Black Maternal Health Awareness Week 2022

James Gray Excerpts

Wednesday 2nd November 2022 Westminster Hall

[David Linden (Glasgow East) (SNP)]

On a point of order, Mr Gray. I do not want to take too long on my point of order, but I thought it would be helpful for the Chamber to note the fact that it is Wednesday morning and that we are delighted to be here for this debate secured by the hon. Member for Streatham (Bell Ribeiro-Addy). I suspect that the hon. Lady will have quite a lot to say over the course of the morning, and I am just keen to ensure that we are all ready to take part in the debate.

[James Gray (in the Chair)]

That is very gracious of the hon. Gentleman. It is not actually a point of order. None the less, I am grateful to him for saying it. I think the hon. Member for Streatham has nearly caught her breath, in which case I would like to call her to speak.

[Jim Shannon (Strangford) (DUP)]

On a point of order, Mr Gray. Obviously, this is a subject matter of much importance, and we should be aware of that. I am sure that the shadow Minister and the Minister are preparing copious replies for the hon. Member for Streatham (Bell Ribeiro-Addy), after she has had a chance to address this really important matter. Mr Gray, you and I and everyone else in the Chamber understand that this debate is vital. Perhaps the hon. Member for Streatham is now ready.

[James Gray (in the Chair)]

Again, that is very creditable of the hon. Gentleman, but it is not a point of order. It is worth recording that the hon. Gentleman has made known to me that in this particular debate, uniquely, he does not intend to speak. This is the first occasion I can remember chairing a debate in Westminster Hall when we did not benefit from his words of wisdom. We note that, and we are grateful to him for being here. We now come to the debate on Black Maternal Health Awareness Week, and I call Bell Ribeiro-Addy to move the motion.

--- Later in debate ---

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

Thank you—Sir James?

[James Gray (in the Chair)]

Sadly no—not yet. It is in the post.

[Caroline Nokes]

That is a terrible omission. It is a pleasure to serve under your chairmanship, Mr Gray. I thank the hon. Member for Streatham (Bell Ribeiro-Addy) for leading this debate on a crucial issue.

The Women and Equalities Committee has twice held one-off evidence sessions—although there is a slight conundrum in twice having one-off sessions—looking at black maternal health. It has taken evidence from campaign groups, such as Five X More, and experts in obstetrics and gynaecology, yet the picture does not change. Looking at the evidence, we have known that there is a disparity in the health outcomes for black mothers since the early 2000s. For 20 years, we have known that there is a problem, yet still it continues. It has been a huge privilege for me to serve on panels alongside people such as Clo and Tinuke from Five X More, who have done so much incredible campaigning to highlight the issue, as has the hon. Member for Streatham. It is crucial that we begin to see progress; we cannot, 12 months or 10 years down the line, continue to have the same debate.

Raising awareness in Parliament is vital, but what we actually need is Government action. The hon. Member for Streatham made a slight dig about Government reshuffles. I am delighted to see the Minister in her place; this is an issue on which we have engaged before and she takes it seriously. I hope that the Secretary of State for Health will himself grasp the issue, and ensure that we drive it forward to see progress.

We have heard that one of the challenges is data, and the lack of specific data being collected on maternal health outcomes for black and Asian women. I pay tribute to Five X More, which carried out its own experiences survey that included 2,000 women—a huge number—reporting their experiences and findings. The thing that really hits home for me is the repeated use of the phrases, “I didn’t feel listened to,” “We weren’t listened to,” and, “What I was experiencing was being ignored.”

I am loth to say that we sometimes have very gendered healthcare, but look at the evidence. Look at the fact that when there is medical research, it is almost exclusively carried out on men; look at the fact that drug trials are carried out on men; look at the fact that some of the highest backlogs as we come out of the pandemic are in health conditions predominantly affecting women. Whether it is in cardiac, obstetrics or another sphere of medicine, too often the experience is, “I didn’t think they were listening to me.” I am sure every Member hears that from their constituents, and that has been my experience as a constituency MP. I hear from my constituents that, specifically in the area of maternity, “I wasn’t listened to. Nobody paid attention. It was my body, and I knew something was wrong.”

Only last week, I received an email from a constituent who had lost his daughter-in-law moments after she gave birth. He was with his son, helping to bring up a baby and pursue a complaints procedure against the hospital in question. Throughout his email, he kept making the point that they had not been listened to. His daughter-in-law had been a midwife, and even she was not listened to.

Talking to black and particularly Muslim women—I should declare an interest as chair of the all-party parliamentary group on Muslim women—they feel that their voices are doubly ignored, and that there is that intersectionality. Whenever I talk to journalists about intersectionality, they look at me and say, “Please don’t use that word. Nobody understands that word.” It is imperative that we all understand that word. You will be discriminated against if you are a woman, and you will be discriminated against if you are a woman from a black, Asian or other minority ethnic group; when the two come together, as we find in maternity units in particular, women’s voices are not heard or listened to.

