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Mr Philip Hollobone (in the Chair)
Before we begin, I encourage Members to wear masks when they are not speaking, in line with current Government and House of Commons Commission guidance. Please also give each other and members of staff space when seated and when entering and leaving the room. Members should send their speaking notes by email to hansardnotes@parliament.uk. Similarly, officials should communicate electronically with Ministers. I now call Bell Ribeiro-Addy to move the motion.
Bell Ribeiro-Addy (Streatham) (Lab)
I beg to move,
That this House has considered Black Maternal Health Week.
It is a pleasure to serve under your chairmanship, Mr Hollobone. I am thankful that we are able to have this debate, which follows from an e-petition debate that was held in April after the petition received over 180,000 signatures. MPs were given the opportunity for the first time to debate a petition calling for improvements to maternal mortality rates and healthcare for black women in the UK.
I would also like to take this opportunity to thank Tinuke and Clo from Five X More, as well as Elsie Gayle, whose tireless campaigning efforts have forced this issue on to the agenda. They have not only provided us with the opportunity to discuss the issue but given a voice to many black women who have experienced a traumatic pregnancy or birth and to those families who have lost loved ones.
For too long the statistics had pointed towards a glaring disparity in black maternal health experiences, and for too long nothing was said. We now have a Black Maternal Health Awareness Week, during which we can highlight the disparities and discuss ways in which we can make pregnancy a safe experience for all, regardless of skin colour.
Members will by now be very familiar with the statistics surrounding black maternal healthcare and mortality, but they bear repeating. In the UK, which is one of the safest countries in the world in which to give birth, black women are still four times more likely to die in pregnancy or childbirth. Black women are up to 83% more likely to suffer a near miss during pregnancy. Black babies have a 121% increased risk of stillbirth and a 50% increased risk of neonatal death. Miscarriage rates are 40% higher in black women, and black ethnicity is regarded as a risk factor for miscarriage. Black mothers are twice as likely to give birth before 37 weeks of pregnancy.
The situation for women and birthing people of mixed heritage and Asian heritage, unfortunately, is not much better, with those of mixed heritage being three times more likely to die in pregnancy and childbirth, and Asian women two times more likely. Asian babies also have a 55% increased risk of stillbirth and a 66% increased risk of neonatal mortality.
However, we all know that racial disparities in health do not begin, and certainly do not end, there. Despite these statistics, despite the number of reports and studies that have been produced in the last year and before, and despite being aware of the glaring disparities in maternal healthcare, we still have no target to end them.
Jim Shannon (Strangford) (DUP)
I thank the hon. Lady for giving way. The statistics are alarming and disconcerting. That black ladies are four times more likely to die in childbirth is shocking. Does she agree that the Government and the Minister now have a responsibility urgently to outline steps to address this? The hon. Lady has outlined the issue, but we want to see what the response will be to make it better.
Bell Ribeiro-Addy
The hon. Member is absolutely right. With disparities such as these and no clear way forward, that is what we are hoping to hear from the Government. With all the information that we have, it is clear that the response is not good enough.
In the USA, where there is also a glaring disparity in maternal health outcomes for black and ethnic minority women, the Government have actually begun to take steps to address the problem. In April, the White House issued its first ever proclamation on black maternal health. President Joe Biden declared a Black Maternal Health Week, to take place annually from 11 to 17 April.
Kirsten Oswald (East Renfrewshire) (SNP)
The hon. Lady is giving a very powerful and important speech. I wonder whether she is aware that research from the USA shows that when black and Asian women do not have pre-existing medical conditions, do have English as their first language and come from middle-class backgrounds, they still have worse outcomes than comparable white women. Does the hon. Lady agree that there is something more going on here, making it all the more pressing that this Government here understand and act?
Bell Ribeiro-Addy
I thank the hon. Lady for that timely intervention. She is absolutely right; that shows that this is clearly about racism. It is important that we look to what other countries that also clearly have issues with racism are doing to tackle it.
Alongside the Black Maternal Health Week proclaimed by the White House, the Biden-Harris administration has outlined several action plans specifically looking at addressing maternal health issues. Through the American Rescue Plan Act 2021, $30 million has been reserved for implicit bias training for healthcare providers, as well as a provision that will allow states to expand post-partum Medicaid coverage from 60 days to a full year.
How have our Government responded in comparison? In response to a question I asked one of our equality Ministers, I was told that there was no target because the numbers were not high enough. Our Government have responded with poorly rolled-out plans that actually exacerbate the issue by ignoring the problem altogether. The NHS long-term plan aimed at providing continuity care for women across the country seemed, on paper, like a really good starting point to improve maternal health outcomes. However, a whistleblower at Worcester Royal Hospital has said that, in reality, it has created a two-tier system for pregnant women. To create the new team of continuity carers, midwives have had to be pulled from the hospital’s core staff, leaving the hospital unit without enough specifically trained staff.
Nickie Aiken (Cities of London and Westminster) (Con)
A constituent of mine, Jade Sullivan, has been in touch with me to share her own experiences of disparities in maternity care and outcomes for black women. Her testimony was incredibly powerful, and I hope to be able to meet with the Minster soon to discuss that in more detail. Does my hon. Friend—I am sorry, I should say the hon. Member, although I hope that she is also my friend—agree with me that we need a clear plan with targets to reduce disparities in maternal health outcomes that actually outline the specific actions needed to improve safety for black mothers and their babies?
