Black Maternal Health Awareness Week 2022

Bell Ribeiro-Addy Excerpts

Wednesday 2nd November 2022 Westminster Hall

[Bell Ribeiro-Addy (Streatham) (Lab)]

I beg to move,

That this House has considered Black maternal health awareness week.

Thank you very much, Mr Gray; it is a pleasure to serve under your chairmanship. I thank my colleagues for their kind points of order. I am thankful, as always, that this debate has been awarded, so that we can once again have this vital discussion about the issues surrounding black maternal health.

Whenever I discuss black maternal health, I always take time to repeat the statistics around black maternal mortality. The reason I do that is twofold. First, the statistics are harrowing, and it is only by confronting them that we can truly begin to address the issue. Secondly, the statistics have not changed at all—the findings that I repeat have not improved, despite this issue having been raised for a number of years. I know that it may take time before we see a real change in statistics, but the Government are yet to introduce any meaningful measures that give us confidence that the statistics will change any time soon. Most notably, they will not even look at producing a target.

I repeat it for everyone who may not have heard that black women are four times more likely to die in pregnancy or childbirth, women of mixed heritage are three times more likely to die in pregnancy or childbirth, and Asian women are twice as likely to die in pregnancy or childbirth. Black babies have a 121% increased risk of stillbirth and a 50% increased risk of neonatal death. Asian babies have a 55% increased risk of stillbirth and a 66% increased risk of neonatal mortality. Black women have a 43% higher risk of miscarriage, and black ethnicity is now regarded as a risk factor for miscarriage.

The last time we had this debate, one of the key themes that kept coming up was data, whether it was Members such as myself raising the fact that the data exists and research has been done—we just need the Government to engage with it—or the Minister who responded, the right hon. Member for Mid Bedfordshire (Ms Dorries), stating that black women are under-represented in the Government’s data. I am pleased to say to the Minister responding today that there is now even more research out there.

Since the last time we had this debate, Five X More has carried out and released the findings of its black maternal experiences survey. This is the largest survey of black women’s maternal experiences ever conducted in the UK. It gathered responses from over 1,300 women and looked at their experience of maternal care. The report highlights all the negative interactions that women experienced with healthcare professionals, from feeling discriminated against in their care to receiving a poor standard of care, which put their safety at risk, and being denied pain relief because of the ridiculous trope that black women are less likely to feel pain.

The report goes on to reveal how the discriminatory behaviour and attitudes that black, Asian and ethnic minority women face have been shown negatively to impact women’s clinical outcomes and their experiences of care. More than half the respondents reported facing those challenges with healthcare professionals during maternity care, and 43% of women reported feeling discriminated against, while 42% of women reported feeling that the standard of care they received during childbirth was poor or very poor, and 36% reported feeling dissatisfied with how their concerns during labour were addressed by professionals.

Further to that, 42% of respondents reported feeling that their safety had been put at risk by professionals during labour or during the recovery period. Of the women who experienced negative maternity outcomes, 61% reported that they were not even offered additional support to deal with the outcome of their pregnancy.

[Jim Shannon]

I am pleased that the hon. Lady has brought this debate to Westminster Hall, and although there might not be big numbers here today to discuss the matter, it is of great importance. Does she not agree that health trusts, which she has referred to, must ensure that no matter the level of the black, Asian and minority ethnic population, staff are adequately trained to deal with the differences with respect to different ethnic groups? Does she further agree that the messaging that comes from the Minister and the Department in this debate is the most important tool that health trusts have to ensure that women of all ages and all ethnic groups are clearly understood and supported, no matter where they are and no matter what the statistics and numbers may be?

[Bell Ribeiro-Addy]

I thank the hon. Member for his intervention, and he is absolutely right. I will come to training soon enough, and to what I believe individual trusts should be doing.

In addition to the Five X More report, Birthrights has recently published the findings of its inquiry into racial injustice and human rights in maternity care. The report uncovers the stories behind the statistics and demonstrates that it is racism—not broken bodies, as we are often told—that is the root of many of the inequalities of maternity outcomes and experiences. The study found that on a number of occasions, black women’s safety was put at risk while they were receiving care. They were ignored or their pain was dismissed, and they experienced direct or indirect racism from care givers. They were subject to dehumanisation. Their right to informed consent was violated and they faced structural barriers to receiving healthcare. Those women were going through one of the most painful experiences of their lives—one that can leave them at their most vulnerable—yet they faced institutional racism that impacted their health and the health of their babies.

During a debate on this subject last year, I called on the Government to launch an inquiry into institutional racism and racial bias in the NHS, as well as in the field of medical education. I reiterate that call today and hope the Minister will address the issue of systemic racism in medical care.

