Black Maternal Health Awareness Week

Afzal Khan Excerpts

Tuesday 29th April 2025 Westminster Hall

[Bell Ribeiro-Addy (Clapham and Brixton Hill) (Lab)]

I beg to move,

That this House has considered Black Maternal Health Week 2025.

It is a pleasure to serve under your chairship, Ms Furniss. Before I get to the crux of this debate, I want to begin by saying that the UK is one of the safest countries in the world for a woman to give birth. I say that at the outset not to diminish the importance of this debate, but to move beyond that platitude—because in the sixth largest economy in the world, this should be one of the safest places to give birth. It is important that we move beyond that and focus on the real and persistent inequalities facing black and minority ethnic women in maternity care. While I am sure it is not the intention to focus on that, it can give the impression that, because the UK is broadly safe, the negative experiences of some women are exceptional and not matters that require significant Government attention. When we detail some of the harrowing experiences of women and hear that response, it can feel as though our concerns are being minimalised, so I hope the Minister will appreciate that I have got that part out of the way. While the UK is among the safest places to give birth, it is by no means perfect, and for many women it is deadly. As always, it is vital to lay out the current state of affairs.

The disparities in maternity care are evident not only in maternal mortality statistics, which show that black and mixed heritage women are three times more likely to die during pregnancy or childbirth as white women, and Asian women twice as likely, but in many other areas. Miscarriage rates are 40% higher in black women, and black ethnicity is now regarded as a risk factor for miscarriage. MBRRACE-UK’s 2023 comparison of care for black and white women who have experienced stillbirth or neonatal death found that the majority of all significant issues were identified in antenatal care for 83% of black women, compared with 69% of white women; 67% of black mothers and babies had a major or significant issue related to pathology, compared with 46% of white mothers and babies; and 75% of black parents and 66% of white parents had significant issues identified during the follow-up or reviews of their and their baby's care.

Public Health England’s 2020 report found that prematurity is a major cause of long-term infant morbidity. Black mothers, particularly those of black Caribbean background, are twice as likely to give birth before 37 weeks. In Five X More’s “Black Maternity Experiences Report 2022”, 27% of the 1,340 survey respondents felt that they received “poor” or “very poor” care during pregnancy and labour, and postnatally. Forty-two per cent of the standard of care during childbirth was “poor” or “very poor”, and I sincerely hope that the findings of Five X More’s next survey, which is currently under way, will show some improvement here.

According to Bliss, many babies born to black mothers require specialist care after birth, particularly due to preterm birth or full term complications, yet significant inequalities persist in neonatal care, admissions, the quality of care received, and outcomes after discharge. Poor care received at such an early stage of life can have critical consequences and lead to long-term health complications for black babies and deepen trauma for their families. Post-natal mental health disparities are also significant; UK studies show that women from black, Asian and minority ethnic backgrounds are more likely to suffer from common mental health disorders, yet are less likely to access treatment.

[Afzal Khan (Manchester Rusholme) (Lab)]

The Caribbean and African Health Network CIC report reveals that the perinatal mental health services lack spaces where black women can feel safe, seen and supported. Does my hon. Friend, and indeed the Minister, agree that more inclusive, high quality and personalised care is required to meet the needs of all women in maternity care?

[Bell Ribeiro-Addy]

I thank my hon. Friend for his intervention; he is absolutely right. I re-emphasise the point that black, Asian and minority ethnic women are more likely to suffer from common mental health disorders, yet are less likely to access treatment. According to MBRRACE-UK’s “Saving Lives, Improving Mothers’ Care” report from last October, deaths from mental health-related causes accounted for 34% of deaths occurring between six weeks and a year after the end of pregnancy. It is vital that all those who experience pregnancy and childbirth receive mental health support, even if they do not necessarily present as struggling with their mental health; but that is especially true of black, Asian and minority ethnic women, who are more likely to have a negative experience during pregnancy and childbirth. Some of these women’s experiences are deeply traumatic and scarring, and can lead to several mental health problems. Despite that, they are less likely to access mental health support, so they are left to try to recover mentally from the experience on their own.