Bell Ribeiro-Addy
I thank the hon. Member because I absolutely agree that that is what we need, but we also need to make sure that these plans are well thought-out and well resourced. As the whistleblower from Worcester pointed out, with the new plan, the ward could often end up being short of five or six midwives per shift. Meanwhile, those with a continuity midwife who are, according to the whistleblower, actually lower risk, are jumping ahead and delivering their babies because the midwife is available straight away.
A system that is supposed to help reduce the rate of stillbirths and maternal mortality has, through its poor implementation, resulted in a two-tier system whereby higher-risk pregnancies are made to wait for deliveries. For example, a woman in need of an urgent caesarean section may have to wait while women with a planned or elective caesarean section are seen first.
Recently, the Health and Social Care Committee’s evaluation of the Government’s progress against their policy commitments in the area of maternity services in England rated the Government’s continuity care commitment as inadequate and in need of improvement. That is simply not good enough. While figures also suggest that the number of women from disadvantaged backgrounds who are likely to experience a high-risk pregnancy are now receiving continuity care, and those numbers are increasing, it is clear that the Government are not on track to meet the target of rolling out their continuity of carer service model to 75% of the most vulnerable groups by March 2024. Without adequate funding and staffing, the two-tier system that has played out in Worcester will continue.
Other measures introduced by the Government to improve maternity healthcare seem to ignore the racial disparities altogether. On 4 July this year, the Department of Health and Social Care announced that it was committing £2.45 million to improve childbirth care. Of that, £2 million was to be allocated to test the best way to spot early warning signs of babies in distress, and the remaining money was allocated to developing a new workforce planning tool for maternity medics, including helping trusts to tackle other inequalities, taking into account local factors such as birth rates, the age of the population, the socioeconomic status of the area, and geographical factors. Those are all important, but at no point in this announcement was there any reference to tackling ethnic disparities in maternal healthcare, despite all of the information we have heard over the past few years in particular.
I ask the Minister why the decision was made to omit a reference to ethnic disparities when research clearly highlights ethnicity as a factor in maternal health outcomes, so much so that a series of papers released in The Lancet regarded black ethnicity as a risk factor for miscarriage. In fact, the only other intervention I have heard has come from the National Institute for Health and Care Excellence, which was to recommend inducing black women at 39 weeks—another tone-deaf response. There have been loads of responses from throughout the sector that really drilled down on what the problem was with this. Christine Ekechi, the co-chair of the Royal College of Obstetricians and Gynaecologists’ race equality taskforce, said that
“Stratifying risk by race alone is a blunt tool to use, and although highlighting higher risk is important, it does not move our understanding further as to why this group of women are at greater risk…Women should always be able to make informed decisions about their own health and care based on real evidence.”
This suggestion was not based on real evidence.
The Royal College of Midwives warned against “blanket approach recommendations” and argued in favour of “personalised care”, saying that
“Black, Asian, mixed, and ethnic minority women face a constellation of biases when accessing maternity services, often experiencing poorer quality of care and lower satisfaction. Introducing an intervention that is singling out women on ethnicity alone, when there are likely to be large differences in health status and values within the group could itself be considered discriminatory.”
Mars Lord, who is a doula and birth activist and started the Not So NICE campaign with her colleague Leah Lewin, said that the recommendations were already affecting black people’s mental health. She said that she had been in contact with
“dozens of black and brown pregnant women and birthing people who are fearful about their birth because they are not seeing any choices”.
Thousands have signed a petition urging the Government to reject the guidance from NICE.
It is clear that without a proper plan to end racial maternity health disparities, the Government are telling black, Asian and ethnic minority women and birthing people right across this country that they do not care: that our pregnancies, our children and our experiences do not matter. If the Government want to show that this is not true—if they want to prove that they care about the experience of every pregnant woman—they have to start, first and foremost, by setting a target to end these maternal health disparities.
When the Minister responds, I want to hear that the Government have set a target to end racial maternal health inequalities. I want to hear that they have a timeframe for when they would like to see these gaps closed and reduced, and exactly how they plan to do this, and I want to hear that the Government have heard what black women have been saying about our experiences of maternal healthcare and how they have often resulted in negative outcomes and traumatic experiences. I also want the Government to say that they will engage with black women to improve our experiences of maternal health services, and that they will be implementing the Joint Committee on Human Rights’ recommendations on black maternal health, as well as those included in the Health and Social Care Committee’s report, “Safety of maternity services in England.”
Finally, when the Minister responds, I hope to hear that the Government intend to launch an inquiry into institutional racism and racial bias within the NHS, as well as within the medical education field. Stereotypes about the pain tolerance of black people, our cultural beliefs and practices, and our perceived understanding of the medical system all contribute to the negative experiences black women have had in maternal services, and they definitely contributed to mine. It is certainly an uncomfortable view to take that medicine, or our fantastic NHS, may operate within a framework that has institutional racist bias, but if we are going to improve the maternal experiences and outcomes of black women, we have to address the racial stereotypes that cause them. We are not going to get there by burying our head in the sand and pretending that these racial injustices do not exist, or that they are not so bad. The colour of a woman or a birthing person’s skin should not impact the experience that they have of maternal healthcare services, their chances of a successful outcome or, in fact, whether they live or die. It is a sad fact that this happens in our country—in the sixth largest economy in the world, in one of the safest places to have a child—so we are calling on the Government to help improve those maternal experiences for all women.
Caroline Nokes (Romsey and Southampton North) (Con)
I put on record my appreciation to the hon. Member for Streatham (Bell Ribeiro-Addy) for having led the debate today and for her incredible work on this important and sensitive issue.