In addition to those two reports, the Muslim Women’s Network recently published a study that reviewed the experiences of Muslim women in maternity care. The report encompasses the maternity experiences of over 1,000 Muslim women, and it once again revealed that a huge proportion of respondents received poor or very poor quality care. There are many examples of substandard care by health professionals, such as dismissing concerns and, again, pain; not offering treatment to relieve symptoms; inconsistency in the way that foetal growth was measured; substandard clinical knowledge; and vital signs being missed, which contributed to poor healthcare.

Some 57% of women felt that they were not treated with respect and dignity in the way they were spoken to or in other acts of care giving, but perhaps the most shocking finding of the report was that 1% of the women who responded reported that their baby had died before or during labour, or within 28 days of birth. In a sample of this size, that equates to 10 women, which is way higher than the three to four who should have been expected.

Those statistics are shocking, but the stories are even more shocking. Each of those reports includes harrowing stories of women being neglected, and of their pain being ignored and their concerns dismissed, resulting in a near miss or, indeed, the loss of their baby. In one account, a woman was not believed when she informed the midwife that she was ready to push. It states that when she eventually began to push,

“Her baby came out still enveloped in the placenta. Several doctors came and she was taken to theatre as it became an emergency situation. It was touch and go but she survived. Due to heavy blood loss she was in a coma for three days. Her baby had to be given intensive care.”

In another account, a woman reports that her baby was struggling to breathe after birth. She says:

“I was told that it was a normal thing for newborns. No checks were done to put my mind at ease. After about 20 mins, my baby stopped breathing. Efforts were made to resuscitate her, but she later died in NICU.”

One woman recalled that during her first check-up, a nurse said that she was shocked that she knew who the father of her baby was because people like her do not usually know.

There are thousands of similar stories of black, Asian and minority ethnic women having negative experiences with healthcare professionals and maternity care. There is an urgent need to address the crisis in maternity care, and I sincerely hope that the Minister will set out concrete steps that her Department and the Government will take to address the problem.

I sincerely hope those measures will look beyond treating black, Asian and minority ethnic women as a problem. We are not the problem and our bodies are not broken. There is no flaw in our genetics and we do not need to be dealt with in a way that reduces negative statistics by just pushing the problem away. The suggestion that black women should be induced earlier because a lot of these issues present after 40 weeks is ridiculous.

The solutions need to address the distinct problems in maternity care; all the evidence suggests institutional racism. We must address biases and assumptions about black women, train medical staff to recognise common symptoms in black women, and tackle the barriers that prevent black women from receiving the quality of maternity care they deserve. That is where the problems lie, and we will overcome them by directly addressing racial disparities.

Last year when we debated this subject, the responding Minister asked me and others to continue to hold her feet to the fire on this issue. I thought they were really receptive and that we were finally going to see some meaningful steps to tackle maternal health disparities. I left the debate feeling slightly hopeful because so much awareness had been raised by the fantastic campaign groups I mentioned earlier, and there was a lot of support across the House. I was therefore really surprised and quite deflated when the next day the Minister moved Departments in a reshuffle. I know Cabinet reshuffles happen all the time—

[David Linden]

All the time.

[Bell Ribeiro-Addy]

They are a standard part of government, but we have lost count of the Health Secretaries and Ministers covering this brief. Today, we have a Minister from a different Department addressing us. I know it may seem like I am making a party political point, but regardless of reshuffles, Government priorities and resignations, the problems in maternity care continue. Although we cannot have continuity in Government for whatever reason, we need continuity in care and a strategy for dealing with racial disparities in maternity care.

It is hard to see the Government taking action when things are changing so frequently, but I sincerely hope the Minister will assure us that the Government are focused on this issue, regardless of the changes, and that her time in this role will be spent tackling black maternal health disparities.

Black women cannot afford to wait any longer for action to be taken. I do not want to have to stand up in another debate and cite exactly the same statistics without any improvement. I know things take time, but it would be sensational to come back next year and report that at least something had changed. The best way for Ministers to exact that change is to set out clearly what the Government are doing and set a clear target.

The answer I have been given in the past when I have asked for a target is that this does not happen to that many women, so a target does not need to be set. I would flip that round: if it is not that many women, surely we can set a target to address it.

--- Later in debate ---

[Caroline Nokes]

I thank the hon. Gentleman for his intervention. I did not think he would be entirely able to resist speaking in the debate. He is right: policies must be data-driven and evidenced, but the evidence is there and has been for many years. We are augmenting and adding to that body of evidence the whole time.