That disparity exists beyond pregnancy and childbirth, and even before conception. According to the Human Fertilisation and Embryology Authority, black women are 25 times less likely to access fertility treatment, and NHS-funded in vitro fertilisation cycles among black patients decreased from 60% in 2019 to 41% in 2021. Black and Asian patients aged 18 to 37 had the lowest IVF success rates compared with white patients in 2020-21, and non-white groups also struggled to access donor eggs, with 89% of egg donors being white, 4% Asian, 3% of mixed heritage and only 3% black.

During the International Women’s Day debate, I highlighted the latest MBRRACE-UK data, which showed a statistically significant increase in the UK’s maternal death rate in the years 2020 to 2022, even when excluding deaths caused by covid-19. Put plainly, more women and babies of all races are dying in the UK now than in the past two decades. This is incredibly worrying, and it means that black women, who often face the worst care, are likely to experience even further deterioration.

When I was researching the latest statistics and figures for this debate, it became increasingly apparent that the data on racial disparities in maternity care is limited and scattered. The data I have cited comes from a collection of reports by various medical bodies and advocacy organisations. Racial disparities are often identified as part of broader studies but, as far as I know, to date there has been no comprehensive medical study dedicated exclusively to racial disparities in maternity care and outcomes, despite the statistics consistently showing how bad things are becoming.

The Lancet’s recent study on maternal mortality and MBRRACE-UK’s reports do include racial breakdowns, but they are based on the data that they have, not the data that they need. A single, dedicated study is yet to be conducted. The lack of comprehensive research makes it incredibly difficult to see a full picture of what is happening, so I hope that the Minister will address that point and highlight what the Government are doing to get a clearer picture of the state of maternity care.

There is no one driver of the racial disparities in maternity care and outcomes. The causes are multifaceted, but overwhelmingly they are the result of a combination of structural racism, unconscious bias, gaps in culturally competent care and socioeconomic inequalities. The first two are incredibly important to highlight. Without acknowledging that the NHS has an issue with institutional racism and unconscious bias, we cannot address the problem. Those issues feed into the quality of care being delivered for black mothers and their babies. The inaccurate and dog-whistle assumptions around black women’s pain tolerance, for example, can lead to women being denied pain medication during childbirth, or misbelieved when raising concerns about pain felt that signals a severe medical condition. Those beliefs are not taught in medical school or during training, yet so many black women have come across a nurse, midwife or doctor who holds them. They are a direct result of institutional racism in the NHS and have a direct impact on the care that women receive.

It is important to note that, although racial disparities in maternity care are experienced regardless of class, occupation, education or geography, socioeconomic inequalities are still a very important factor in determining health outcomes and experiences. Women living in the most deprived areas have a maternal mortality rate more than twice that of women living in the least deprived areas. Black and minority ethnic people are 2.5 times more likely to be in relative poverty and 2.2 times more likely to live in deep poverty.

The combination of socioeconomic inequalities and institutional racism in the NHS is having a dual impact on black mothers’ experiences of maternity care and health outcomes. Much of the previous Government’s work to improve maternity care was focused on co-morbidities and socioeconomic drivers of poor health. Indeed, it is crucial that those areas are addressed, but without looking at the structural racism and unconscious bias in the NHS, the problems will persist.

I want to recognise the campaign groups that are pushing the issue up the political agenda. In the absence of concrete Government or NHS action, advocacy groups have stepped in to offer their solutions and recommendations. Where they can, they also offer alternative care and training. First—always first—I commend Five X More, which established Black Maternal Health Awareness Week in 2019. Its work empowers black women to make informed decisions during pregnancy, and it advocates for systemic change. It is currently conducting its second national survey, building on its impactful 2022 research.

Five X More is calling for a measurable Government target to end racial disparities in maternal death, a commitment that the Labour Government support but have yet to implement. I hope that the Minister will confirm today whether such a target will be set, how it will be measured and when we can expect it. Five X More also advocates for mandatory annual maternity surveys focused on black women’s experiences, compulsory anti-racism and cultural competence training for all maternity professionals, and improved data collection on ethnicity and outcomes.