Black Maternal Health Awareness Week

Ashley Dalton Excerpts

Tuesday 29th April 2025 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Ashley Dalton)]

It is a pleasure to serve under your chairmanship, Ms Furniss. Before I begin, I thank my hon. Friend the Member for Clapham and Brixton Hill (Bell Ribeiro-Addy) for securing this important debate during Black Maternal Health Awareness Week. It is so important that we raise awareness of the disproportionate challenges faced by black mothers during pregnancy and after childbirth; debates in weeks such as this are critical to that.

I want to pay tribute to the charities that do so much vital work in this space: the Motherhood Group, Five X More, Black Mums Upfront, which is part of Bliss, and Ebony Bonds, to name just a few. I am taking this debate on behalf of the Minister for women’s health and patient safety, Baroness Merron. I also want to thank all hon. Members for their contributions to this debate. I will seek to pick up and answer all their queries, but if they feel I have not done so by the end of the debate, I ask them to please get in touch and I can ensure we respond.

I want to thank the charity Sands for shining a spotlight on some of the most heartbreaking cases of baby loss in the UK, and for giving a voice to so many black and Asian women who have gone through the nightmare of losing a child. One such case was Amber Lincoln from Woolwich in south-east London. She was miscategorised as low risk when she was pregnant, and nearly died from undetected complications after her delivery. A series of individual and systemic failings led to cancellations and delays, and her twins, Anaya and Mael, were born and died at 22 weeks in November 2022, before she could access the care she needed. Amber said:

“If the NHS just listened to me. And just put my appointment through when I was constantly asking. If they had the notes there properly I wouldn't have been treated that way.”

She said the fact she was mixed race led midwives to focus on diabetes and high blood pressure rather than other high-risk indicators. I wish I could stand here and say that Amber was an isolated case, but her story will sound familiar to black women up and down the country, and it shows in the figures. The latest data from MBRRACE-UK shows maternal mortality rates for women from black ethnic backgrounds are more than double those for white women. Black women and their babies are also at higher risk of stillbirth, neonatal death and miscarriage. That should shame us in modern Britain.

Tackling inequalities and racism in maternity services is an absolute priority for this Government. Our manifesto committed to setting an explicit target to close the black and Asian maternal mortality gaps. That commitment has not wavered—we are working hard not only to set a target but to set the actions that will help deliver it. It is crucial we set the right targets and ensure the system is supported to achieve them, which is why the Government are currently considering the action needed that would drive change on the ground, ensuring that targets set are evidence-based, and women and baby-centred.

Our ambition is not just to improve maternal outcomes; we want to improve black women’s experiences of maternity care too. We know that too often black women are not listened to and experience racism and bias. That is completely unacceptable. Importantly, our ambition must also extend beyond maternity services, so that we can tackle wider health inequalities, including the determinants of ill health. I know that health inequalities do not start at the door of maternity services, and nor do they end when women go home.

Here is what we are doing and where we need to go further. We are aware of calls for a national inquiry into maternity care, which we will carefully consider. There have been a number of reviews, inquiries and wider research in recent years that have provided a shared and clear sense of the issues in maternity and neonatal care. The most important priority must remain for us to target resources and efforts to address the existing issues identified and avoid any further delays. The focus must be to address inequalities and the action taken to do so for women and babies.

NHS England is now in the final year of delivering its three-year plan to improve maternity and neonatal services. Central to the plan is the objective to reduce inequalities for all in maternity access, experience and outcomes, and taking steps to tackle and address inequalities for black women. To achieve this objective, all local areas now have in place and are implementing their equity and equality action plans. Those plans detail local interventions tailored to population needs, in order to tackle inequalities for women and babies from ethnic minorities and those living in the most deprived areas. There have been some great examples of local best practice within those plans, ranging from targeted pre-conception health support to tailored support to ensure equitable access to care, and bespoke communications for pregnant asylum seekers and refugees.

As part of the three-year delivery plan, all local areas are working to implement version three of the Saving Babies’ Lives care bundle, which provides maternity units with guidance and interventions to reduce and tackle the inequalities in stillbirths, neonatal deaths, brain injuries and pre-term births. Those local and national interventions are essential steps to improving equity and equality in maternity care.

In parallel, however, it is vital that we continue to work to foster a culture of safety, compassion, honesty and one that is actively anti-racist, which must be led by outstanding leadership. I am pleased that all 150 maternity and neonatal units in England have signed up to the perinatal culture and leadership programme.

For clarity, and I think particularly for the shadow Minister, we recognise that racism and unconscious bias need to be tackled, that they are unacceptable and must be tackled in the NHS.

[Dr Johnson]

Will the Minister give way on that point?

[Ashley Dalton]

I will finish what I am saying and then I will give the shadow Minister an opportunity to come back to me.

To clarify, this work is not only about the behaviours that we must tackle in the NHS; it is also about the systems that we create in the NHS and ensuring that those systems do not consciously or subconsciously discriminate against people on the grounds of their race. That is what we mean and that is why we are putting in place training for leaders in our maternity units. We will ensure that they are signed up to the perinatal culture and leadership programme, to ensure that those systems are as equitable as they possibly can be.

[Dr Johnson]

I thank the Minister for giving way. I think we all agree that racism is wrong and must be weeded out wherever it happens. Could she say, in answer to the question posed by the hon. Member for Clapham and Brixton Hill (Bell Ribeiro-Addy) at the beginning of her speech, whether she believes that the NHS is structurally racist?