I will not be entirely negative, because we have some great opportunities. I was pleased to see Dame Lesley Regan appointed women’s health ambassador earlier this year. I welcome, reinforce, champion and offer anything I can to help the women’s health strategy. Finally, we have one of those, and I pay tribute to the Minister who was instrumental in getting that published. What we now need from the strategy is outcomes. That has to be the focus. What is happening to drive outcomes, and to ensure that the disparities we know exist are recognised, acted on and reduced? Our goal has to be to reduce that horrendous figure of four times as many maternal deaths for black women. We have to improve the outcomes for black babies, so that there is not, as I think the hon. Member for Streatham said, a more than 100% likelihood of stillbirth—

[Bell Ribeiro-Addy]

Increased risk.

[Caroline Nokes]

Increased risk. The hon. Lady is absolutely right to highlight that as an imperative. We must ensure that we reduce the inequity, of which there are many drivers. She was with me when the Women and Equalities Committee took evidence from Professor Sir Michael Marmot, who talks so compellingly about health inequalities and their drivers.

I will not say that there is anything wrong with black women’s bodies—there is not—but we have to look at housing conditions, air quality and the areas where they live. Air quality is a significant driver of poor health outcomes. We have to look at what we are doing around smoking cessation, which is good for not just black women, but all women. We have to look at obesity, which is, again, a crucial factor for all women.

I look forward to seeing, in the remainder of this Parliament, focused and determined action around obesity, smoking cessation and air quality. There are targets on all those things, but—how can I put this gently?—there has been a little backsliding on some of them. Targets have been pushed into the dim and distant future, and there is less commitment around drives to reduce obesity and smoking, which are incredible drivers of poor health outcomes across the population. We should double down on our commitment to those targets.

I hope that in due course—I get fed up of saying “in due course”, which is a standard ministerial answer—to see a White Paper on health disparities. It is imperative that we get that done, and that the women’s health strategy is seen as a driver to ensure that we improve outcomes. First and foremost, I reiterate the calls from the hon. Member for Streatham for targets. I am never a great fan of targets if they are just there for the collection of targets, but if they work, and we see that in many instances they do, we should have them.

We should have time-limited targets, so that in maybe three years we can look and say, “Nothing has changed.” Looking at the data and the evidence from campaign groups, I see that over 20 years, nothing has changed. I do not want to be here in 20 years’ time giving the same speech on this important issue, feeling that nothing has changed. I look forward to the Minister’s comments, and reiterate my congratulations to the hon. Member for Streatham on calling for today’s debate.

--- Later in debate ---

[Bell Ribeiro-Addy]

I thank all Members for participating in the debate and adding their voices to all those that are calling for steps to be taken to end racial disparities in maternity care. It is always reassuring to hear just how much support there is across the House when the issues are raised. I thank the hon. Member for Strangford (Jim Shannon), who is always a huge support in a range of different debates, but who has been particularly helpful today. I also thank the right hon. Member for Romsey and Southampton North (Caroline Nokes), who does fantastic work as the Chair of the Women and Equalities Committee and also as the chair of the APPG on Muslim women.

I will point out some of the disparities that she has touched on, including those detailed in a report from the Muslim Women’s Network. That report showed that Muslim Somali women who had given birth in other parts of Europe found that, although they faced worse discrimination in society in those other parts of Europe, they received much better maternal care in hospitals in those other European countries, namely Norway and Sweden, than they did in the UK. They had better outcomes as well. That is definitely something for us to look at.

My hon. Friend the Member for Putney (Fleur Anderson) and the right hon. Member for Romsey and Southampton North pointed out the different factors that affect black maternal health outcomes, which all come full circle to point to the institutional racism that black women face across society. I thank the hon. Member for Leicester East (Claudia Webbe) very much for raising the issue of the health disparities White Paper. We absolutely need to see the White Paper soon. Without it, I am not sure how we are going to set a benchmark for things changing overall.

The hon. Member for Glasgow North East (Anne McLaughlin) is not here, but she is hugely supportive, and I hope she feels better soon. The hon. Member for Glasgow East (David Linden) did some great work with the all-party parliamentary group on premature and sick babies, and I was pleased to see the group calling for anti-racism across care. That has been particularly important.

Yesterday, we had a lobby in Parliament in which Five X More lobbied parliamentarians. I thank all those who signed the pledge calling on the Government to use existing data to close the gap and to address overall disparities in maternal outcomes. Tinuke and Clo from Five X More continue to punch well above their weight. Five X More is the only black maternal health charity focused specifically on the outcomes for black women, and also the only such charity that I can think of that receives no funding. It has been able to do all this work off its own bat, which is testament to Tinuke and Clo and their dedication to resolving these disparities.

