Black Maternal Health Week

Diane Abbott Excerpts

Tuesday 14th September 2021 Westminster Hall

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

I am grateful for the opportunity to speak in this important debate on an important subject. I congratulate my hon. Friend the Member for Streatham (Bell Ribeiro-Addy), who made it possible. In particular, to speak in Black Maternal Health Awareness Week feels right and appropriate.

For all mothers-to-be, pregnancy is a challenging time, as I remember. Pregnant women feel vulnerable as their bodies are changing. For a first-time parent, in particular, the uncertainty of parenting can be daunting. It is very important that all mothers-to-be have access to high-quality services. Many do, thanks to our NHS. Our NHS is staffed by so many dedicated professionals, who provide exemplary support for many new mothers.

I want to make it clear that this debate is not designed to berate or admonish hard-working NHS staff. In fact, many staff in maternity services are black. Nevertheless, as colleagues have said, the extraordinary disparities in black maternal health cannot, and must not, be ignored any longer. I am aware that the Government do not like to talk about racial disparities, but Ministers can scarcely blame black women themselves for the disparities in maternal outcomes for black women.

The time is now for the Government and those in charge of the NHS to take these issues seriously. As Members have said, statistics show that black women in the UK have a fourfold higher increased possibility of dying in pregnancy, compared with their white counterparts. Disparities in mortality rates extend to babies as well as mothers. Mortality rates remain higher for black, black British, Asian or Asian British babies. That must have something to do with the disparities in the whole area of the maternal experience.

As a number of Members have said, these statistics show that there is a major problem in maternal health. So, the question is this: what are we going to do about it? To NHS managers and commissioners who may listen to this debate or read the transcript of it, I would ask: how will you ensure that black women are listened to? A number of Members who have spoken in this debate have made the point that black women, however confident and educated they might be in other circumstances, do not feel that they are listened to when it comes to the maternal experience. How will we close the pain gap, to ensure that black women are not left to suffer without the pain relief that apparently is readily given to white mothers?

The 2019 NHS Long Term Plan is a start, but it lacks concrete steps to address this disparity. It makes no mention of addressing disparities even in the administration of pain relief, among other things. I am hopeful that the Minister will touch on these issues when she responds to the debate.

So I say to the Government: what is the plan to address these disparities? What explanation can be given for them? Ministers have said in the past that we no longer see a Britain where the system is deliberately rigged against ethnic minorities. If they believe that, what will they do about the disparities in maternal outcomes?

If the Government and those managing our NHS wish to close this gap, they have to put black women at the centre of their thinking and listen to what they say about their experience, both after and during childbirth. That means that there must be clear and binding targets, data collection and monitoring to support and judge progress on this issue. It also means funding for new and existing projects to tackle this disparity and to take the measures that I and others have outlined.

I thank campaigners, such as those at Five X More, who have worked so hard to ensure that this matter is not forgotten. Black women and their babies deserve better. At no point in any woman’s life does she feel more vulnerable than in childbirth, and black women should not have to believe or understand that they will have a poorer outcome simply because of the colour of their skin and their babies’ skin.

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[Anne McLaughlin]

I completely agree with my hon. Friend. It is up to the many Members of this House who are not already doing it to do it, and those of us who are doing it must keep repeating over and over again that black women are four times as likely to die during pregnancy and childbirth as white women. For women from mixed backgrounds it is three times as likely, and for Asian women it is twice as likely.

The reason we need to keep saying that is that, despite the fact that the inequality and disparity in maternal and newborn health has been highlighted for many years, we still do not fully understand why it exists, as we have heard, and we do not have the targets that we need to tackle it. The right hon. Member for Romsey and Southampton North (Caroline Nokes), the Chair of the Women and Equalities Committee, of which I recently became a member, said that the statistics are so stark that there should be immediate change. She called on the Government to meet ambitious targets rapidly, and I completely agree.

