Black Maternal Health Week

Florence Eshalomi Excerpts

Tuesday 14th September 2021 Westminster Hall

[Florence Eshalomi (Vauxhall) (Lab/Co-op)]

It is a pleasure to serve under your chairmanship, Mr Hollobone. I pay tribute to my constituency neighbour, my hon. Friend the Member for Streatham (Bell Ribeiro-Addy), for her powerful opening speech and for the work that she has been doing to lead on this really important issue.

The theme for this year’s Black Maternal Health Awareness Week is “changing the narrative”. We have to change the narrative. There is a call for a sea change in the outcomes for black women during pregnancy, and in finding ways to empower black patients to advocate for their health. We have known for years that women of black, Asian and mixed heritage face significantly higher maternal and prenatal mortality rates, and that women from black and minority ethnic backgrounds discover many conditions during their pregnancy. I discovered that I had fibroids at my first maternal scan during my first pregnancy. As an expectant mother, that brought a level of fear and anxiety—what would happen to me and my baby? In most cases fibroids can be unharmful, but in a small number of cases they can cause complications for the growth of the child and for both mother and baby during labour.

Unfortunately, we know that black and minority ethnic women are sometimes not listened to during the course of their pregnancy, and that there can be unconscious bias as a result of the structural inequality and institutional racism in our healthcare system. As my hon. Friend the Member for Streatham highlighted, Professor Knight suggests in the MBRRACE-UK report that a number of black and ethnic minority people face microaggressions, which means that symptoms can be indicative of complications that are missed, and that they are not given the attention they need. The “changing the narrative” campaign helps to empower black women to make their voices heard on this issue. It is crucial that their voices are listened to, and that their experiences are heard. I pay tribute to Five X More for the vital work that it has been doing to lead the campaign and, most importantly, to get the Government to listen to the many voices of the black and Asian women who are suffering in this area.

As a mother to two young children, who were born just across the river at St Thomas’ Hospital, this issue is close to my heart and those of many of my constituents in Vauxhall. More than 1,000 Vauxhall residents signed the petition urging the Government to pay close attention to this issue and to improve health outcomes and maternal rates for black women in the UK. Compared with white European women, black African women in the UK are 83% more likely to suffer near-misses in childbirth, and black Caribbean women are 80% more likely to do so. My two children were very stubborn and did not want to come out; in the end, they had to be evicted by C-section. My first pregnancy was fine: I was induced, it did not work, so the C-section was the next day. My second pregnancy did not go so well. Having gone through a C-section, I did not want that again. I tried to explain to the doctors that my body did not respond to induction and that if they just gave me time, the baby would eventually come out. Everything did not go to plan and I was rushed to theatre for an emergency C-section.

Panic, fear and the unknown, added to the fact that they had not been able to contact or locate my husband, meant my body froze and rejected the epidural. I heard the doctor’s words that I would have to go under general anaesthetic. I asked, “What? I am going to be put to sleep and you are going to deliver this baby. What if I don’t wake up?” I was lucky because I did wake up, after many hours. A number of black women are not as lucky; they do not wake up. It is important that we listen to black women and the experiences of all women, because they know their bodies best.

During the debate earlier this year, alongside the petition in April, the Minister would not set a target around black maternal health:

“We cannot set targets until we know what we are trying to achieve through those targets and what we need to address.”—[Official Report, 19 April 2021; Vol. 692, c. 172WH.]

We know that black women in the UK are four times more likely to die in pregnancy and childbirth; women of mixed heritage are three times more likely; and Asian women twice as likely. Those statistics paint a clear picture of the problem we need to solve. It is now five months since we last discussed this issue in the House. I have one question for the Minister: what research has been done to set the target, so that we can measure the progress to end this disparity? If none, what steps is she taking to gather the data urgently to tackle this problem as soon as possible? One death is far too many. It is important that we listen to those women and address this issue urgently.

--- Later in debate ---

[The Minister for Patient Safety, Suicide Prevention and Mental Health (Ms Nadine Dorries)]

It is a great pleasure to serve under your chairmanship for the first time, Mr Hollobone. I thank all Members who have taken the time to attend the debate, in particular the hon. Member for Streatham (Bell Ribeiro-Addy), who I have heard speak before about her experience on this issue. I think she is incredibly brave to campaign and highlight the issue in the way she does. I thank her for her thoughtful considerations. I know that she is holding my feet to the fire as well as the Department’s, and that is a huge assistance in pushing the agenda forward within the Department of Health and Social Care.

I stand responding to the debate as a brand new grandmother of 18 days. The delivery was not uneventful, and the baby arrived early, which is a similar story to that of the hon. Member for Vauxhall (Florence Eshalomi) at St Thomas’. Having given birth myself three times, I understand in a very raw way the pressures that all women experience, and I lived through just two weeks ago how emotional and incredibly frightening it can be when things do not go to plan.

This is the second annual awareness week we have had to highlight the disparities for black women in maternal health outcomes in the UK.

[Florence Eshalomi]

Congratulations to the Minister, it is always a joy to see more children and grandchildren. I am still getting to grips with motherhood with my four-year-old and six year-old. The statistics clearly show that the maternal death rates, and negative experiences, of black and Asian women are higher, but this does not negate the fact that some white women also go through similar experiences. Does the Minister agree that improving the maternal health outcomes of one group will improve the outcomes for all groups?

[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.