How could I forget my hon. Friend the Member for Bolton South East (Yasmin Qureshi)? I welcome her to her new post of shadow equalities Minister, and I was very pleased to hear her commit the Labour party to bringing about that target. That was very clear, and it shows that the party is listening to what black women have asked for over the past few years when these issues have arisen.

The research has already been done and we simply want the Government to engage with it. While we are calling for more data to be captured, we want the Government to engage with the data that already exists. That is key because so much work has gone on with other organisations, including the Muslim Women’s Network and Birthrights, to produce the reports that we have referenced today, and to lobby and campaign. Those things exist and they need to be acted on.

Those organisations have gone out and spoken to a great many women—sadly, women who did not want to engage with the Government’s surveys, which is worrying and something that needs to change. I pay tribute to all those women because it is difficult to relive your trauma in that way and to recount all those awful things that have happened. I know it has been for me, but I thank all those women who came forward to share their stories. They need to understand, as I am sure they do, that that makes a difference moving forward.

I thank the Minister for her response to the debate and the detail about what is already being done. That is really helpful, and I am pleased to hear a change in attitude as to how these issues are addressed. I have been concerned in the past, particularly with respect to the Commission on Race and Ethnic Disparities report and some of the responses that I have received personally, about the willingness of Ministers to admit that racial disparities exist and to focus on those, rather than saying that they do not exist. I would encourage you to read all the reports I have referenced today, but you say you have, which is great. Not only the statistics, but the personal accounts, do not make for easy reading, but they definitely make for a greater understanding of what has been happening.

I want to touch on one thing or two things that the Minister said specifically. You are absolutely right that people’s socioeconomic status has a direct effect on health outcomes, but the Five X More report, and the other two reports, found that black women report the same disparities regardless of their level of education and socioeconomic status. We need to look closely at that and acknowledge that the issue is purely racism: institutional racism goes far beyond all the other factors that we would usually expect to have an impact.

I want to leave the Minister with a few more suggestions about things that you might wish to introduce.

[James Gray (in the Chair)]

That she might wish to introduce. The hon. Lady keeps saying “you”, but when you say “you”, you mean me. I am not involved in any of these things. She might do those things.

[Bell Ribeiro-Addy]

My apologies. I would like to leave the Minister with a few more suggestions about measures that her Department might wish to introduce. The first is for the Government to introduce this target. I understand your reasoning—

[James Gray (in the Chair)]

Her.

[Bell Ribeiro-Addy]

I understand the Minister’s reasoning for not having a target. It may appear logical, but given that the data shows that those women’s children have a 43% increased chance of being miscarried, and a 121% increased chance of being stillborn, I do not understand how the Government can say that they will look at all these measures surrounding the issue but will not specifically set a target to bring it to an end. That is not acceptable, and I do not believe that the women who continuously campaign for a target will accept that, so I ask the Minister to look at it again.

I understand that there are great challenges in looking at disparities across the board. All those things need to be addressed and different Departments need to be brought in, but as I said in relation to socioeconomic status and other factors, there is a culture of institutional racism in our NHS, which needs to be resolved. Obviously, that will start with data. The NHS must improve the quality of ethnic coding and ensure that the data is accurately recorded. I am really concerned about how skewed the recording is.

At our APPG meeting yesterday, we heard that even when it comes to simple things such as trying to find out how many women have claimed compensation for things that have happened, the women’s age and the area they have come from is recorded, but their race is not. That seems like a major oversight, especially when other pieces of data are being gathered.

I support Five X More’s call for the Government to introduce an annual maternity survey targeted specifically at black women, similar to the Care Quality Commission’s maternity survey, because I believe that its results could be used to inform public and parliamentary accountability and improve maternity health services. Although few women contributed to the Government’s survey, there is a willingness among black, Asian and minority ethnic women to record their issues and experiences, as the other campaigns have proved.

I reiterate the call for an inquiry into institutional racism in the NHS. That is the only way that we will change some of the outcomes, especially given the information that has been gathered on what the issues are. Yes, we have to look at air quality and other co-morbidities, but until we address racial bias, assumptions among medical staff, and teaching and training, certain things will just not change.

Finally, please engage with the campaigners. I understand that there is a lot of listening going on. In the past few years, there have been more conversations, and they are more likely to be included in working groups, but it is one thing to say, “Yes, we have to look at this. This is really awful,” and another thing entirely to engage with them, work with them across different issues and show that the things they are asking for are being met within the NHS’s plan. Please do engage with the campaigners. They know what they are talking about and have the data that the Government have not been able to collect from women. They understand the issues and are making the right calls about what we need to do to bring this horrible disparity to an end, to close this racial divide and ensure that black women, Asian women and women of mixed heritage have safe births.

Question put and agreed to.

Resolved,

That this House has considered Black Maternal Health Awareness Week.