Black Maternal Healthcare and Mortality

Wera Hobhouse Excerpts

Monday 19th April 2021 Westminster Hall

[Wera Hobhouse (Bath) (LD)]

I am grateful that we are debating this important petition today and pay tribute to the women who have bravely shared their stories, from those involved in the “Dispatches” documentary to the Five X More campaigners to some of my own constituents in Bath.

The disparity in maternal health outcomes between black and Asian women and white women is one of the most frightening elements of systemic racism in today’s society. The statistics revealed in the MBRRACE report should shock and horrify us all. It should go without saying that health outcomes should never be determined by race, but for too many women this is the awful reality when accessing healthcare. One of my constituents said:

“I have two dual heritage daughters. As things stand, they are three times more likely to die during pregnancy and childbirth than my white friends’ daughters.”

Another wrote to me to share her concern that her race affected the way she was treated.

She felt she was not properly informed about the options open to her, her concerns were not taken seriously, and she could not say no when she felt uncomfortable.

Closing the gap between maternal health outcomes for white women and for women of colour must be a priority for the Government. It is not enough merely to recognise the disparity; we need a specific target to dramatically cut the rate of maternal deaths among black women. I urge the Minister to ensure that targets are in place to halve the disparity in the next five years. We need more and properly funded investigations into maternal death, with recommendations that are actioned. We need national accreditation for those who provide language support in maternity care, and we need to look at health outcomes for those new mothers who have no recourse to public funds because of insecure immigration status.

On top of that, if we are serious about eliminating maternal health inequalities, we must tackle the inequalities that exist in all areas of society. We know that the pandemic has made all inequalities much worse. Women from ethnic minority backgrounds made up 56% of all pregnant women having to go to hospital in the early months of the pandemic. Women from ethnic minority backgrounds are more likely to be key workers, giving them an increased risk of contracting the virus. They are more likely to be in insecure employment, which leaves them without basic maternity rights. They are at risk of higher exposure to discrimination and poor treatment at work, affecting their mental health. Once again, I urge the Treasury to look at Maternity Action’s proposals for amending the furlough scheme. It would allow employers to claim 100% of the cost of maternity suspension for women who are over 28 weeks pregnant, or pregnant women with underlying health conditions—we have heard today that underlying health conditions make it much more risky for pregnant women from different ethnic backgrounds.

I hope that the powerful personal stories shared by so many brave women will spur urgent action from the Government. We need to listen to black women, to ensure that pregnancy and childbirth are safe for all.

--- Later in debate ---

[Ms Dorries]

I will go further and explain what we are hoping to do to make a difference. We know that for every woman who dies, 100 women have a severe pregnancy complication or a near miss. That has been mentioned a number of times. When that woman survives, she will often have long-term health problems. Disparities in the number of women experiencing a near miss also exist between women from different ethnic groups. Because near misses are more common than maternal deaths, we can investigate those disparities at local and regional level, to better understand the reasons for disparity, to assess local variation and to identify areas with less disparity and, hence, best practice.

[Wera Hobhouse]

Is it not clear from everything we hear that black women and women from ethnic minorities feel that the health system does not communicate appropriately, so they do not understand all the choices available to them? Is that not a way of getting to the bottom of what is going wrong?

[Ms Dorries]

That is certainly one of the many issues highlighted in the report, but it is not the only one. We have commissioned the policy research unit in maternal and neonatal health and care at the University of Oxford to undertake research into the disparities in the near misses, and to develop an English maternal morbidity outcome indicator. The research will explore whether the indicator is sufficiently sensitive to detect whether the changes made to clinical care are resulting in better health outcomes. Five X More called for that in its list of 10 requests.

We are putting the research in. We have found a way to look at the research in order to make the differences that need to be made. We can do that by examining the near misses. What happened in those cases and in those women’s experiences? What went wrong? Do the women feel that they were not listened to? Was it a matter of treatment? Was it a lack of understanding? We need to understand that by looking at the near misses. The research is being undertaken, but it will take some time. Hopefully, when that is reported, we will be able to make progress on the issue of setting targets.

This Government are no strangers to setting targets. On the very sad issue of baby loss, we set a target to reduce neonatal stillbirth and neonatal mortality rates by 20% by 2020. We have reached almost 25%. We have smashed that target and are still pushing forward to improve that situation even more. We are not afraid of setting targets, but when we are setting them we have to know how to achieve better outcomes. The hon. Member for Battersea (Marsha De Cordova) mentioned continuity of carer. She is absolutely right about those figures. We know that continuity of carer works incredibly well, particularly for black women and women from ethnic minorities. Having the same midwife throughout the process of pregnancy makes a huge difference. That is being rolled out across the country. I am sure that the hon. Lady has spoken to the chief midwifery officer, who is a huge supporter of the policy. We are continuing to roll it out and make progress with it. It has been slightly more difficult during the 12 months of the covid pandemic, particularly because many trusts did not continue with home births.

We are not afraid of setting targets, however. Setting targets in maternity units is what we are about, to make them safer places in which to give birth and in order to reduce both neonatal and maternal mortality rates, but we need to do the research on the near misses, to understand what the problems are. We cannot set targets until we know what we are trying to achieve through those targets and what we need to address. Five X More has asked for that research to be done. It needs to be done, and it will be done.

We are committed to reducing inequalities and to improving outcomes for black women—we work at that daily. I established the maternity inequalities oversight forum to focus on inequalities so that we in Government understand what the problems are. The forum also brings together experts from across the UK—we have met MBRRACE-UK and Maternity Voices—who have done their own research and studied this problem, to hear their findings and recommendations. Professor Jacqueline Dunkley-Bent, the chief midwifery officer for England, is leading the work to understand why mortality rates are higher, to consider the evidence on reducing mortality rates, and to take action to improve the outcomes for mothers and their babies.

NHS England is working with a range of national partners, led by Jacqueline Dunkley-Bent and the national speciality adviser for obstetrics, to develop an equity strategy that will focus on black, Asian and mixed-race women and their babies, and on those living in the most deprived areas. The Cabinet Office Race Disparity Unit has also supported the Department of Health and Social Care in driving positive actions through a number of interventions on maternity mortality from an equalities perspective. The Royal College of Obstetricians and Gynaecologists has established—