disparity and urged the Government to introduce one. I call on the Government today to rectify that urgently and set ambitious targets to address and eliminate these inequalities, including to halve the number of black maternal deaths by 2023.
The 2019 MBRRACE-UK report revealed that almost all those who died during or after pregnancy had multiple issues such as mental or physical health problems or were victims of domestic abuse or were living in a deprived area. More than half of those who died were overweight or obese. Black women are more likely to have conditions that can put them at greater risk, including cardiac disease, diabetes and high blood pressure. We must ask the deeper question of why black and Asian women are more likely to have those pre-existing health conditions in the first place. There is no specific genetic connection between all black people. Many of these pre-existing conditions are non-communicable diseases that are driven by social determinants of health, such as poverty, education and housing. Women living in the most deprived areas were three times more likely to die than those living in more affluent areas. Social services were involved in the lives of 20% of the women who died.
We are now a year into a pandemic that has laid bare the pervasive health inequalities that exist in our country. We have seen clearly that race, class, housing, education, income and employment all directly define someone’s chances of survival. More than half of pregnant women admitted with covid-19 in the first two months of the pandemic were black, Asian or from another minority ethnic group. Black women have been eight times more likely to be admitted to hospital as a result of coronavirus. These inequalities are widening and will become more profound as deprivation and disadvantage continue to be fuelled by the pandemic and women continue to suffer.
The recent Sewell report, backed by the Government, who allegedly had a hand in doctoring its findings, had the gall to assert that structural racism no longer exists as a dominating force in Britain today. The figures and the stories that we have heard today tell a very different story, so will the Minister go back to the Government and appeal to them to rectify the report, given the undeniable evidence we have heard today? This must be a turning point. The Government must commit today to a national strategy to tackle health inequality, which must include a road map and a timeframe for the eradication of the racial injustice in maternity care.
Anne McLaughlin (Glasgow North East) (SNP) [V]
I am happy to speak under your chairmanship today, Sir Gary, although what we are discussing is a very unhappy set of circumstances. I thank Five X More for the petition and the debate, and the hon. Member for Newcastle upon Tyne North (Catherine McKinnell) for leading it. I confess—I know I am not alone in this—I knew very little about this subject until hearing from Five X More , and I am someone with a long-term interest in racial inequality, so I thank it sincerely. Many hon. Members have spoken powerfully today. I pay particular respect to the courage of the hon. Member for Streatham (Bell Ribeiro-Addy).
In the UK, almost 800,000 women give birth every year. That is 800,000 interactions with their national health service, making childbirth the No. 1 reason for engagement with the NHS. For a large proportion of women, it is their first adult contact with health services, and maternity care should be a unique opportunity to mitigate some of the factors that perpetuate health and social inequalities. I have no doubt that for many it is, regardless of ethnicity. I also have no doubt that the vast majority of healthcare workers care deeply about the people they work with. This debate is more about the system itself and the structural inbuilt inequalities.
We are hearing through heartbreaking testimony and alarming reports that these inequalities are very much there, putting black mothers and babies at a significantly higher risk of maternal and perinatal death. It is worth repeating again and again that black women are four times more likely to die during pregnancy or shortly after giving birth than white women. Women from mixed-race backgrounds are three times as likely and Asian women twice as likely. Most alarming to me is the fact that this inequality and disparity in maternal and newborn health has been highlighted for several years, yet there is still no target to end this. Why on earth not?
I want to pay tribute to MBRRACE-UK for the work that it has done in the confidential inquiry into maternal deaths. There is a coldness to research and statistics that often lets us forget what MBRRACE-UK points out: behind each number is a mother, a father, a baby, a family and a community left devastated by these events. Five X More has published a comprehensive list of suggestions for the Government to act on, as many hon. Members have noted today. I will note just one: the advice to listen to the voices and experiences of black women. Listen!
