Black Maternal Healthcare and Mortality

Catherine McKinnell Excerpts

Monday 19th April 2021 Westminster Hall

[Catherine McKinnell (Newcastle upon Tyne North) (Lab) [V]]

I beg to move,

That this House has considered e-petition 301079, relating to Black maternal healthcare and mortality.

It is an honour to speak under your chairmanship, Sir Gary. I am also honoured to open this debate on behalf of the Petitions Committee and the more than 187,000 people who signed the petition organised by campaigners Tinuke Awe and Clo Abe.

The petition highlights the shameful fact that in 21st-century Britain, the colour of a woman’s skin affects how safe she and her child are during pregnancy and birth. That is one of the starkest examples of racial health inequalities in this country. As Tinuke and Clo have pointed out, the latest data show that black women are more than four times more likely than white women to die during pregnancy or in the six weeks after giving birth. Women from Asian backgrounds are twice as likely as white women to die during pregnancy. To put that into context, I should state from the outset that the UK is one of the safest countries in the world to give birth. Deaths during pregnancy are very rare. I am sure the Minister will reiterate that in her response.

Around one in 10,000 pregnant women dies every year from causes related to their pregnancy. Every single one of those deaths is a tragedy, but they are a very small proportion of all pregnancies. The situation has also improved slightly over the last 10 years. Those figures mask the underlying, long-standing and shocking inequalities in maternal mortality, yet we do not have a base of research and evidence to fully explain their root causes and to point the way forward. There is still no Government target to eliminate the gap. That needs to be addressed urgently.

What do we know about women who die during or shortly after pregnancy? Pregnancy alters the way the body works. Two thirds of all pregnant women who die fall victim to complications such as heart disease or the care they receive while pregnant. Most do not die during childbirth itself. Dr Christine Ekechi, co-chair of the race equality taskforce at the Royal College of Obstetricians and Gynaecologists, points out that black women are more likely to have pre-existing health conditions that lead to greater risks during pregnancy. However, she also highlights that the obvious question to ask is why black non-transmissible health issues such as cardiac disease and high blood pressure are more prevalent in the first place. If it is a result of existing social and economic inequalities, that must be addressed.

Across all ethnicities, most pregnant women who die have complex medical needs, but leading maternal health researchers such as Professor Marian Knight have expressed concerns that our health and social care system is just not set up to deal with that complexity. Clinics are often based at different hospitals, requiring separate appointments. Communication between them does not seem to happen in the way it should. Women are often expected to juggle other childcare and work commitments while attending myriad appointments at a range of different institutions. Not all women have the same support and security at home and at work, and the system does not account for that.

Accounts have shown that the symptoms that pregnant women present with are too often dismissed and attributed to pregnancy itself, when they could be indicators of serious underlying medical complications. Pregnant women from all backgrounds report not being listened to despite the fact that that is crucial to the physical and mental wellbeing of both mother and child. Professor Knight points to what she calls the “constellation of biases” that black and Asian women are subject to. Those range from lack of listening, learning and nuance around women’s backgrounds and the most appropriate care, to micro-aggressions, all the way to completely unacceptable race-related perceptions such as the entirely unsubstantiated notion that black women have higher pain thresholds. If pregnant women are not being listened to and their symptoms are not taken seriously, or if they feel that they will not be, that is a recipe for tragedy.

It is important that public awareness of that issue has finally begun to increase, which is in no small part thanks to the work of such campaigners as Tinuke and Clo and the initiatives that they have launched, such as Black Women’s Maternal Health Awareness Week, which was first held last September, and the petition that we are debating. More women are now coming forward with their experiences, and five times more have shared their stories. One woman recounted:

“As soon as the second midwife was on shift she just seemed to have one goal in mind and that was delivering my baby as soon as possible, she didn’t seem to care about easing any part of my pain or reassuring me for the many worries I had at the time—she rushed my labour along and as a result almost cost me my sons life.”

Another said:

“I already seemed like that hyper-emotional black woman worried about nothing and I let that silence me. I really wish in this moment I expressed my concern or spoke up, because I honestly couldn’t have fathomed that what happened next would come.”

The reaction on social media to Channel 4’s recent “Dispatches” documentary was also very telling. One Twitter user said:

“For many Black women ‘The Black Maternity Scandal’ on Ch 4 is sadly not shocking or eye opening at all. Not being listened to in times of pain has become far too normal and it has to change.”

Another wrote:

“For many of us Black and Brown women, this felt like the first time our stories and traumatic, hurtful experiences got a small hearing on national TV.”

Pregnancy can be a special and exciting time, but it can also be exhausting and terrifying. For any woman to have to spend it not being listened to or not receiving the most appropriate care because of the colour of her skin is nothing short of appalling, so it is unsurprising that there is now an increasingly vocal consensus on the urgent need for more research and evidence, and for firm commitments from the Government and the NHS to end the scandal. We need to address the under-researching of health issues that black women face, and get a clear picture of the data on maternal deaths among different ethnic groups. Many different ethnicities are grouped together under broad categories, which risks missing cultural nuances, misrepresenting experiences and leading us to the wrong conclusions.

Maternal deaths are just the tip of the iceberg. For every woman who dies, many more will have severe pregnancy complications, and there is evidence of disparities between ethnic groups in that respect, too. However, the number of those cases and the impact on their families and lives is not recorded. Lack of research on those so-called near misses is a gap in the knowledge base that must be urgently and proactively corrected.

Tinuke and Clo are asking MPs to act by signing up to the Five X More black maternal health pledge, which I know many colleagues who have spoken today have already supported. One of the asks is that the Government implement the recommendations of the Joint Committee on Human Rights, including the introduction of a firm target to end the disparity in maternal deaths. I would be grateful if the Minister would tell us whether the Government agree with the Joint Committee on Human Rights, the chief midwifery officer and the petitioners that such a target must be put in place. It would also be useful to know whether the Government intend to address the data gap in medical research in the upcoming women’s health strategy.

I want to end by quoting what Tinuke said in an interview with The Guardian last year:

“In 1991 when my mum gave birth to me she was at greater risk of dying. In 2020 when I gave birth to my daughter that risk had increased and I was five times more likely to die…I’ll be damned if my daughter, whenever she decides to give birth, is 25 times more likely to die.”

That truly is a source of shame for this country, which is why today must mark the day that future generations start to look back and wonder how on earth this situation was ever tolerated for so long.

--- Later in debate ---

[Catherine McKinnell [V]]

Thank you, Sir Gary. I thank the Minister for her response, and everybody who has contributed to the debate, which has been very moving and powerful, and also very painful. I thank in particular my hon. Friend the Member for Streatham (Bell Ribeiro-Addy) for sharing such a powerful personal story.

I hope that the debate has helped to raise awareness and understanding of why the issue must be urgently addressed, and I hope that we have done justice to the passionate and powerful campaigning of Clo and Tinuke. I know that they and we all want to see change, so I hope that the Government and NHS leaders have heard that call today. I urge the Minister to meet those who are affected, to continue to listen and to ensure that data continues to be collected and that changes are made to put an end to the five times more statistic for good.

Question put and agreed to.

Resolved,

That this House has considered e-petition 301079, relating to Black maternal healthcare and mortality.