When we talk to the Royal College of Obstetricians and Gynaecologists, as the hon. Member for Streatham has done, it calls for specific targets for black maternal health outcomes, and it is right to do so. Although it may be a small number as a percentage of births every year, it is still a significant number. The loss of one mother is one too many.

--- Later in debate ---

[Fleur Anderson (Putney) (Lab)]

It is a pleasure to serve under your chairship, Mr Gray, and to be in this debate, although I hope that in future there will be no need for one, because we will have solved these issues, and women using maternity services can expect the same care and equal outcomes. That is why I was keen to be here, and I congratulate my hon. Friend the Member for Streatham (Bell Ribeiro-Addy) on bringing forward the debate and on pursuing this issue. I look forward to hearing the Minister’s response because it needs to be a priority.

In Wandsworth, 30% of residents are from black and ethnic minority backgrounds, and black maternal health is a big issue for us in Putney. We have a group called Putney Black Lives Matter. We meet to discuss important local issues, and black maternal health was highlighted as an issue of major importance. We are few here today, but across the country it is a big issue for many people: last year’s petition to improve maternal mortality rates and healthcare for black women was signed by 187,520 people, of whom 200 were from Putney.

I thank the campaign groups that have raised the issue so strongly: the Five X More campaign, Bliss, Sands, Birthrights, and the Royal College of Obstetricians and Gynaecologists. They have raised the issues of systemic racism and structural barriers, which lead to the appalling statistics read out by my hon. Friend the Member for Streatham. The statistics are worth reiterating, because they are at the heart of the issue. Black babies have a 50% increased risk of neonatal death and a 121% increased risk of stillbirth. Black women have a 43% higher risk of miscarriage, and are four times more likely to die during pregnancy or up to six weeks post-partum. Women of mixed heritage are three times more likely to die during pregnancy, and Asian women twice as likely. Those are horrendous statistics. Each loss of life is a tragedy, but it is also a gross injustice about which we should all care deeply. The statistics need to be understood, and need to change.

It is important to place those awful statistics in the wider picture of health inequalities. Black women face disparities when it comes to stillbirth, cancer diagnosis and outcomes, and access to fertility treatment. That is entrenched and deep-rooted inequality, racism and sexism. It will be hard to turn that around. The Minister will need to come back to this again and again, and to knock heads together in different Departments across Government to change it. But it must be done.

I have a lovely list of seven things on which I want to see action, and I hope that the Minister will respond to it. First, we need a whole-Government approach that recognises inequalities and their links to wider Government policies, as was mentioned by the Chair of the Women and Equalities Committee, the right hon. Member for Romsey and Southampton North (Caroline Nokes). We need the White Paper on health disparities, which will look across Departments. We need a new tobacco control plan for England, public health measures to address obesity, and a new air equality target for England, because those are all factors in increased black maternal mortality figures.

Black communities in the UK have an increased risk of poorer maternal and perinatal outcomes, including stillbirth and miscarriage. There are also inequalities in exposure to air pollution; that is the link between air pollution and maternal health inequalities. We must commit to reaching the interim World Health Organisation targets by 2030, rather than 2040; we can speed that up. What gets counted counts, and if there is a target, people strain to reach it more strongly. Dangerous levels of air pollution, especially in our urban areas, must be addressed.

The second issue is the continuity of carer. I pay tribute to the NHS South West London Clinical Commissioning Group—now the NHS South West London Integrated Care Board—and its chief nurse for what they do to tackle black maternal inequalities, especially in the area of continuity of carer. Women need the same team throughout pregnancy. I also pay tribute to our wonderful Emerald midwifery team from the St George’s University Hospitals NHS Foundation Trust. Where there is continuity of carer, women are 16% less likely to lose their babies. That is a major focus for change in south-west London. Local maternity systems across the country have been asked to implement equity and action plans, which include the target of 75% of women from black, Asian and mixed ethnic groups receiving continuity of carer by 2024. I hope that we can increase that figure. Progress is being made towards the target. However, we must look at the target, find out whether there is enough data to measure it, and ensure that across the country, no matter where people live, we strive towards it. Will the Minister comment on the status of the continuity of carer target?

In their response to the Health and Social Care Committee report on the safety of maternity services in England, the Government accepted the recommendation on training for continuity of carer teams. It is essential that there be training across the board and implementation of continuity of carer teams, but obviously that relies on there being enough staff, which depends on the midwife workforce having enough funding.

Thirdly, I would like an end to charging migrant women for maternity care. Charging for care deters many women from seeking vital antenatal care, and it is shocking that the MBRRACE-UK confidential inquiry on maternal death identified that three women who died may have been reluctant to seek care because of cost. It is shocking that that happens in this day and age, in our communities—that women may be afraid to seek care because of their immigration, asylum seeker or migrant status.