Maternity Action notes that a reason for the disparity, as the hon. Member for Erith and Thamesmead (Abena Oppong-Asare) has noted, is that migrant women with insecure status face charges of £7,000 or more for essential NHS maternity care. That will clearly deter lots of these women from attending for care. Maternity Action has rightly called for an end to no recourse to public funds rules, as others have today. The rules exclude some migrants from access to top-up payments such as housing benefit, universal credit, child benefit and other critically important benefits. Many working people are paid so little that they require those top-ups just to survive, but many migrant women with work visas and jobs and others with limited leave to remain do not have the right to what is considered essential for everybody else.
Finally, Maternity Action and others are calling for a welfare safety net for all pregnant women. I will add to that by talking about how important universality can be. In Scotland, there is universal access to free prescriptions, but even more relevant to this debate is universal access to the baby box. It is not a poor baby’s box, but a “welcome to the world” baby box. It is free to all new parents and is based on the Finnish model, which has a proven record of decreasing infant mortality. The box includes essential items for a baby’s first weeks and months, and it provides a safe space for babies to sleep near their parents. However, one of the most important aspects of the baby box is that it brings women in touch with healthcare workers before and after the baby is born. Those workers can then support the mother and baby.
Every baby should be born with an equal start in life, and the SNP Government are exploring even more ways in which the baby box can be used to promote women’s health and support mental health. I mention the baby box not to say that Scotland does everything so much better than the rest of UK, but it is something that I would love to see the rest of the UK adopt. It is not just about health and being in touch with health services; it is about the psychological impact of the Government telling people, particularly migrants to this country, that their babies are welcome and loved. So much work was done on ensuring that it was not seen as a poor baby’s box that, in 2019, 47,000 baby boxes were delivered to new parents in Scotland—a 93% uptake. That is what happens when there is universality.
As we know, the mortality risk from covid-19 among ethnic minority groups is twice that for white patients, and that is after potential confounding factors such as age, sex, income, education, housing tenure and area deprivation have been taken into account. A recent report found that black pregnant women are eight times more likely to be admitted to hospital with coronavirus, and Asian women are four times more likely. There is simply no hiding from this issue. If we are to fully understand race and health, we have to fully understand the role of ethnicity and racism in our society—the everyday acts of discrimination, the unconscious and implicit biases, and the cultural and structural racism that we are now being told does not exist.
I do not have the time or expertise to delve deeply into this issue, so I am glad that others are speaking about it. One of those is Dr Christine Ekechi, who is the spokesperson for racial equality at the Royal College of Obstetricians and Gynaecologists. She said:
“it’s important for us to acknowledge that we are still humans, and so there are lots of things that can operate at a conscious level, but there are many things that operate at a subconscious level.”
Dr Ekechi has suggested that we need more diversity in healthcare systems and that healthcare professionals should check themselves for whatever biases they may have. I expect the vast majority would want to do that, and we should be supporting them. It is one of the things that we will be looking at on the all-party parliamentary group on unconscious bias, because it does exist. We should be finding ways to help people unravel their biased thinking, because it has a massive impact on people’s lives.
I want to add to some of what others have said about the Commission on Race and Ethnic Disparities report. Rather than focusing on structural inequalities, it attempted to explain them by talking about economics, geography and family units. Academics have accused the report of cherry-picking data to reach predetermined conclusions. They say it is littered with mistakes and selective quoting, in an attempt to tell us that
“the British discourse on race is obsessed with victimhood when it should be celebrating progress.”
That is not surprising, given that the author has already said many times in the past that he does not believe structural inequality exists, but it also chimes with a growing trend among Conservative politicians to claim that there is no such thing as structural racism in the UK. However, even the Prime Minister now seems to be distancing himself from the report, saying recently:
“I’m not going to say we agree with every word.”
For those who may not know and who may be watching, if we say the health service is structurally racist, it does not mean that it is populated by racists. It means that the way it is structured is for white people and that it takes into consideration their needs—culture, language, health trends and so forth—with very little flexibility to take account of anyone else’s. We need to change the structures and make them more flexible, which is what this debate is calling for. After all, our NHS is not a national white person’s health service; it is supposed to be for everybody equally.