Alongside me, she is a member of the Women and Equalities Committee. We have been privileged to listen to the evidence of black and mixed-race mothers about the experiences that they have had in giving birth and in supporting their family members in giving birth. We have heard some real horror stories of lost sisters and lost daughters, because their maternal health outcomes have been worse than the outcomes that my hon. Friends the Minister and the Member for Cities of London and Westminster (Nickie Aiken) and I would have had.
It is wrong that in 21st century Britain we can still expect black and mixed-race women and women from ethnic minorities to have such a massive disparity of experience. The Five X More campaign has done some incredible work. In the Select Committee, we have been lucky enough to do roundtables with them, and to listen to their experiences, their recommendations and the changes that they believe would make a real difference.
Those stories have been difficult but important to listen to. The thing I took away was how fed up those women were about having to repeatedly tell the story. They feel that they are not being listened to, that there is no change and that they are not seeing action, when actually, as the hon. Member for Streatham has pointed out, the statistics are so stark that this should be driving immediate and rapid change.
In November last year, the Joint Committee on Human Rights discussed targets. I can sometimes be a bit sceptical about targets and think they do not necessarily always drive the right outcomes and behaviours, but this is a clear case where I think that they would and where I want to see the Government have real ambition to set a target and a timeframe, so that we can see that four times more disparity driven down and ended. It is crucial that we try to do that in a very rapid timescale.
There have also been clear recommendations from the Health and Social Care Committee. Indeed, the Government should be responding to them imminently. Can the Minister update us on that in her response and give us an indication about whether the Government will embrace those recommendations?
I am conscious that my hon. Friend the Minister has done good work on the subject and last year set up a forum designed to bring together experts in the field to meet key stakeholders, to consider and to address the inequalities for women and babies from different ethnic backgrounds and socioeconomic groups. We cannot shy away from that. We also have to look at some of the intersectional challenges, and ensure we are looking not just at race but at the socioeconomic situation.
Can the Minister outline how that forum is assisting policy making? It is crucial and we want to understand what role those experts are playing in feeding into Government to drive policy change. Can she indicate how often the forum has met and what the key recommendations have been? How quickly will those recommendations be acted upon, if indeed they will be acted upon?
One challenge that we heard at the Women and Equalities Committee roundtables was about research. Many experts felt that there was already a great depth of research that had been done, that the knowledge was there and that perhaps further research was not needed. In April this year, we heard that the Government had commissioned the policy research unit in maternal and neonatal health and care at the University of Oxford to develop an English maternal morbidity outcome indicator, which is not easy to say. That is crucially important. We want to see how that indicator is working and when we expect it to be rolled out. I would like to hear the Minister today update us on that work and give us some indication as to whether she is any closer to committing to a target for reducing the deaths of black women in childbirth.
Towards the end of her contribution, the hon. Member for Streatham spoke about continuity of care, which is crucial. We know very well that if there is continuity of care during pregnancy then the birth outcomes would be better for both mother and child. The NHS long-term plan included targeted support around continuity of care, with an aim that by March this year most women would receive the sort of crucial continuity that we are calling for. That was a target that was set, so I would very much welcome the Minister’s updating us on how that is going. We heard from the Health and Social Care Committee that the targets for continuity of care were inadequate and in need of improvement, so perhaps we can have an indication of how the Government will achieve that.
The hon. Member for Streatham finished her speech with a commentary on institutional racism in the national health service. I was really struck—I was going to say this time last year, but perhaps it was a bit earlier—when we took evidence in the Women and Equalities Committee on how much worse the outcomes of covid were for people from black, Asian and minority ethnic communities. One of the messages that we heard from healthcare professionals from black and Asian backgrounds who were working in the NHS was that they were scared to speak up. They were scared to tell their stories to line managers about the pressures that they faced when working in our NHS. In many instances, they felt exposed to racism if they asked for perfectly reasonable adaptations or changes, or for greater levels of personal protective equipment. It is absolutely wrong in the 21st century that we have people working in our health service who are frightened to speak up.
I was struck when we took evidence during the roundtable discussions with black and minority ethnic mothers, and indeed with experts—we heard from Christine Ekechi, who is the most incredible woman, and from the doula Mars Lord, to whom the hon. Member for Streatham referred. They made a really important, shocking and, in many ways, depressing point: too many black women and their partners were not being listened to during childbirth. They were trying to convey how they felt and the worries they had when they felt that things were going wrong. Mothers going through childbirth were scared and instinctively felt that something was going wrong, and they told us repeatedly that they were not listened to. In a 21st-century health service in the sixth largest economy in the world, that is simply not acceptable.
Florence Eshalomi (Vauxhall) (Lab/Co-op)
It is a pleasure to serve under your chairmanship, Mr Hollobone. I pay tribute to my constituency neighbour, my hon. Friend the Member for Streatham (Bell Ribeiro-Addy), for her powerful opening speech and for the work that she has been doing to lead on this really important issue.
The theme for this year’s Black Maternal Health Awareness Week is “changing the narrative”. We have to change the narrative. There is a call for a sea change in the outcomes for black women during pregnancy, and in finding ways to empower black patients to advocate for their health. We have known for years that women of black, Asian and mixed heritage face significantly higher maternal and prenatal mortality rates, and that women from black and minority ethnic backgrounds discover many conditions during their pregnancy. I discovered that I had fibroids at my first maternal scan during my first pregnancy. As an expectant mother, that brought a level of fear and anxiety—what would happen to me and my baby? In most cases fibroids can be unharmful, but in a small number of cases they can cause complications for the growth of the child and for both mother and baby during labour.