My fourth point is about further evidence, research and data, which was mentioned by other hon. Members. Differences in outcomes and the reasons for them are unclear and under-researched, but we know that what gets counted counts. I join campaigners in calling for an annual maternity survey of black women, and increased research to identify the conditions that disproportionately affect black women. We should improve the ethnic coding of health records, and the system through which women submit feedback, so their voices are heard. It should be as easy as possible for them to provide feedback while they are still in hospital or under maternity care, so that we can hear those voices and they can feed into the survey data.

My fifth point is about maternity bereavement services. As was highlighted last week during the debate on baby loss, there is a difference in bereavement services across the country. On whether there are adequate bereavement services for those women who, sadly, suffer bereavement, the figures are shocking. St George’s University Hospitals NHS Foundation Trust, of which Queen Mary’s Hospital in my constituency is part, now has two bereavement midwives, two specialist consultants and one part-time psychotherapist in the maternity bereavement team. There are dedicated places for those who have suffered bereavement in maternity services across the NHS South West London Integrated Care Board area, which is to be welcomed. However, is this happening across the whole country? That is questionable. That support is very important at the time of loss, but also during care in future pregnancies.

Sixthly, I request, as others have, a White Paper on health disparities. That is important if we are to tackle the issue and look at the many other underlying reasons for the statistics. Seventhly, I ask for a target. In any ministerial meetings on this important issue, I hope that a target will be the Minister’s No.1 ask. We need one, followed by a concentrated effort to achieve it. I hope that will lead to the change we need.

In conclusion, black women cannot afford to wait any longer for action. There needs to be a clear action plan, data, transparency and a target. I look forward to hearing the Minister’s response, but I look forward even more to action. I thank all the midwives, in maternity services throughout the country, who give extraordinary care, and who go above and beyond.

[James Gray (in the Chair)]

The hon. Member for Leicester East (Claudia Webbe) was not here at the start of the debate, but unusually we have plenty time, so I am happy to call her to speak.

--- Later in debate ---

[James Gray (in the Chair)]

That she might wish to introduce. The hon. Lady keeps saying “you”, but when you say “you”, you mean me. I am not involved in any of these things. She might do those things.

[Bell Ribeiro-Addy]

My apologies. I would like to leave the Minister with a few more suggestions about measures that her Department might wish to introduce. The first is for the Government to introduce this target. I understand your reasoning—

[James Gray (in the Chair)]

Her.

[Bell Ribeiro-Addy]

I understand the Minister’s reasoning for not having a target. It may appear logical, but given that the data shows that those women’s children have a 43% increased chance of being miscarried, and a 121% increased chance of being stillborn, I do not understand how the Government can say that they will look at all these measures surrounding the issue but will not specifically set a target to bring it to an end. That is not acceptable, and I do not believe that the women who continuously campaign for a target will accept that, so I ask the Minister to look at it again.

I understand that there are great challenges in looking at disparities across the board. All those things need to be addressed and different Departments need to be brought in, but as I said in relation to socioeconomic status and other factors, there is a culture of institutional racism in our NHS, which needs to be resolved. Obviously, that will start with data. The NHS must improve the quality of ethnic coding and ensure that the data is accurately recorded. I am really concerned about how skewed the recording is.

At our APPG meeting yesterday, we heard that even when it comes to simple things such as trying to find out how many women have claimed compensation for things that have happened, the women’s age and the area they have come from is recorded, but their race is not. That seems like a major oversight, especially when other pieces of data are being gathered.

I support Five X More’s call for the Government to introduce an annual maternity survey targeted specifically at black women, similar to the Care Quality Commission’s maternity survey, because I believe that its results could be used to inform public and parliamentary accountability and improve maternity health services. Although few women contributed to the Government’s survey, there is a willingness among black, Asian and minority ethnic women to record their issues and experiences, as the other campaigns have proved.

I reiterate the call for an inquiry into institutional racism in the NHS. That is the only way that we will change some of the outcomes, especially given the information that has been gathered on what the issues are. Yes, we have to look at air quality and other co-morbidities, but until we address racial bias, assumptions among medical staff, and teaching and training, certain things will just not change.

Finally, please engage with the campaigners. I understand that there is a lot of listening going on. In the past few years, there have been more conversations, and they are more likely to be included in working groups, but it is one thing to say, “Yes, we have to look at this. This is really awful,” and another thing entirely to engage with them, work with them across different issues and show that the things they are asking for are being met within the NHS’s plan. Please do engage with the campaigners. They know what they are talking about and have the data that the Government have not been able to collect from women. They understand the issues and are making the right calls about what we need to do to bring this horrible disparity to an end, to close this racial divide and ensure that black women, Asian women and women of mixed heritage have safe births.

Question put and agreed to.

Resolved,

That this House has considered Black Maternal Health Awareness Week.