[Ashley Dalton]

The shadow Minister will know that that is not actually the question that my hon. Friend asked. She asked about systemic racism. We recognise that racism and unconscious bias can play a part both in the behaviours of some people, which must be tackled, and in the way that systems are structured. That is why the training that we are introducing will help to tackle racism. It is not necessarily the case that there is racism throughout the NHS, but we must do everything we possibly can to make sure that NHS systems are as equitable as they can be.

[Dr Johnson]

I thank the Minister for giving way again. I confess that I thought I heard the hon. Member for Clapham and Brixton Hill say “structural”. However, if the word she used was “systemic”, does the Minister think the NHS is systemically racist?

[Ashley Dalton]

I think that we have to do everything possible to make sure that all the systems in the NHS are as equitable as possible.

We have set clear expectations for escalation and accountability through the three-year plan, and all 150 maternity and neonatal units in England have signed up to the perinatal culture and leadership programme. We are supporting staff to hold up their hands when things go wrong through the Freedom to Speak Up initiative. Our approach to tackling inequalities in maternity and neonatal care must be underpinned by evidence, research and—critically—working with women and their families. As my hon. Friend the Member for Sherwood Forest (Michelle Welsh) pointed out, it is crucial that women’s voices, including black women’s voices, are heard.

My hon. Friend the Member for Clapham and Brixton Hill mentioned funding for research. The National Institute for Health and Care Research has launched a £500 million funding call that challenges researchers and policymakers to come up with new ways of tackling maternity inequalities and poor pregnancy outcomes. The NIHR has also invited applications for funding of up to £500,000 for a research project to understand how biases in medical devices used during the pregnancy and neonatal period might be contributing to inequalities for women and babies.

NHSE is working closely with the NHS Race and Health Observatory on the outputs of the learning and action network programme, which aims to address inequalities for women and babies from black, Asian and other ethnic minority backgrounds. Local maternity and neonatal voices partnerships bring together the voices and experiences of women and families to improve maternity and neonatal care. More than a quarter of the partnership leads are from ethnic minority groups. Women’s voices must continue to be at the heart of our improvements to care.

I will be frank with colleagues: although the measures I have set out are important, I do not believe they will be enough to meet the scale of our ambitions. The Government are committed to ensuring that all women and babies, regardless of their ethnicity, background or location, receive the high-quality, equitable care they deserve. Many of these initiatives began under the previous Government, and although there has been some progress across maternity and neonatal care—for example, good progress has been made in reducing the number of stillbirths and neonatal deaths—we have much further to go to improve care and tackle inequalities.

Looking forward, we are clear that we want to see high-impact actions to tackle inequalities and racism in maternity services. Baroness Merron and the Secretary of State are working closely across the sector to identify the right actions and interventions to deliver the required change.

The shadow Minister asked about data collection. Data on women’s ethnic background is routinely collected by services at multiple points throughout maternity care. The data is used to disaggregate reporting of adverse outcomes, such as maternal mortality, by ethnicity. Differences by ethnicity are also reported as part of the Care Quality Commission’s annual survey, which asks a sample of pregnant women and new mothers about their experiences of NHS maternity services. NHS trusts are incentivised to collect this information through the maternity incentive scheme, which is a financial incentive programme that is designed to enhance maternity safety in NHS trusts. Safety action 2 of the maternity incentive scheme incentivises trusts to submit digital information, including ethnicity data, to the maternity services dataset.

Some of our processes will take time to implement, but we need to understand the immediate actions that can begin to deliver change here and now. I therefore reiterate our commitment to setting an explicit target to close the black and Asian maternal mortality gap. We must get this right. Targets must be evidence based, and that is why it is so important that the data is collected, as I have said, that our targets are women and baby-centred and, crucially, that the system is supported to meet the targets that are set. To this end, NHS England has undertaken a review of the evidence base and conducted extensive stakeholder engagement to identify the key drivers of inequalities for black and Asian women and babies—again ensuring that black women’s voices are heard.

[Dr Johnson]

The Minister talks about the importance of setting an achievable target and working on how it will be delivered, but the Government have now been at this for 10 months, and it was a manifesto commitment. Will she at least commit to a date by which it is likely to be set? Nothing will happen until there is a target and a plan. The Government are spending time deciding when to make a target, and all the while women are waiting.

[Ashley Dalton]

We are working at pace, ensuring that what we do is right and that it is achievable. The shadow Minister will be aware that the Government are developing a 10-year plan for health, and women’s health, including maternity health, will be at the centre of it. We want to ensure that whatever we put in place dovetails with all the other interventions and actions that the Government are putting forward.

The areas identified for intervention so far include the improper management of existing conditions, racism and discrimination, and access to care. We are clear that we want to see innovative and high-impact ideas that will shift the dial. We want to make sure not just that we are coming up with some sort of plan, but that it can be delivered and will be impactful.

Let me assure my hon. Friend the Member for Clapham and Brixton Hill that this issue keeps us up at night. I know that she will continue to hold us to account. I began my speech by referencing Amber’s story. She asked how she could put her trust in a system that let her down so badly, and I completely understand why she felt that way. It is our duty to make sure that women like Amber can trust the system with something as precious as their children, and to prevent what should be one of the most joyful days in their lives from becoming a tragedy.