Unfortunately, we know that black and minority ethnic women are sometimes not listened to during the course of their pregnancy, and that there can be unconscious bias as a result of the structural inequality and institutional racism in our healthcare system. As my hon. Friend the Member for Streatham highlighted, Professor Knight suggests in the MBRRACE-UK report that a number of black and ethnic minority people face microaggressions, which means that symptoms can be indicative of complications that are missed, and that they are not given the attention they need. The “changing the narrative” campaign helps to empower black women to make their voices heard on this issue. It is crucial that their voices are listened to, and that their experiences are heard. I pay tribute to Five X More for the vital work that it has been doing to lead the campaign and, most importantly, to get the Government to listen to the many voices of the black and Asian women who are suffering in this area.
As a mother to two young children, who were born just across the river at St Thomas’ Hospital, this issue is close to my heart and those of many of my constituents in Vauxhall. More than 1,000 Vauxhall residents signed the petition urging the Government to pay close attention to this issue and to improve health outcomes and maternal rates for black women in the UK. Compared with white European women, black African women in the UK are 83% more likely to suffer near-misses in childbirth, and black Caribbean women are 80% more likely to do so. My two children were very stubborn and did not want to come out; in the end, they had to be evicted by C-section. My first pregnancy was fine: I was induced, it did not work, so the C-section was the next day. My second pregnancy did not go so well. Having gone through a C-section, I did not want that again. I tried to explain to the doctors that my body did not respond to induction and that if they just gave me time, the baby would eventually come out. Everything did not go to plan and I was rushed to theatre for an emergency C-section.
Panic, fear and the unknown, added to the fact that they had not been able to contact or locate my husband, meant my body froze and rejected the epidural. I heard the doctor’s words that I would have to go under general anaesthetic. I asked, “What? I am going to be put to sleep and you are going to deliver this baby. What if I don’t wake up?” I was lucky because I did wake up, after many hours. A number of black women are not as lucky; they do not wake up. It is important that we listen to black women and the experiences of all women, because they know their bodies best.
During the debate earlier this year, alongside the petition in April, the Minister would not set a target around black maternal health:
“We cannot set targets until we know what we are trying to achieve through those targets and what we need to address.”—[Official Report, 19 April 2021; Vol. 692, c. 172WH.]
We know that 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; and Asian women twice as likely. Those statistics paint a clear picture of the problem we need to solve. It is now five months since we last discussed this issue in the House. I have one question for the Minister: what research has been done to set the target, so that we can measure the progress to end this disparity? If none, what steps is she taking to gather the data urgently to tackle this problem as soon as possible? One death is far too many. It is important that we listen to those women and address this issue urgently.
Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)
I am grateful for the opportunity to speak in this important debate on an important subject. I congratulate my hon. Friend the Member for Streatham (Bell Ribeiro-Addy), who made it possible. In particular, to speak in Black Maternal Health Awareness Week feels right and appropriate.
For all mothers-to-be, pregnancy is a challenging time, as I remember. Pregnant women feel vulnerable as their bodies are changing. For a first-time parent, in particular, the uncertainty of parenting can be daunting. It is very important that all mothers-to-be have access to high-quality services. Many do, thanks to our NHS. Our NHS is staffed by so many dedicated professionals, who provide exemplary support for many new mothers.
I want to make it clear that this debate is not designed to berate or admonish hard-working NHS staff. In fact, many staff in maternity services are black. Nevertheless, as colleagues have said, the extraordinary disparities in black maternal health cannot, and must not, be ignored any longer. I am aware that the Government do not like to talk about racial disparities, but Ministers can scarcely blame black women themselves for the disparities in maternal outcomes for black women.
The time is now for the Government and those in charge of the NHS to take these issues seriously. As Members have said, statistics show that black women in the UK have a fourfold higher increased possibility of dying in pregnancy, compared with their white counterparts. Disparities in mortality rates extend to babies as well as mothers. Mortality rates remain higher for black, black British, Asian or Asian British babies. That must have something to do with the disparities in the whole area of the maternal experience.
As a number of Members have said, these statistics show that there is a major problem in maternal health. So, the question is this: what are we going to do about it? To NHS managers and commissioners who may listen to this debate or read the transcript of it, I would ask: how will you ensure that black women are listened to? A number of Members who have spoken in this debate have made the point that black women, however confident and educated they might be in other circumstances, do not feel that they are listened to when it comes to the maternal experience. How will we close the pain gap, to ensure that black women are not left to suffer without the pain relief that apparently is readily given to white mothers?
The 2019 NHS Long Term Plan is a start, but it lacks concrete steps to address this disparity. It makes no mention of addressing disparities even in the administration of pain relief, among other things. I am hopeful that the Minister will touch on these issues when she responds to the debate.
So I say to the Government: what is the plan to address these disparities? What explanation can be given for them? Ministers have said in the past that we no longer see a Britain where the system is deliberately rigged against ethnic minorities. If they believe that, what will they do about the disparities in maternal outcomes?
If the Government and those managing our NHS wish to close this gap, they have to put black women at the centre of their thinking and listen to what they say about their experience, both after and during childbirth. That means that there must be clear and binding targets, data collection and monitoring to support and judge progress on this issue. It also means funding for new and existing projects to tackle this disparity and to take the measures that I and others have outlined.