In the previous debate on this matter, I focused on some of the shocking statistics that MBRRACE-UK highlighted in its confidential inquiry into maternal deaths; I shall repeat some of them. For every 100,000 women who gave birth between 2016 and 2018, 34 black women, 25 mixed ethnicity women and 15 Asian women died, compared with eight white women. Behind those numbers are people—women and babies. Compared with babies of a white ethnicity, black babies have a 121% increased risk of stillbirth and a 50% increased risk of neonatal death, and the gap has been widening since 2013. So there are these tiny human beings—boys and girls—who never got a chance at life. There are grieving fathers and husbands. There are whole families and whole communities.

In addition to the higher mortality rates, other concerns include the number of near misses and the number of times that women have felt that their voices have not been heard because of their skin colour. The hon. Member for Vauxhall (Florence Eshalomi) described a terrifying experience, when she must have felt completely powerless. That is wrong. I was shocked to hear many stories of mothers denied pain relief or left to suffer with undiagnosed post-partum conditions. I know that these things happen to women who are not black—it is always wrong—but for someone to be treated differently because of their skin colour surely compounds the problem. Just as we would research and address any medical causes of these things, we must research and address this issue. I echo the calls of the hon. Member for Streatham for the Government to address it.

As someone who is white, it took me some time to learn that people who are black just know when someone’s behaviour towards them is because of their skin colour. It is hard to explain. It was hard for me to understand at first, and obviously it is harder for me as a white woman to explain it because I do not experience it, but I have no doubt about it. I encourage everyone who does doubt it to really listen to what black and Asian mums are saying and trust that they just know.

NHS GP Dr Adwoa Danso has pointed out that instances of medical mistreatment have impacted on black, Asian and minority ethnic communities’ faith in the health services, and we saw that when it came to getting the covid vaccine. There is a further suggestion that, as the majority of migrants are disproportionally black, Asian and mixed ethnicity, the Home Office’s hostile environment immigration policy makes public services incredibly difficult to access. The right hon. Member for Hackney North and Stoke Newington (Ms Abbott) talked about the hostile environment and has campaigned hard against it for many years.

Women seeking asylum have been blocked or refused by reception staff acting as gatekeepers, often in conjunction with expectations or experiences of prejudice and discrimination. The hostile environment also leads to decisions such as taking women seeking asylum out of supportive communities and into places such as the so-called mother and baby unit in Glasgow, where tiny babies are put in tiny rooms with not even enough room to crawl. The frustrating thing for me as an MP representing Glasgow North East, in a country where we have our own Government, is that our Government can do nothing about it because all the decisions about it are taken down here in Westminster.

[Ms Abbott]

Does the hon. Lady agree that the hostile environment affects not just the pregnant women themselves but may well affect black staff, who feel, as we have heard, frightened to speak up about what they are seeing?

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[Ms Dorries]

The hon. Lady is absolutely right. I am very proud of the work that we have done in the Department of Health and Social Care, and in the NHS, to improve maternal outcomes for everyone, particularly over the last few years. The statistics speak for themselves. However, I will focus on the issue of black women and maternal health, because there is a great deal that we have done since the hon. Member for Streatham had the last debate. I am looking forward to informing her about the work that has been undertaken since then. I thank her for instigating this debate, and I hope that she continues to hold our feet to the fire. It is important that people do raise this issue, as she does, as often as possible in Parliament.

In response to the incredibly articulate speech by my right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes), it is right to raise the report by the Health and Social Care Committee, which I will respond to next week. A number of the questions that have been asked today will be included in that response, so I will not steal my own thunder—I will wait to provide a response next week.

I thank the co-founders of the Five X More campaign, Clotilde and Tinuke, and all the health care professionals and organisations who campaign to raise awareness of this week. I have visited Tommy’s maternity unit three times now, and the hon. Member for Streatham is right to raise the point that the majority of staff, doctors and midwives are black. I am incredibly impressed with the way that Tommy’s addresses this issue; they are pioneers in addressing maternity inequalities and outcomes, and they do fantastic work. I pay tribute to Tommy’s, and all hospitals, who I know are putting their weight behind reducing maternity inequalities and outcomes—Tommy’s is certainly at the forefront of that work. My granddaughter was born at Chelsea and Westminster hospital, so I thank them too—they are pretty amazing as well.