This is a moral issue. As Alexandre Dumas wrote:
“Moral wounds have this peculiarity—they may be hidden, but they never close; always painful, always ready to bleed when touched, they remain fresh and open in the heart.”
I will end with the words of Amy Gibbs, the chief executive of Birthrights:
“A lot of black and brown people in the birthing world are understandably frustrated by calls for more research when what’s needed is action.”
I think she is right. We need to act now. No more endless research: let us just do something about this.
Marsha De Cordova (Battersea) (Lab)
It is a pleasure to serve with you in the Chair, Sir Gary. I am grateful to my hon. Friend the Member for Newcastle upon Tyne North (Catherine McKinnell) for leading the debate on behalf of the Petitions Committee. I also congratulate the formidable campaigners Tinuke and Clo, the founders of the Five X More campaign, who got the petition debate in Parliament today. The petition received more than 180,000 signatures. It is not before time that such a huge injustice is finally receiving the attention it deserves.
We have heard some powerful contributions from right hon. and hon. Members this evening, including my right hon. and learned Friend the Member for Camberwell and Peckham (Ms Harman), the Chair of the Joint Committee on Human Rights. Just last year, the Committee published its report “Black People, Racism and Human Rights”, which contains shocking findings, particularly that the care that many black people receive is unequal to what is given to white people. I urge the Minister to accept all the recommendations of that report.
My hon. Friend the Member for Edmonton (Kate Osamor) highlighted, as others have done, the choice made in the report of the Commission on Race and Ethnic Disparities to sideline the institutional and structural racism that exists across society, but more so in the health service. My hon. Friend the Member for Streatham (Bell Ribeiro-Addy) made a powerful contribution sharing her lived experience. I thank her for doing so, but also for her tireless campaigning on the issue. She has been brave, and I thank her for that.
More importantly, my hon. Friend the Member for Vauxhall (Florence Eshalomi) highlighted some of the issues related to underlying health conditions in her own experience of being diagnosed with fibroids and also of being a sickle cell carrier. I also urge the Minister to listen to my hon. Friend the Member for Luton North (Sarah Owen), to give 20 minutes of her time to her and her constituent and to hear their experiences.
I also want to mention the contribution of my hon. Friend the Member for Dulwich and West Norwood (Helen Hayes), who highlighted the fact that we need to focus more on issues relating to research. Unless we do the work, we will not move forward and bring an end to this crisis.
As we have heard, it is absolutely shameful that black women continue to be four times more likely to die in childbirth and pregnancy than white women. That inequality has existed for decades, with little action being taken to address it. [Interruption.]
Sir Gary Streeter (in the Chair)
Order. Does any Member present have to go to vote physically, or is everyone on a proxy vote? If everyone is happy, let us continue.
Marsha De Cordova
Last week I met campaigners, obstetricians, midwives and black, Asian and ethnic minority women with lived experience of maternal health complications. They were very clear that socioeconomic determinants such as income, housing and occupation and comorbidities only partially explain the inequalities affecting black maternal health. It is absolutely clear that structural racism is a driver of disparities in treatment, and it is a missed opportunity that the Commission on Race and Ethnic Disparities chose to sideline that important issue. I hope the Minister will choose to ignore and reject that view.
Black and Asian women, and their partners, regardless of their socioeconomic status, are not being listened to, not being respected and not being cared for. When they voice pain or concern during pregnancy or childbirth, they are branded as “aggressive” or “angry”, while dangerous stereotypes about “strong black women” mean that black women are often not offered the same treatment as white women.
It is outrageous that racist myths about black women having higher pain thresholds than other women continue to affect their treatment. Meanwhile, the lack of cultural competency in medical training means that complications experienced by black women are not spotted early enough. For example, black women have shared accounts of how their anaemia was not picked up soon enough because of the colour of their skin.