I thank campaigners, such as those at Five X More, who have worked so hard to ensure that this matter is not forgotten. Black women and their babies deserve better. At no point in any woman’s life does she feel more vulnerable than in childbirth, and black women should not have to believe or understand that they will have a poorer outcome simply because of the colour of their skin and their babies’ skin.
Anne McLaughlin (Glasgow North East) (SNP)
It is a pleasure, Mr Hollobone, to serve under your chairmanship today.
I start by paying tribute to the hon. Member for Streatham (Bell Ribeiro-Addy) for securing this debate in Black Maternal Health Week. Clearly, she is determined that something will be done to change this terrible situation, and rightly so. Persistence very often pays off and I am sure that she will persist until change comes. I also know that this is a very personal matter for her and nothing that happens in the future can change what happened to her and her child. The fact that she keeps fighting so that the situation changes for others says much about her and I am more than happy to offer her my support.
Just as the hon. Member and others will keep raising this issue, so should we all keep raising it again and again, as others have today, until it is no longer true that black women are four times more likely to die during pregnancy and childbirth than white women. I repeat that: four times more likely to die. Women from mixed backgrounds are three times—
Kirsten Oswald
To highlight what my hon. Friend is saying, it seems to me that it is inconceivable that the general public know about this issue. If people understood what a huge disparity in maternal health outcomes there is for black women and for mixed race women, I feel sure that there would be a huge outcry. It is really important that the Minister takes that point on board and takes every step possible to deal with this terrible blight.
Anne McLaughlin
I completely agree with my hon. Friend. It is up to the many Members of this House who are not already doing it to do it, and those of us who are doing it must keep repeating over and over again that black women are four times as likely to die during pregnancy and childbirth as white women. For women from mixed backgrounds it is three times as likely, and for Asian women it is twice as likely.
The reason we need to keep saying that is that, despite the fact that the inequality and disparity in maternal and newborn health has been highlighted for many years, we still do not fully understand why it exists, as we have heard, and we do not have the targets that we need to tackle it. The right hon. Member for Romsey and Southampton North (Caroline Nokes), the Chair of the Women and Equalities Committee, of which I recently became a member, said that the statistics are so stark that there should be immediate change. She called on the Government to meet ambitious targets rapidly, and I completely agree.
In the previous debate on this matter, I focused on some of the shocking statistics that MBRRACE-UK highlighted in its confidential inquiry into maternal deaths; I shall repeat some of them. For every 100,000 women who gave birth between 2016 and 2018, 34 black women, 25 mixed ethnicity women and 15 Asian women died, compared with eight white women. Behind those numbers are people—women and babies. Compared with babies of a white ethnicity, black babies have a 121% increased risk of stillbirth and a 50% increased risk of neonatal death, and the gap has been widening since 2013. So there are these tiny human beings—boys and girls—who never got a chance at life. There are grieving fathers and husbands. There are whole families and whole communities.
In addition to the higher mortality rates, other concerns include the number of near misses and the number of times that women have felt that their voices have not been heard because of their skin colour. The hon. Member for Vauxhall (Florence Eshalomi) described a terrifying experience, when she must have felt completely powerless. That is wrong. I was shocked to hear many stories of mothers denied pain relief or left to suffer with undiagnosed post-partum conditions. I know that these things happen to women who are not black—it is always wrong—but for someone to be treated differently because of their skin colour surely compounds the problem. Just as we would research and address any medical causes of these things, we must research and address this issue. I echo the calls of the hon. Member for Streatham for the Government to address it.
As someone who is white, it took me some time to learn that people who are black just know when someone’s behaviour towards them is because of their skin colour. It is hard to explain. It was hard for me to understand at first, and obviously it is harder for me as a white woman to explain it because I do not experience it, but I have no doubt about it. I encourage everyone who does doubt it to really listen to what black and Asian mums are saying and trust that they just know.
NHS GP Dr Adwoa Danso has pointed out that instances of medical mistreatment have impacted on black, Asian and minority ethnic communities’ faith in the health services, and we saw that when it came to getting the covid vaccine. There is a further suggestion that, as the majority of migrants are disproportionally black, Asian and mixed ethnicity, the Home Office’s hostile environment immigration policy makes public services incredibly difficult to access. The right hon. Member for Hackney North and Stoke Newington (Ms Abbott) talked about the hostile environment and has campaigned hard against it for many years.
Women seeking asylum have been blocked or refused by reception staff acting as gatekeepers, often in conjunction with expectations or experiences of prejudice and discrimination. The hostile environment also leads to decisions such as taking women seeking asylum out of supportive communities and into places such as the so-called mother and baby unit in Glasgow, where tiny babies are put in tiny rooms with not even enough room to crawl. The frustrating thing for me as an MP representing Glasgow North East, in a country where we have our own Government, is that our Government can do nothing about it because all the decisions about it are taken down here in Westminster.
Anne McLaughlin
Absolutely. The right hon. Member for Romsey and Southampton North mentioned evidence from the Women and Equalities Committee. I was not on the Committee at the time, but NHS staff gave evidence saying that they felt unable to speak up. A number of years ago when I was a Member of the Scottish Parliament, I met with a group of South African nurses, and they were astonished that they were able to meet with a parliamentarian, because they thought it was not their right to be represented. They told me the things that were happening to them in their jobs in the NHS, and they certainly needed someone to support and represent them, so, yes, I do completely agree with the right hon. Member for Hackney North and Stoke Newington.
