Black Maternal Health Week

Caroline Nokes Excerpts

Tuesday 14th September 2021 Westminster Hall

[Caroline Nokes (Romsey and Southampton North) (Con)]

I put on record my appreciation to the hon. Member for Streatham (Bell Ribeiro-Addy) for having led the debate today and for her incredible work on this important and sensitive issue.

Alongside me, she is a member of the Women and Equalities Committee. We have been privileged to listen to the evidence of black and mixed-race mothers about the experiences that they have had in giving birth and in supporting their family members in giving birth. We have heard some real horror stories of lost sisters and lost daughters, because their maternal health outcomes have been worse than the outcomes that my hon. Friends the Minister and the Member for Cities of London and Westminster (Nickie Aiken) and I would have had.

It is wrong that in 21st century Britain we can still expect black and mixed-race women and women from ethnic minorities to have such a massive disparity of experience. The Five X More campaign has done some incredible work. In the Select Committee, we have been lucky enough to do roundtables with them, and to listen to their experiences, their recommendations and the changes that they believe would make a real difference.

Those stories have been difficult but important to listen to. The thing I took away was how fed up those women were about having to repeatedly tell the story. They feel that they are not being listened to, that there is no change and that they are not seeing action, when actually, as the hon. Member for Streatham has pointed out, the statistics are so stark that this should be driving immediate and rapid change.

In November last year, the Joint Committee on Human Rights discussed targets. I can sometimes be a bit sceptical about targets and think they do not necessarily always drive the right outcomes and behaviours, but this is a clear case where I think that they would and where I want to see the Government have real ambition to set a target and a timeframe, so that we can see that four times more disparity driven down and ended. It is crucial that we try to do that in a very rapid timescale.

There have also been clear recommendations from the Health and Social Care Committee. Indeed, the Government should be responding to them imminently. Can the Minister update us on that in her response and give us an indication about whether the Government will embrace those recommendations?

I am conscious that my hon. Friend the Minister has done good work on the subject and last year set up a forum designed to bring together experts in the field to meet key stakeholders, to consider and to address the inequalities for women and babies from different ethnic backgrounds and socioeconomic groups. We cannot shy away from that. We also have to look at some of the intersectional challenges, and ensure we are looking not just at race but at the socioeconomic situation.

Can the Minister outline how that forum is assisting policy making? It is crucial and we want to understand what role those experts are playing in feeding into Government to drive policy change. Can she indicate how often the forum has met and what the key recommendations have been? How quickly will those recommendations be acted upon, if indeed they will be acted upon?

One challenge that we heard at the Women and Equalities Committee roundtables was about research. Many experts felt that there was already a great depth of research that had been done, that the knowledge was there and that perhaps further research was not needed. In April this year, we heard that the Government had commissioned the policy research unit in maternal and neonatal health and care at the University of Oxford to develop an English maternal morbidity outcome indicator, which is not easy to say. That is crucially important. We want to see how that indicator is working and when we expect it to be rolled out. I would like to hear the Minister today update us on that work and give us some indication as to whether she is any closer to committing to a target for reducing the deaths of black women in childbirth.

Towards the end of her contribution, the hon. Member for Streatham spoke about continuity of care, which is crucial. We know very well that if there is continuity of care during pregnancy then the birth outcomes would be better for both mother and child. The NHS long-term plan included targeted support around continuity of care, with an aim that by March this year most women would receive the sort of crucial continuity that we are calling for. That was a target that was set, so I would very much welcome the Minister’s updating us on how that is going. We heard from the Health and Social Care Committee that the targets for continuity of care were inadequate and in need of improvement, so perhaps we can have an indication of how the Government will achieve that.

The hon. Member for Streatham finished her speech with a commentary on institutional racism in the national health service. I was really struck—I was going to say this time last year, but perhaps it was a bit earlier—when we took evidence in the Women and Equalities Committee on how much worse the outcomes of covid were for people from black, Asian and minority ethnic communities. One of the messages that we heard from healthcare professionals from black and Asian backgrounds who were working in the NHS was that they were scared to speak up. They were scared to tell their stories to line managers about the pressures that they faced when working in our NHS. In many instances, they felt exposed to racism if they asked for perfectly reasonable adaptations or changes, or for greater levels of personal protective equipment. It is absolutely wrong in the 21st century that we have people working in our health service who are frightened to speak up.

I was struck when we took evidence during the roundtable discussions with black and minority ethnic mothers, and indeed with experts—we heard from Christine Ekechi, who is the most incredible woman, and from the doula Mars Lord, to whom the hon. Member for Streatham referred. They made a really important, shocking and, in many ways, depressing point: too many black women and their partners were not being listened to during childbirth. They were trying to convey how they felt and the worries they had when they felt that things were going wrong. Mothers going through childbirth were scared and instinctively felt that something was going wrong, and they told us repeatedly that they were not listened to. In a 21st-century health service in the sixth largest economy in the world, that is simply not acceptable.

--- Later in debate ---

[Ms Dorries]

Absolutely—across black, Asian and mixed ethnic minority groups as well. The point has been made today that black women do not feel listened to. We hear stories of complaints about pain, prolonged labour and other issues, and black women just do not feel as though they are being listened to in that environment. The core finding of the Cumberlege report, which addressed mesh, sodium valproate and Primodos, was that women are not being listened to, and black women probably even more so in the maternity setting. That issue for women, black women, Asian women and women from mixed ethnic backgrounds needs to be addressed. Women have to be listened to.

Turning to covid-19 and vaccinations, covid-19 has further exposed some of the health and wider inequalities that persist within our society. While considering disparities in the context of the pandemic, initial data suggests that vaccine uptake among ethnic minorities is lower than for other groups. Covid-19 vaccines are recommended in pregnancy. Vaccination is the best way to protect against the known risks of covid-19 for women and babies, including admission of the woman to intensive care and premature birth of the baby.

New findings from a National Perinatal Epidemiology Unit-led study showed that of the 742 women admitted to hospital since vaccination data has been collected, only four had received a single dose of the vaccine and none had received both doses. That means more than 99% of pregnant women admitted to hospital with symptomatic covid-19 are unvaccinated. That is quite stark.

[Caroline Nokes]

On that point, will my hon. Friend reassure me and all Members that the Government will keep pushing the crucial message that the vaccine does not affect fertility or pregnancy, and that it is important for pregnant women and women of childbearing age to get the vaccine?

[Ms Dorries]

Absolutely. My right hon. Friend has done it for me, but I absolutely encourage women to get the vaccine because 99% is a huge figure. There is a basis of mistrust. The reason why many black women do not access some of the health services they should do before pregnancy is because they do not feel listened to and they do not feel they can trust their practitioner. The message of “Take the vaccine” must be pushed.

I will finish by taking the opportunity to urge women to continue to access maternity care and to stress that pregnant women should never hesitate to contact their midwife, maternity team or GP, or to call NHS 111 if they have any concerns. That also applies if parents are worried about their health or the health of their newborn baby. I urge expectant mothers to have their covid-19 vaccination as soon as possible. I do not think we can give out that message often enough.