This debate comes a few days before this year’s World Patient Safety Day; the theme this year is safe maternal and new born care. It provides an opportunity to mark the progress made across the system in improving outcomes and safety, but also to recognise that further work is needed. At its best, NHS care offers some of the safest maternal and neonatal outcomes in the world. However, the disparities that exist between black and white women in pregnancy and childbirth experiences are unacceptable. I am committed to both reducing this disparity in health outcomes, and improving the experience of care.

We cannot beat around the bush any longer on some of the reasons why we experience these inequalities. They are complex, and there is no one answer as to how we can address this subject. Personal, social, economic and environmental factors all play a part; we must address the causes of disparities to improve outcomes and experiences of care. I was delighted that last week NHS England and NHS Improvement published their equity and equality guidance, which responds to findings that maternal and perinatal mortality show worse outcomes for those in black, Asian and mixed ethnic groups. They invested £6.8 million in the guidance to improve equity and equality action plans, and implement targeted and enhanced continuity of care.

We know that pregnancy lasts around 40 weeks. However, when a woman walks into a hospital to give birth, those 24 or 48 hours—however many hours she is in hospital—are not what wholly contributes to her experience of the healthcare sector, or her outcome. A lifetime approach is needed to address some of the reasons why some women are more at risk of poorer outcomes than others. We know that there are many health issues that contribute to poorer outcomes in pregnancy, including alcohol, obesity and smoking. The chief medical officer recently published a report that showed that, in some of our seaside towns, 25% of women are smoking at the beginning of pregnancy. I think the figure was that 22% were still smoking by the end of their pregnancy. There are inequalities and health disparities that we really need to address.

For that reason, we have established the newly formed Office for Health Improvement and Disparities, which launches on 1 October, to target those health disparities, including racial and ethnic disparities in health, and to improve pre-conception health to support women to be in their best health throughout pregnancy.

[Ms Abbott]

rose—

[Ms Dorries]

I will just finish the point on the office of disparities, because it is quite important. It is a huge step to establish an office that will actually deal with this particular issue. It will tackle inequalities across the country, and will be co-led by the newly-appointed deputy chief medical officer, Dr Jeannelle de Gruchy.

The office will be a vital part of the Department of Health and Social Care, and will drive the prevention agenda across Government to reduce health disparities. I hope the hon. Member for Streatham welcomes the establishment of this new body to tackle the top preventable risk factors for poor health, which include obesity, unhealthy diets, lack of physical activity, smoking and alcohol consumption. Equity and equality guidance will also be issued.

It is a huge step to look at those lifetime health experiences that contribute to what happens at the point of delivery and throughout pregnancy. Until we improve, and look at what happens before, using a lifetime view of health that includes women’s experiences of health throughout, then tackling what happens when they walk through a labour ward door will continue to be very difficult.

[Ms Abbott]

I think everyone present welcomes the establishment of the new office. The Minister has mentioned obesity, alcohol and smoking as risk factors in pregnancy; I take it she is not suggesting that the disproportionate outcomes we have for black women are because we are more likely to be obese, smoke or drink.

[Ms Dorries]

No.

[Ms Abbott]

I just wanted to get that clear.

[Ms Dorries]

Absolutely. The office will look at all pregnancies, and the negative contributing factors. I believe that one in four women—black and white women—who present in labour are obese. That has an incredibly high risk factor during labour, so it is to address inequalities across the board. My right hon. Friend the Member for Romsey and Southampton North mentioned socio-economic groups, and the disparities they experience: smoking, alcohol and other negative factors that contribute during pregnancy are across the board, and they need to be addressed. That is the reason why the office has been established.

The cessation of smoking during pregnancy was something we campaigned on a lot in the past. I have noticed, probably since we passed the legislation to ban smoking in many places, the emphasis has almost come off the importance of not smoking during pregnancy. The CMO’s report highlights that, in some areas of low socio-economic grouping, 25% of women are starting pregnancy smoking. That highlights the fact that we need to put more emphasis on, and focus on, those health disparities.