Black Maternal Health Awareness Week

Debate between Bell Ribeiro-Addy and Caroline Johnson

Tuesday 29th April 2025 Westminster Hall

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

It is a pleasure to serve under your chairmanship, Ms Furniss. I, too, congratulate the hon. Member for Clapham and Brixton Hill (Bell Ribeiro-Addy) on securing this important debate today. As she said in her opening speech, the UK enjoys some of the best outcomes in the world when it comes to maternity health, but there is always more work to be done to improve our outcomes further. I hope we can all agree that equal access to the best care, for all across our society, should always be our target. That should be based on excellence across the board as standard.

We are considering Black Maternal Health Awareness Week, which is part of National Minority Health Month, and I welcome the opportunity to discuss this topic and exchange views with colleagues from across the House. Colleagues will know that as a clinician myself, I am always guided by data when assessing current healthcare practices and new policy proposals. A 2023 report by the maternal, newborn and infant clinical outcome review programme found that in the period from 2019 to 2021, 241 UK women died during pregnancy or up to six weeks after the end of pregnancy. That equates to a rate of 11.7 women per 100,000 giving birth. Each of those cases represents a tragedy for the woman and baby involved and their family and loved ones, and we must do all we can to prevent them.

The data does, as has been mentioned, also show that women from black backgrounds face a mortality rate much higher than the average; it is equal to 37.2 per 100,000. Women from Asian backgrounds also face a higher rate, at 17.6 per 100,000. Clearly, those figures present a pretty stark picture, but we must exercise care in the interventions that we make, and balance our desire to solve the problem with ensuring that we do that in a way that resolves the problem without risking creating others.

At the outset, it is crucial to ask what the Government are doing to understand the specific causes of these outcome disparities, because if we understand the causes, we will be better able to manage and treat them. The Kirkup and Ockenden reports have already been mentioned. What are the Government doing to ensure that those recommendations are fully implemented, and to develop a strategy to ensure that all women have the opportunity for a safe pregnancy and birth? What kinds of data held by the NHS and the Department of Health and Social Care might cast light on other demographic, economic or geographical patterns that contribute to these numbers, which we may be able to help to resolve?

We know that the most significant factor in predicting death during the maternity period is a pre-existing medical condition, and we know that disparities exist in the incidence of some pre-existing conditions that are relevant between some ethnic groups in the wider population. For example, a 2018 research paper in the American Journal of Kidney Diseases found that rates of heart disease were 20% higher among the black community than those from white backgrounds, and rates of stroke were a remarkable 40% higher. Do the Government know how the rates of pre-existing conditions among ethnic groups are influencing the figures on maternal health, and how are they going to work to reduce the risks of such conditions among these groups to try to improve the care not just during maternity, but during the whole of black ladies’ or ethnic minority ladies’ lives?

Maternal mortality itself arises from a number of conditions and causes. In the period from 2019 to 2021, for example, 14% of maternal deaths were attributed to cardiac disease, 14% to blood clots, 10% to sepsis and 9% to epilepsy or stroke. What are the Government doing to understand the prevalence of those conditions among ethnic groups, how the conditions can be prevented, how they can be identified in black women—indeed, in all women—how they can be better treated to save lives, how they can be better managed to save lives, and what research can be done to ensure that they are, if possible, prevented?

Socioeconomic deprivation has also been mentioned, and it is important to consider the impact of deprivation. In the period from 2019 to 2021, 12% of women who died during pregnancy or in the year afterwards were at severe and multiple disadvantage. That included, in particular, women who had suffered mental health conditions or domestic abuse, or had a history of substance abuse. How do the Government understand these factors and their influence on mortality rates, and what are they doing to help to resolve those issues?

Closer to home, in February 2022 the NHS Race and Health Observatory published “Ethnic Inequalities in Healthcare: A Rapid Evidence Review”. The authors of that report noted:

“Tackling poorer care and outcomes among ethnic minority women and babies continues to be a focus within the…NHS England and NHS Improvement Maternity Transformation Programme Equity Strategy, which includes pledges to improve equity for mothers and babies and race equality for staff.”

The Government’s abolition of NHS England risks placing that ongoing programme of work, like many others, in jeopardy. Will the Minister tell us the current status of the maternity transformation programme and the implementation of the equity strategy under the NHSE and DHSC reorganisation? How is that work being prioritised, given the many other demands on the Department’s time and resources—not least from the reorganisation—that might previously have been spent on improving care?