Maternity Action research found that, just like staff who were too afraid to report, black and minority ethnic women tended not to report negative experiences, and they were less likely to be treated with kindness by health professionals or spoken to using terms they could understand. Although data has not been collected recently, a 2007 confidential inquiry into maternal and child health found that between 2003 and 2005 10% of all maternal deaths were women who could not speak English. As we heard earlier in an intervention from my hon. Friend the member for—Eastwood?
Anne McLaughlin
It is Eastwood in the Scottish Parliament. Forgive me, Mr Hollobone. As my hon. Friend said, studies in America show that even among women who come from fairly well-off backgrounds and who do speak English, black and Asian women are still disproportionately affected.
If I worked in maternity care in the NHS and heard someone like me saying these things, I would naturally feel defensive. Instead, what I ought to do is think about it, read up on it, question myself—and I do regularly—and really listen to what people are saying. I have no doubt that the vast majority of healthcare workers care deeply about the people they work with. The debate is more about the system itself and the inbuilt structural inequalities. For those who may be watching and do not know this, if we say the health service is structurally racist, it does not mean it is populated by racists: it means the way in which it is structured is for white people from certain backgrounds. It takes into consideration their needs, culture and language, with very little flexibility to take into account anyone else’s. Changing the structures makes them more flexible, and that is what the debate is calling for, in addition to addressing the very specific problems that have been talked about. After all, our NHS is not a white person’s NHS, it is an NHS for everybody.
I had decided that I was only going to speak for five minutes, and I think if I had not taken interventions then I would have done, but I think it is worth saying why I had decided that. I wanted to give the hon. Member for Streatham longer—and I know she will want to say a few words at the end—because, even though I have ended up taking 10 minutes, I do believe that part of offering support is saying less and listening more.
Mr Philip Hollobone (in the Chair)
We now come to the Health Minister, Nadine Dorries. After the Health Minister has spoken, Bell Ribeiro-Addy will have a few minutes to sum up.
The Minister for Patient Safety, Suicide Prevention and Mental Health (Ms Nadine Dorries)
It is a great pleasure to serve under your chairmanship for the first time, Mr Hollobone. I thank all Members who have taken the time to attend the debate, in particular the hon. Member for Streatham (Bell Ribeiro-Addy), who I have heard speak before about her experience on this issue. I think she is incredibly brave to campaign and highlight the issue in the way she does. I thank her for her thoughtful considerations. I know that she is holding my feet to the fire as well as the Department’s, and that is a huge assistance in pushing the agenda forward within the Department of Health and Social Care.
I stand responding to the debate as a brand new grandmother of 18 days. The delivery was not uneventful, and the baby arrived early, which is a similar story to that of the hon. Member for Vauxhall (Florence Eshalomi) at St Thomas’. Having given birth myself three times, I understand in a very raw way the pressures that all women experience, and I lived through just two weeks ago how emotional and incredibly frightening it can be when things do not go to plan.
This is the second annual awareness week we have had to highlight the disparities for black women in maternal health outcomes in the UK.
Florence Eshalomi
Congratulations to the Minister, it is always a joy to see more children and grandchildren. I am still getting to grips with motherhood with my four-year-old and six year-old. The statistics clearly show that the maternal death rates, and negative experiences, of black and Asian women are higher, but this does not negate the fact that some white women also go through similar experiences. Does the Minister agree that improving the maternal health outcomes of one group will improve the outcomes for all groups?
Ms Dorries
The hon. Lady is absolutely right. I am very proud of the work that we have done in the Department of Health and Social Care, and in the NHS, to improve maternal outcomes for everyone, particularly over the last few years. The statistics speak for themselves. However, I will focus on the issue of black women and maternal health, because there is a great deal that we have done since the hon. Member for Streatham had the last debate. I am looking forward to informing her about the work that has been undertaken since then. I thank her for instigating this debate, and I hope that she continues to hold our feet to the fire. It is important that people do raise this issue, as she does, as often as possible in Parliament.
In response to the incredibly articulate speech by my right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes), it is right to raise the report by the Health and Social Care Committee, which I will respond to next week. A number of the questions that have been asked today will be included in that response, so I will not steal my own thunder—I will wait to provide a response next week.
I thank the co-founders of the Five X More campaign, Clotilde and Tinuke, and all the health care professionals and organisations who campaign to raise awareness of this week. I have visited Tommy’s maternity unit three times now, and the hon. Member for Streatham is right to raise the point that the majority of staff, doctors and midwives are black. I am incredibly impressed with the way that Tommy’s addresses this issue; they are pioneers in addressing maternity inequalities and outcomes, and they do fantastic work. I pay tribute to Tommy’s, and all hospitals, who I know are putting their weight behind reducing maternity inequalities and outcomes—Tommy’s is certainly at the forefront of that work. My granddaughter was born at Chelsea and Westminster hospital, so I thank them too—they are pretty amazing as well.
This debate comes a few days before this year’s World Patient Safety Day; the theme this year is safe maternal and new born care. It provides an opportunity to mark the progress made across the system in improving outcomes and safety, but also to recognise that further work is needed. At its best, NHS care offers some of the safest maternal and neonatal outcomes in the world. However, the disparities that exist between black and white women in pregnancy and childbirth experiences are unacceptable. I am committed to both reducing this disparity in health outcomes, and improving the experience of care.
