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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.