The previous Government improved the number of midwives per baby and made progress towards the national maternity safety ambition of halving the 2010 rate of stillbirths, neonatal maternal deaths and brain injuries in newborn babies. When will the Government set out their ambition for the next decade? The Labour Government promised more than 1,000 new midwives in their manifesto last year. Will the Minister update us on how many of those 1,000 midwives are now working for the NHS?

The Minister for Care recently stated that the 41 maternal mental health services are now live and will be active in every integrated care system by the end of 2025-26. How will the Government ensure that access to those services can continue when ICSs face such high cuts in funding?

Colleagues have mentioned the possible influence of systemic racism or unconscious bias in maternal outcomes. The NHS has an employed population of 1 million, and it is likely that some bad apples will be found within that overwhelmingly brilliant staff cohort, but I dispute that the NHS overall is a racist organisation. I work in the NHS—I should declare that interest—and I have not seen evidence of structural racism.

The Royal College of Obstetricians and Gynaecologists reported that, as of 2024, 45% of obstetric and gynaeco-logical doctors identify as of a black, Asian or minority ethnic background, and 26% of births were to women of black or other minority ethnic backgrounds. Figures for midwives are harder to assert, because they are collated with nursing staff, but the proportion among nurses is 22%.

[Bell Ribeiro-Addy]

I just want to check whether the hon. Lady understands that structural racism is about not the number of people within an organisation, but the way the organisation is set up and treats different people. Does she understand that having a high proportion of ethnic minority people does not necessarily mean that an organisation such as the NHS—which, I might add, in its senior levels is run by people mostly not from ethnic minorities—does not discriminate against people in a certain way?

[Dr Johnson]

I understand the hon. Lady’s point. I do not dispute that some women, men, boys or children have awful experiences at the hands of bad apples. That will happen within any organisation of that size—the NHS employs more than 1 million people. That is wrong and should be rooted out; it is absolutely clear that that should stop. However, I work in the national health service, and I think the vast majority of people who go to work in it do so to care for the patients in front of them as best they possibly can. Care should be provided on the basis of clinical need and should not be affected by the ability to pay or by any other socioeconomic, ethnic or other demographic data. Although I accept the point that some individuals will have experienced poor care, which is reprehensible, I do not think that is the majority situation by quite some margin. I think most people receive extremely good care in the NHS, and care that is delivered on the basis of their clinical need, not the colour of their skin.

[Bell Ribeiro-Addy]

Does the hon. Lady accept that, given that she is not of an ethnic minority and has not looked at the information given by a number of women from ethnic minority backgrounds who have experienced this, she is not really in a position to say that what they say they experienced does not exist?

[Dr Johnson]

That is not what I said.

--- Later in debate ---

[Bell Ribeiro-Addy]

I am just challenging her point. Just because for one or two reasons she may not have seen any institutional racism in the NHS, that does not mean it does not exist. Further, the figures for black maternal mortality are the same in the United States, which has a completely different healthcare system from ours, but they are not the same in countries in Africa or the Caribbean, where black women are the majority. Does she see why that can point only to institutional racism? It is a completely different healthcare system in United States. The only difference is that we are both living in societies where institutional racism is known to be a problem.

[Dr Johnson]

I think we can both agree that any examples of racism are reprehensible and should be rooted out and that, in the examples given, people are speaking truthfully of their perceptions and what they have experienced. No one is denying the experiences of individuals or groups who have experienced poor care and that that poor care should stop. I just do not think that that suggests the NHS itself is a racist organisation, because I do not believe that it is. That is our point of difference. I think the staff who work in the NHS are overwhelmingly not racist. They want to care for people on the basis of clinical need to the very best of their ability, regardless of any ethnic minority status.

[Bell Ribeiro-Addy]

I did not say that the people in the NHS are racist; I said the NHS has a problem with institutional racism. I hope the hon. Member will accept that there are distinctions between those two things.

[Dr Johnson]

I think we have both made our positions clear. I accept that some people will have received poor care and that the people who delivered that poor care need to be hauled over the coals. They need to be called out for what they have done and we must ensure that such care does not happen again. But I do not accept that the NHS is a racist organisation.

Another issue is language barriers. It is well recognised that it is difficult for people who have a language barrier to access health services. Can the Minister tell us what the Government are doing to help with that? In recent years in my medical career I have seen improvements in the delivery of language services, but when I was a more junior doctor an appointment needed to be booked in advance and an interpreter had to attend in person. Sometimes they were available and sometimes they were not. Sometimes other members of staff or family members would be used to interpret, which is a poor standard of care, relatively speaking.