We cannot beat around the bush any longer on some of the reasons why we experience these inequalities. They are complex, and there is no one answer as to how we can address this subject. Personal, social, economic and environmental factors all play a part; we must address the causes of disparities to improve outcomes and experiences of care. I was delighted that last week NHS England and NHS Improvement published their equity and equality guidance, which responds to findings that maternal and perinatal mortality show worse outcomes for those in black, Asian and mixed ethnic groups. They invested £6.8 million in the guidance to improve equity and equality action plans, and implement targeted and enhanced continuity of care.
We know that pregnancy lasts around 40 weeks. However, when a woman walks into a hospital to give birth, those 24 or 48 hours—however many hours she is in hospital—are not what wholly contributes to her experience of the healthcare sector, or her outcome. A lifetime approach is needed to address some of the reasons why some women are more at risk of poorer outcomes than others. We know that there are many health issues that contribute to poorer outcomes in pregnancy, including alcohol, obesity and smoking. The chief medical officer recently published a report that showed that, in some of our seaside towns, 25% of women are smoking at the beginning of pregnancy. I think the figure was that 22% were still smoking by the end of their pregnancy. There are inequalities and health disparities that we really need to address.
For that reason, we have established the newly formed Office for Health Improvement and Disparities, which launches on 1 October, to target those health disparities, including racial and ethnic disparities in health, and to improve pre-conception health to support women to be in their best health throughout pregnancy.
Ms Dorries
I will just finish the point on the office of disparities, because it is quite important. It is a huge step to establish an office that will actually deal with this particular issue. It will tackle inequalities across the country, and will be co-led by the newly-appointed deputy chief medical officer, Dr Jeannelle de Gruchy.
The office will be a vital part of the Department of Health and Social Care, and will drive the prevention agenda across Government to reduce health disparities. I hope the hon. Member for Streatham welcomes the establishment of this new body to tackle the top preventable risk factors for poor health, which include obesity, unhealthy diets, lack of physical activity, smoking and alcohol consumption. Equity and equality guidance will also be issued.
It is a huge step to look at those lifetime health experiences that contribute to what happens at the point of delivery and throughout pregnancy. Until we improve, and look at what happens before, using a lifetime view of health that includes women’s experiences of health throughout, then tackling what happens when they walk through a labour ward door will continue to be very difficult.
Ms Abbott
I think everyone present welcomes the establishment of the new office. The Minister has mentioned obesity, alcohol and smoking as risk factors in pregnancy; I take it she is not suggesting that the disproportionate outcomes we have for black women are because we are more likely to be obese, smoke or drink.
Ms Dorries
Absolutely. The office will look at all pregnancies, and the negative contributing factors. I believe that one in four women—black and white women—who present in labour are obese. That has an incredibly high risk factor during labour, so it is to address inequalities across the board. My right hon. Friend the Member for Romsey and Southampton North mentioned socio-economic groups, and the disparities they experience: smoking, alcohol and other negative factors that contribute during pregnancy are across the board, and they need to be addressed. That is the reason why the office has been established.
The cessation of smoking during pregnancy was something we campaigned on a lot in the past. I have noticed, probably since we passed the legislation to ban smoking in many places, the emphasis has almost come off the importance of not smoking during pregnancy. The CMO’s report highlights that, in some areas of low socio-economic grouping, 25% of women are starting pregnancy smoking. That highlights the fact that we need to put more emphasis on, and focus on, those health disparities.
Anne McLaughlin
Maybe I am misunderstanding, but this Office for Health Improvement and Disparities is going to look at things like smoking—you can stop smoking and can be supported in that, and you can stop drinking and can be supported in that—and I think all this is really good, but people cannot change their skin colour. Will it be looking at how ethnicity impacts on women’s and babies’ chances?
Ms Dorries
Absolutely—across black, Asian and mixed ethnic minority groups as well. The point has been made today that black women do not feel listened to. We hear stories of complaints about pain, prolonged labour and other issues, and black women just do not feel as though they are being listened to in that environment. The core finding of the Cumberlege report, which addressed mesh, sodium valproate and Primodos, was that women are not being listened to, and black women probably even more so in the maternity setting. That issue for women, black women, Asian women and women from mixed ethnic backgrounds needs to be addressed. Women have to be listened to.
Turning to covid-19 and vaccinations, covid-19 has further exposed some of the health and wider inequalities that persist within our society. While considering disparities in the context of the pandemic, initial data suggests that vaccine uptake among ethnic minorities is lower than for other groups. Covid-19 vaccines are recommended in pregnancy. Vaccination is the best way to protect against the known risks of covid-19 for women and babies, including admission of the woman to intensive care and premature birth of the baby.
New findings from a National Perinatal Epidemiology Unit-led study showed that of the 742 women admitted to hospital since vaccination data has been collected, only four had received a single dose of the vaccine and none had received both doses. That means more than 99% of pregnant women admitted to hospital with symptomatic covid-19 are unvaccinated. That is quite stark.
Caroline Nokes
On that point, will my hon. Friend reassure me and all Members that the Government will keep pushing the crucial message that the vaccine does not affect fertility or pregnancy, and that it is important for pregnant women and women of childbearing age to get the vaccine?
Ms Dorries
Absolutely. My right hon. Friend has done it for me, but I absolutely encourage women to get the vaccine because 99% is a huge figure. There is a basis of mistrust. The reason why many black women do not access some of the health services they should do before pregnancy is because they do not feel listened to and they do not feel they can trust their practitioner. The message of “Take the vaccine” must be pushed.