So I ask the Minister what action she is taking to tackle structural racism and to build trust in maternity services for black, Asian and ethnic minority mothers and their partners and for healthcare professionals, including midwives, as many have shared their experiences of occupational discrimination, as was highlighted in the Public Health England report last year. I would really like the Minister to address this issue. Additionally, cultural competency and unconscious bias training is an essential part of ending these inequalities, so will she commit to improving training in the health service and in medical schools?
We are all aware of the importance of data, which as we have heard is central to closing the maternal mortality gap. Many mothers and medical professionals have shared accounts of how pregnant women are recorded as being white if they do not disclose their ethnicity, meaning that it is difficult to track complications. Therefore, the recording of data is essential, so will the Minister commit to ensuring that all maternity services record the specific ethnicity of all mothers?
It is clear that fatalities are just the tip of the iceberg, with many women speaking of the near-misses and poor treatment they have experienced. I have heard from many medical professionals that data on near-misses could easily be made available, but it is not being. Will the Minister therefore commit to collecting and publishing data on maternal near-misses by ethnicity, and, if so, can she set a timeline for that commitment, with some clear milestones?
Midwives consider the continuity-of-care model as a way to help bridge some of these inequalities. A 2016 study found that women who see the same midwife throughout their pregnancy are 16% less likely to lose their baby. The NHS standard contract for 2019-20 stipulated that 35% of women will be booked on to a continuity-of-care pathway by March 2020. Can the Minister confirm whether that target was met? Can she also say what is being done to meet that target in the NHS long-term plan, which aims to provide continuity of care for 75% of black, Asian and ethnic minority women by 2024?
Before I close, I want to mention how the hostile environment is exacerbating this problem, as mentioned by my hon. Friends the Members for Erith and Thamesmead (Abena Oppong-Asare) and for Dulwich and West Norwood. Charging for maternity services and no recourse to public funds conditionality mean that many women are either becoming indebted as a result of their pregnancy or are turning away from health services all together for fear of being reported to the Home Office. Many women subject to charging are destitute and unable to pay, and three of the 209 women whose deaths were investigated in the 2019 MBRRACE-UK report were affected by charging for NHS maternity care. Does the Minister agree that charging women for maternity care is cruel and dangerous during this pandemic?
I want to make it clear that black maternal health and mortality is an avoidable inequality, and it is scandalous that the Government have not yet set a target to end this injustice in the NHS long-term plan, so will the Minister commit to doing so today? The NHS long-term plan sets many targets for other issues, so why not for black maternal health?
Let me be absolutely clear that a Labour Government would be committed to ending the crisis in black maternal health and mortality, and that the Government must take urgent action now. We need a national strategy to tackle health inequalities as a matter of urgency, which must include a target and a commitment to end the mortality gap between black, Asian and ethnic minority women and white women and to tackle structural racism once and for all, not deny its existence. We cannot afford for this not to be a priority.
The Minister for Patient Safety, Suicide Prevention and Mental Health (Ms Nadine Dorries)
I thank all Members of the House who have taken the time to attend and speak in today’s debate, and particularly the hon. Member for Newcastle upon Tyne North (Catherine McKinnell) for having secured the debate. Along with everyone else, I also thank the co-founders of the Five X More campaign, Clo and Tinuke, for their incredible work. Their petition to Parliament has generated a huge amount of interest and support, and their work to improve maternity mortality rates and healthcare outcomes for black British women is inspiring and brings this deeply important issue the attention it deserves.
Every woman deserves to have safe care, to feel that her voice has been heard and to be an informed decision maker in her own care. The NHS is one of the safest places in the world to have a baby. Few women in the UK die during childbirth. Between 2016 and 2018, 217 out of 2.2 million women died during, or up to six weeks after, pregnancy from causes associated with their pregnancy. That equates to 9.7 maternal deaths per 100,000 pregnancies. We also know from the MBRRACE-UK maternal mortality reports that some of these deaths could have been prevented. Sadly, evidence shows that, currently, there remains a more than fourfold difference between maternal mortality rates among women from black ethnic backgrounds and among white women in England. There also remains an almost twofold difference between women from Asian ethnic backgrounds and white women. Those disparities are worrying and must be addressed, and I have heard all of the calls to do that today.
