Black Maternal Health Week

Bell Ribeiro-Addy Excerpts

Tuesday 14th September 2021 Westminster Hall

[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 [e-mail]. 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.

--- Later in debate ---

[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.