I will finish by taking the opportunity to urge women to continue to access maternity care and to stress that pregnant women should never hesitate to contact their midwife, maternity team or GP, or to call NHS 111 if they have any concerns. That also applies if parents are worried about their health or the health of their newborn baby. I urge expectant mothers to have their covid-19 vaccination as soon as possible. I do not think we can give out that message often enough.
Bell Ribeiro-Addy
I will try not to take up too much time. I am pleased we have had such a full discussion this morning. I know many Members across the House wanted to participate, but were unable to attend. I take confidence in knowing there are many Members in the House who are committed to reducing racial disparities in maternal healthcare.
I want to start by thanking Members who have contributed to the debate and I apologise for any mispronunciations of constituency names. Starting with some simple ones, I thank the hon. Member for Cities of London and Westminster (Nickie Aiken) and the right hon. Member for Romsey and Southampton North (Caroline Nokes) for pointing out how much black women do not feel listened to. The fact about socioeconomic groups was key. I also thank them for pointing out that, because of racism that exists in our society, 70% of black people in this country live in the poorest areas. That definitely has an impact.
I thank my hon. Friend the Member for Vauxhall (Florence Eshalomi) for sharing her experiences. It will be of great encouragement to her to know that St Thomas’ Hospital where she had her two wonderful children—they are my mates—has undergone five times more training than others and many of the midwives have done it, which is great. There are other NHS trusts like Croydon Health Services NHS Trust, which has put together a campaign called HEARD that is meeting these needs, taking steps and training in the gap where it has not been asked to train, and it should be congratulated for that.
My right hon. Friend the Member for Hackney North and Stoke Newington (Ms Abbott) made the point that we cannot blame black women for the situations that they find themselves in. Sadly, that is what happens, regardless of confidence, education and socioeconomics. As my right hon. Friend rightly pointed out, this does not always change outcomes, something which the hon. Member for East Renfrewshire (Kirsten Oswald) also pointed out.
I thank the hon. Member for Glasgow North East (Anne McLaughlin) for her frank comments about race and the articulate way in which she described exactly what institutional racism is. If only we had that level of understanding right across the House, I believe that this country would be a different place.
I also thank the Minster for her response and congratulate her on the birth of her grandchild. I thank her for committing to ending racial disparities. I think that this new body sounds like a positive thing, but I am concerned that, despite the new body and what it is going to tackle, it is still unclear whether the Government have understood that institutional racism is a serious factor affecting these outcomes and have made a direct commitment to changing that, especially in the light of the race report.
Ms Dorries
I have intervened, Mr Hollobone, because I think we have time. I probably should have also mentioned the Maternity Inequalities Oversight Forum, which is due to meet again next week. I do not want to give the impression that the new office which we are launching on 1 October will replace all the other work and everything else that we are doing. The Maternity Inequalities Oversight Forum still meets and, on the question about how it informs policy, it works hand in hand with the board of equalities and disparities. As the hon. Lady knows, we also have the patient safety board.
I can assure her that at all meetings, when we talk about maternal inequalities, the situation is something which has to be addressed and turned around in whatever way we can. This is why the Office for Health Improvement and Disparities is being established. We have to turn around the dreadful, appalling figures which pertain solely and uniquely to black women’s experience of maternity. I want her to understand that all the rest of the work is still going on, because this remains a focus in the Department. I urge her to keep calling her debates and to keep raising the issue, because it helps to drive things forward and helps us to develop acceptable and welcomed policies. I thank her for recognising the work of the disparities and inequalities board; it is just another tool that we put into the box to help fight a much bigger problem that we have to solve.
Bell Ribeiro-Addy
I thank the Minister, but my main point was that while the work is ongoing, given what has been said in the past about institutional racism, will it be with a recognition of how it affects our various bodies, not least the NHS? Accepting that point, which many of us do not believe has been done before, is key to making sure that we get the outcomes that we need overall.
As many Members know, this topic is particularly close to me and is not always easy for me to talk about. Many of those engaged in the campaign to end racial disparity in maternal health care experienced the same thing. When we detail our past events and the experiences, we do not do so to gain sympathy. We do so to give a voice to the hundreds of black women each year who have similar experiences, and in the hope that our stories will help to spur the change needed so that black women no longer face negative outcomes and the negative treatment we so often face. Bringing children into this world should not be a matter of life or death. We have a duty here, particularly with what we are tasked to do every day in our work, not just for the mothers who do not survive the dangerous birth experiences but for the many who go on to experience trauma.
I hope that the Government have been spurred into further action. I will continue to hold the Minister’s feet to the fire, since she sounds as if she enjoys it. I call on the Government to do a lot more: to ensure that we have proper data collection; to increase the support available for at-risk women; to implement the recommendations of the Joint Committee on Human Rights report “Black people, racism and human rights”; to identify those barriers to accessing maternal mental healthcare services and increasing the accessibility of mental health services after miscarriage and traumatic maternal experiences; to engage with black women in improving their experiences of maternal health services; and to commission a review of institutional racism and racial bias in the NHS and medical education to address the learned stereotypes about black and ethnic minority women that impact us so much.
By committing to those steps, the Government can demonstrate that they are serious about tackling racial disparities. Members have heard me say it before, and I will say it again: the colour of woman’s or a birthing person’s skin should not have an impact on their health or the health of their baby. The sad reality is that in this country it does, and while the Government appear to hear and are making some headway, I really want them to listen. I believe that they will truly have listened only when we have those targets and those very clear mechanisms to end institutional racism in our health service.
Question put and agreed to.
Resolved,
That this House has considered Black Maternal Health Week.