However, let me address the points that have been raised by speakers today—many of which have been raised repeatedly—beginning with the right hon. and learned Member for Camberwell and Peckham (Ms Harman). We need to fundamentally understand why this issue occurs and why we have these disparities. The statistics tell only part of the story: the lived experiences of black women need to be understood, appreciated and heard for us to really gain an understanding of the full picture. I think it was the hon. Member for Liverpool, Riverside (Kim Johnson) who read out some of the reasons for these disparities that are given in the report. As we know, and as we could tell from that report and from the list that she read, which was just the tip of the iceberg, the reasons are incredibly complex.
That is why, last month, I announced that the Government are embarking on the first women’s health strategy for England. That strategy is, first and foremost, about listening to women’s voices. The call for evidence that launched on International Women’s Day seeks to understand women’s experience of the health and care system, and we have already seen an incredible response to it. Many thousands of women across the country have come forward to share their experiences through the online survey, which takes just a few minutes to complete, so I will unashamedly make another call in this debate for any woman who has not yet completed the online survey to do so.
However, women from black and other ethnic minority groups are under-represented in the responses we have received so far, and today’s debate has reiterated just how important it is to ensure that the health and care system is listening to women of all backgrounds. I encourage any woman listening to this debate, and in particular women from black and ethnic minority groups, to come forward and have their voice heard. By better understanding women’s experiences, we can ensure that the health system truly meets the needs of women as they should be met. The complaint that women’s voices are not heard—that women are not listened to and are spoken down to in the healthcare sector—is a common one across the board from women, and was highlighted in Baroness Cumberlege’s recent “First Do No Harm” report.
Disparities in maternal mortality rates among women from different ethnic groups have been well documented for many years. The numbers are just not acceptable, and the Government are committed to reducing those inequalities. The charity Five X More has campaigned to make the NHS commit to a target to reduce inequalities and close the current gap in maternal mortalities. There are considerable limitations on producing an England-level indicator of maternal mortality by ethnicity. Many Members raised that point. The fact is that maternal deaths are rare, even among women from black ethnic groups. Because of the very low numbers, even a large reduction in mortality rates for a particular ethnic group would not necessarily be attributable to a genuine improvement in the quality of care.
Marsha De Cordova
The issue is that there is a need for a target. When a target is set, work can take place towards a reduction. The Minister says it might be difficult to record the figures by ethnicity. Could she explain why it would be difficult?
Ms Dorries
I will go further and explain what we are hoping to do to make a difference. We know that for every woman who dies, 100 women have a severe pregnancy complication or a near miss. That has been mentioned a number of times. When that woman survives, she will often have long-term health problems. Disparities in the number of women experiencing a near miss also exist between women from different ethnic groups. Because near misses are more common than maternal deaths, we can investigate those disparities at local and regional level, to better understand the reasons for disparity, to assess local variation and to identify areas with less disparity and, hence, best practice.
Wera Hobhouse
Is it not clear from everything we hear that black women and women from ethnic minorities feel that the health system does not communicate appropriately, so they do not understand all the choices available to them? Is that not a way of getting to the bottom of what is going wrong?
Ms Dorries
That is certainly one of the many issues highlighted in the report, but it is not the only one. We have commissioned the policy research unit in maternal and neonatal health and care at the University of Oxford to undertake research into the disparities in the near misses, and to develop an English maternal morbidity outcome indicator. The research will explore whether the indicator is sufficiently sensitive to detect whether the changes made to clinical care are resulting in better health outcomes. Five X More called for that in its list of 10 requests.
We are putting the research in. We have found a way to look at the research in order to make the differences that need to be made. We can do that by examining the near misses. What happened in those cases and in those women’s experiences? What went wrong? Do the women feel that they were not listened to? Was it a matter of treatment? Was it a lack of understanding? We need to understand that by looking at the near misses. The research is being undertaken, but it will take some time. Hopefully, when that is reported, we will be able to make progress on the issue of setting targets.
This Government are no strangers to setting targets. On the very sad issue of baby loss, we set a target to reduce neonatal stillbirth and neonatal mortality rates by 20% by 2020. We have reached almost 25%. We have smashed that target and are still pushing forward to improve that situation even more. We are not afraid of setting targets, but when we are setting them we have to know how to achieve better outcomes. The hon. Member for Battersea (Marsha De Cordova) mentioned continuity of carer. She is absolutely right about those figures. We know that continuity of carer works incredibly well, particularly for black women and women from ethnic minorities. Having the same midwife throughout the process of pregnancy makes a huge difference. That is being rolled out across the country. I am sure that the hon. Lady has spoken to the chief midwifery officer, who is a huge supporter of the policy. We are continuing to roll it out and make progress with it. It has been slightly more difficult during the 12 months of the covid pandemic, particularly because many trusts did not continue with home births.
We are not afraid of setting targets, however. Setting targets in maternity units is what we are about, to make them safer places in which to give birth and in order to reduce both neonatal and maternal mortality rates, but we need to do the research on the near misses, to understand what the problems are. We cannot set targets until we know what we are trying to achieve through those targets and what we need to address. Five X More has asked for that research to be done. It needs to be done, and it will be done.
We are committed to reducing inequalities and to improving outcomes for black women—we work at that daily. I established the maternity inequalities oversight forum to focus on inequalities so that we in Government understand what the problems are. The forum also brings together experts from across the UK—we have met MBRRACE-UK and Maternity Voices—who have done their own research and studied this problem, to hear their findings and recommendations. Professor Jacqueline Dunkley-Bent, the chief midwifery officer for England, is leading the work to understand why mortality rates are higher, to consider the evidence on reducing mortality rates, and to take action to improve the outcomes for mothers and their babies.
NHS England is working with a range of national partners, led by Jacqueline Dunkley-Bent and the national speciality adviser for obstetrics, to develop an equity strategy that will focus on black, Asian and mixed-race women and their babies, and on those living in the most deprived areas. The Cabinet Office Race Disparity Unit has also supported the Department of Health and Social Care in driving positive actions through a number of interventions on maternity mortality from an equalities perspective. The Royal College of Obstetricians and Gynaecologists has established—
Sir Gary Streeter (in the Chair)
Order. Will the Minister kindly leave two minutes for Catherine McKinnell at the very end?
Ms Dorries
I will end there, but if any hon. Members wish to speak with me about the work we are doing and the research we have undertaken with Oxford University, we are happy to share more. I say in response to the hon. Member for Luton North (Sarah Owen) that very few personal meetings have taken place, but I would be happy to meet her and her constituent.
Sir Gary Streeter (in the Chair)
Thank you very much, Minister. It is very important that Catherine McKinnell has the final word.
Catherine McKinnell [V]
Thank you, Sir Gary. I thank the Minister for her response, and everybody who has contributed to the debate, which has been very moving and powerful, and also very painful. I thank in particular my hon. Friend the Member for Streatham (Bell Ribeiro-Addy) for sharing such a powerful personal story.
I hope that the debate has helped to raise awareness and understanding of why the issue must be urgently addressed, and I hope that we have done justice to the passionate and powerful campaigning of Clo and Tinuke. I know that they and we all want to see change, so I hope that the Government and NHS leaders have heard that call today. I urge the Minister to meet those who are affected, to continue to listen and to ensure that data continues to be collected and that changes are made to put an end to the five times more statistic for good.
Question put and agreed to.
Resolved,
That this House has considered e-petition 301079, relating to Black maternal healthcare and mortality.